Published Jan 25, 2010
*I posted this in the new grads section but I also want to hear from the experienced nurses*
Hi. I'm a relatively new nurse in a general ICU (we get a variety of patients). Considering the shortage of jobs for new nurses, I'm very grateful I found a job in an area of nursing that I find interesting albeit challenging. When I interviewed for the job, I was told that the Patient:Nurse ration was 2:1, and very rarely would a nurse have 3 patients. Well as it turned out, 3:1 is the norm on the unit (we're chronically understaffed) as I've seen more nurses tripled than doubled on any given day. Is that the norm in ICUs? Or is it just because we're a general ICU? I personally think it's dangerous because there is no way a nurse can be in 3 rooms at a time, and inevitably, one or more patients receive less than optimum care, especially if one of the three patients is more critical than the others. I worry about liability should something go wrong on the nurses' watch (more like the absence of it). Should I be concerned about this or is this the way things are in most ICUs?
PS: It's insane that nursing units across the country are so understaffed (putting more stress and workload on the nurses especially the more experienced ones) while thousands of nurses, new and old, remain without work.
It is only common in those units that have no interest in retaining their staff. Just for fun measure the acuity of the three patients you are assigned.http://www.sfar.org/scores2/tiss282.html Evidence has shown that one nurse can care for a total of 46 points in the TISS acuity system.
That site is a great resource Chisca. And what you said about staff retention makes sense; I'm not exactly sure what the turn over is but folks who have been here longer say we have way more 'new' people than 'old' people.
Dec' 08 grad here. We rarely see 3:1 assignments, even when our acuity is low (which does happen...our hospital has no step-down unit so they tend to hang out in ICU longer.) Hope you're able to find a unit that cares enough about your license to be VERY careful with this practice.
We're never 3:1, ever. People would be quitting left and right if we did. I barely have time for break with 2 patients typically, how you even do it with 3:1 is beyond me. You'd spend your entire shift just doing vitals, outputs and turning.
yes thats exactly it and we're trippled at least 3-4 out of 7 nights a week. I happily grab 3 vents.... you get three using the call buzzer and your done:uhoh3:
It doesn't sound very safe to me unless the patients acuity is less than ICU status. Sometimes we will get a few patients who are ready to go to the step down but there are not beds and only then do we do 3 patient assignments. 3 vents is not really acceptable in the ICU unless you have a designated tech/lpn/nusing assistant with you alone. ( not the rest of the floor)
ghillbert, MSN, NP
I work in the SICU of a larger hospital and the only time we have ever trippled is in time of a natural disaster like a massive snow storm prevents staff from getting to the hospital. I would refuse to do it in less dire circumstances and if I have three patients then our nurse manager had better be there doing patient care.
You mentioned patients using the call light. If this is an ICU how can you have so many who are capable of using a call light? In my unit we call the call light the "transfer light". If they are well enough to use the call light they need to go to step down. (Mostly an inside joke) Sometimes there is so much time between patients who are capable of using the call light, when it does go off I have forgoton what that sound is and have to investigate.
XingtheBBB, BSN, RN
lol about the transfer light!
I work in a general icu and we also have a stepdown unit. about 95% of the time i have 3 patients. Usually 1-2 are vents and 1 is a needy floor type patient. They are considering making the icu 1:3 ratio because they say we are honestly spoiled by having only 2 patients and that we can really handle 3. however, isn't that why its called an intensive care unit? stepdown usually has 1:3 and the telemetry floor 1:4-5. :S
I am also a new grad in the MICU. Our hospital gets tripled often enough. I have been off orientation for about 1 month and just last week, I was tripled for the first time. I would say that at least one of our units is tripled 5 out of the 7 days.
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