ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping?

Specialties MICU

Published

*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.

"Slamming a liter of epi" means nothing. If you don't know the concentration then you have no idea what the patient is actually getting. Was it 16mg/1000ml? 32mg/1000ml? 64mg/1000ml? If you don't have the mcg/kg/min and concentration then it's an anecdote with no real meaning. My hospital'standard (a 1600 bed level 1 trauma center - since this is thrown around so much) is 16mg/250ml with a "suggested" infusion rate of 0.1-0.15mcg/kg/min. Of course we go WELL above the suggested maximum dose during codes. What's there to lose at that point?

Specializes in Telemetry, Cardiac Stepdown, MICU/SICU.

I work in a 16 bed SICU. We have quite a few swans, a few IABP's, but not ECMO or CRRT. Our ratio is 2:1 except:

~newly admitted DKAs (not all the time, but they're trying to make it a rule)

~Fresh open hearts (until extubation)

~IABP

~or REALLY sick pts (but only if staffing allows)

In the 16 months I've worked here, I've only had to take 3 patients maybe 2 days--no fun. If that was the norm, I wouldn't be here. 4:1?.....You couldn't pay me enough--that was the ratio on the cardiac stepdown I worked prior and I ran my legs off then with lower acuity pts.

Look up Safe Harbor and get that number written down. You might need it. Refuse assignments when you know it is too much because once you accept them, they are yours! Compromise if you can, i.e. "I will take the three patients, but I want someone else to do all of their oral meds, their glucometer checks and maybe calculate the I/O at the end of the shift for me.

And people wonder why the burn out for ICU nurses are 3-7 years!! Why doesn't someone call safe harbor??? What happens when JACHO is visiting? Do they fix these issues during that time? I am so curious! I can understand an occasional tripling but every day! NO WAY! SAFE HARBOR! Look them up, know who they are and what they do and use the number!

In CA, they only have 2:1 ratios because it is now a set standard in that state. We, in other states, have to fight for legislation to pass that will support that in whatever state you are in! Get a petition going and attend the meetings at the capitol when the nurses associations meet.

Good luck!

Worked an HCA facility where we often had staffing issues and worked 3:1 ratios. It was not all that bad. What makes it dangerous to me was navigating the annoying families. When you add that third patient you also add another family with their questions, concerns and multiple BS. I would gladly take 3 patients everyday if I could avoid the crazy family members and their 50 billion phone calls a day.

Specializes in ICU/ER.

we have 3:1 ratios in icu. it is pretty much the norm and the unit is set up for that ratio with the number of beds. i worked in the unit for 1 yr and ran my butt off. it was really bad when we were full and had a bunch of low sick patients, esp. when you unit manager is awol and the assist manager is pretty much useless cause she is always having to do "pi projects".

In the icu I work in we only rarely do 3:1 if we have one icu pt and two PCU pts or all PCU pts waiting for beds. 3:1 ICU pts is ver very unsafe in my opinion

Honestly, sometimes 2:1 is hard enough, these patients are unpredictable, but 2:1 is appropriate. However, 3:1 is unsafe IMO. Even if you have a pt that is a q4 hour vs, he or she can be a "dinger' or very needy. Sometimes I find myself in that pt's room than in my critical patients. A pt like that can take up your whole time, and next thing you know... your other patients are tanking. And who is going to get blamed if something happens to your other patients? Yep... You... and only you... I understand that there are a lot of staffing shortages and budget cuts going around, but it is unsafe for our patients and is a disaster looming against us and our licenses.

On top of that, in our hospital, we have no techs or secretaries at night.

I just searched for a thread talking about being tripled every night and this sounds exaclty like my unit. Though it happens more often to us night shifters in my ICU since we have a slower shift, it still doesnt seem right. Ive been tripled once before with a q30min Stroke scale on one pt, q1hr FSBS on the other, and the other pt was intubated but was off sedation so constantly on the call light. None of these were extremely sick or unstable pts and were all pretty easy to care for but what if pt#2's blood sugar was 5 for 2 hours bc i was busy caring for my other pts? Or pt#1 had a massive bleed from the clot buster? I'm honestly a little scared for my license when I think about all the possible scenarios..

Anyways, I've been in this ICU for about 9 months and Im thinking of switching to a diff unit in a larger where I worked as a tech before i graduated..where nurses never get tripled AND they have a tech every night. The only reason I would stay where I am is because we see it all and it is great experience for whatever the future brings(NP/CRNA/neither?) Does anybody think Im completely crazy for staying or do you think I'm right to stay for the experience?

If I was you I would definitely explore my options Go-Getter. I just wouldn't feel right condoning that kind of on the edge care by staying. Sounds like you deserve a better unit to work on. We are 3 to 1 rarely, and they are usually a stable bunch. 2:1 is the standard with 1:1 when necessary due to acuity.

I am 2 weeks off orientation in an SICU and I see tripling happening all of the time. We have a high turnover rate with nurses and the morale is horrible. I'm scared when the day comes that I'm assigned 3 patients. I don't think it's right. I've heard a charge nurse make the statement about a nurse being upset that she was tripled , "well, their not really bad patients." I don't care if the patients are considered good or bad; it's just not right.

On 2/4/2013 at 10:25 PM, PMFB-RN said:

Our current hospital (IndiCRNA & mine) is a very good hospital. Union and non Magnet. We are treated and paid very well. Lots of long time nurses here and few opening.

Bringing up an old thread but wondering if you wouldn't mind telling me which hospital this is? Is this in the Eau Claire area? I was looking through threads for CRNA and IndiCRNA (hasn't been active for year) mentions half his CRNA class was from the same hospital ICU. I'm from northern WI and CRNA is the ultimate goal so I'd love to get the best experience. Thanks!

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
On 12/11/2021 at 12:15 AM, Lunatunagirl said:

Bringing up an old thread but wondering if you wouldn't mind telling me which hospital this is? Is this in the Eau Claire area? I was looking through threads for CRNA and IndiCRNA (hasn't been active for year) mentions half his CRNA class was from the same hospital ICU. I'm from northern WI and CRNA is the ultimate goal so I'd love to get the best experience. Thanks!

Sent you a PM

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