*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.
I have had pts that were singled due to acuity, esp traumatic brain injuries and crrt. I have been tripled with a stable vent, a post cath MI, and a GI Bleed, or similar.
We frequently get pre op cabg patients with IABP's... they can move very little so they are the frequent call buzzer offenders. Same thing is true with your swanned heart failures on high dobutamine and what not... buzz. So these are certainly not ready for step down and just documenting everything every hour for three of these guys plus meds assessing and turning.... yikes!
We do tripple, we never have an open bed, there are always vents waiting in the ER... so if there is a call in... thats what happens
Don't usually see it, but aw it happen the other day...the nurse they gave the assignment to was agreeable, a very good and very experienced nurse, and the CM had her back...
We are supposed to be 1:1 or 1:2 in our ICU but more and more are 1:3 because our staff retention rates are terrible and nurses are leaving right and left... bad management... there was uproar in the unit when it was mentioned we may go to a 1:3 ratio even in non-extraordinary circumstances. In my opinion, it's just not safe.
One of the other new nurses, fresh off a mere 3-4 months of orientation, got tripled... with 3 "stable patients." One was septic and crashed. The other went into respiratory failure and had to be intubated. And my friend cried because of how stressful it was. Not a great way to keep your staff, to put it mildly. You can never predict what an ICU patient is going to do, even if they're bound for transfer. We're all just waiting for a sentinel event from an overworked, tripled nurse...
I work in a community hospital, we are a mixed unit icu/ccu. 16 beds. Only on rare occasions do we have more than 2 patients. Maybe if you have 1 or both patients on transfer and you're only doing vitals q 4hrs. The only other time is to cover so you don't have to call the on-call person in 1 or 2hrs before the shift ends. In that instance we all pull together so pretty much everyone has that "3rd" patient. We don't do fancy stuff like IABP'S, we help insert them, then ship them out. But we do get pretty involved septic shocks, hypothermic protocols etcs.
apocatastasis, It is as if you work at my hospital. This is exactly what is happening at my facility and we are paying overtime daily. I pick-up extra shifts during the week and get overtime on a WOW program. I probably make 47 an hour. It is not worth the pay.
In my unit vents are 1:1. If census is low then HDU patients (stable, non-vented) are 1:1, if we're busy, one nurse will take two HDU patients, no more. Most other ICUs in the area are similar.
In my unit vents are 1:1. If census is low then HDU patients (stable non-vented) are 1:1, if we're busy, one nurse will take two HDU patients, no more. Most other ICUs in the area are similar.[/quote']
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
We are supposed to be 1:1 or 1:2 in our ICU but more and more are 1:3 because our staff retention rates are terrible and nurses are leaving right and left... bad management... there was uproar in the unit when it was mentioned we may go to a 1:3 ratio even in non-extraordinary circumstances. In my opinion, it's just not safe.
One of the other new nurses, fresh off a mere 3-4 months of orientation, got tripled... with 3 "stable patients." One was septic and crashed. The other went into respiratory failure and had to be intubated. And my friend cried because of how stressful it was. Not a great way to keep your staff, to put it mildly. You can never predict what an ICU patient is going to do, even if they're bound for transfer. We're all just waiting for a sentinel event from an overworked, tripled nurse...
*** I don't understand why you and the nurses in your unit accept report on that 3rd patient? SHort of a huge emergency like a devistating snow storm or another 9/11 I won't take 3, even when I am sure I can handel it I don't want to set a precedence.
That said now that I have escaped the Magnet hospital treadmill and got a job in a nice non Magnet union hospital it isn't an issue.
traumalover, RN
101 Posts
What kind of pts are we talking about?
A walkie-talkie on Amio?
Or CRRT, septic shock, IABP?
I have had pts that were singled due to acuity, esp traumatic brain injuries and crrt. I have been tripled with a stable vent, a post cath MI, and a GI Bleed, or similar.