ICU Patient Ratios

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Hi all. I work in a 40 bed ICU (7 CV, 33 General ICU) we'll say staffing has been far from ideal for a long time, that's old news in my world, we're always told that's changing, but that's neither here nor there at this time.

My question/concern is, we recently got a new leader and are hearing from her that we are actually complaining without cause and that th er e are places that 7 mechanically ventilated patients to 1 RN is acceptable and even normal. I've never in my life heard this and am concerned that's going to be required of us soon. My gut says no way, not in an ICU setting, but I thought I'd put it out there as a question for more minds than I possess.

Specializes in ICU, Med-Surg, Float.
How does an RN have a cvvh assignment and not a patient assignment in your unit? If my patient is on cvvh I'm 1:1 with them, and doing all of their care, assessments, and running the machine as well. Dialysis RNs never touch anything r/t cvvh in my hospital.

Us too! Dialysis nurse will come up and run HD but if they're on CVVH then that's just added in to our workload.

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Specializes in Cardiac/Transplant ICU, Critical Care.
How does an RN have a cvvh assignment and not a patient assignment in your unit? If my patient is on cvvh I'm 1:1 with them, and doing all of their care, assessments, and running the machine as well. Dialysis RNs never touch anything r/t cvvh in my hospital.

The ICU nurse that is assigned to the CVVH patient (1:1) is the primary care nurse for that patient and does all of the patient's care i.e. running the machine, baths, meds, etc.

The CVVH/Dialysis Nurse does rounds and if the filter clots, does restarts for all of the CVVHs in house through all 5 of our units, they also do rounds/restarts/disconnects on all PD patients on the floors. Over night we have a CVVH/Dialysis Nurse that is our main point of contact between the Primary Care Team and Nephrology.

This comes into play if the patient's electrolytes are not as stable as we need them to be and have to make a switch on the dialysate bags from say BGK 4/2.5 to say BGK 2/3.5, or braun. Or if the patient is unable to hold onto any bicarb, we will have Nephrology work their magic to optimize the CVVH so that the pt can hold onto it. Also if we are having issues with the filter clotting too fast Nephrology will make the call to start citrate and a CA++ gluc drip. Also if we think it is an access issue, Nephrology will prevent us from restarting CVVH until the vas cath is rewired or a fresh one is put in.

So say there are 9 CVVHs in house, each CVVH patient will have 1:1 ratio with an RN in their respective unit unless they are extremely short staffed. Let's say there are 4 in CTICU, 2 in CCU, 2 in MICU, and 1 in SICU. THE CVVH Nurse will do rounds a few times a shift on all 9 of the patients and be Nephrology's hand in doing their will. So the CVVH nurse in not the Primary Care Nurse for all CVVH patients, rather, is another line of care and management for the devices.

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Yes I am having a tough time transitioning from a 12 bed neuro ICU at a large state teaching hospital where the ratio was never more than 1:2 except in very rare circumstances, like once in the year and half I was there, to working in a 10 bed ICU in a small community (for profit) hospital. We have no admins and 9 times out of 10 no techs. More often than not, the ratio is 3:1, if not 4:1, sometimes having a vented patient on one side of the unit and other patients on the other side, with no RT in the unit listening to the vents. Often one of the patients is a step-down boarder, which is manageable when they are independent, but many are total care and with no techs it's impossible to provide good ICU care to the really sick patients when the unit is flooded with boarders. Usually there are only two or three nurses on the unit, even when it's full or it's not full but admissions keep coming in. As I said I'm having a rough time with this transition and often feel that it is not safe for patients. Was I just spoiled where I came from and I should just get used to this because it's how it is? Should I move to CA?

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Specializes in ICU, Med-Surg, Float.
Yes I am having a tough time transitioning from a 12 bed neuro ICU at a large state teaching hospital where the ratio was never more than 1:2 except in very rare circumstances, like once in the year and half I was there, to working in a 10 bed ICU in a small community (for profit) hospital. We have no admins and 9 times out of 10 no techs. More often than not, the ratio is 3:1, if not 4:1, sometimes having a vented patient on one side of the unit and other patients on the other side, with no RT in the unit listening to the vents. Often one of the patients is a step-down boarder, which is manageable when they are independent, but many are total care and with no techs it's impossible to provide good ICU care to the really sick patients when the unit is flooded with boarders. Usually there are only two or three nurses on the unit, even when it's full or it's not full but admissions keep coming in. As I said I'm having a rough time with this transition and often feel that it is not safe for patients. Was I just spoiled where I came from and I should just get used to this because it's how it is? Should I move to CA?

Omg that sounds terrifying. And unsafe! What if you're at the other end of the unit washing a boarder and the vent alarms? I'd be filling in incident forms on every shift, stating that the workload makes it unsafe for your patients...

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Specializes in Dialysis.

What kind of acuity system is used to determine the staffing pattern?

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1:1 ITU patients and 1:2 for hdu

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Specializes in Dialysis.

"Acuity can be defined as the measurement of the intensity of nursing care required by a patient. An acuity-based staffing system regulates the number of nurses on a shift according to the patients' needs, and not according to raw patient numbers."

Using the Acuity Based Staffing Model to Determine Nurse Staffing

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Specializes in Trauma Surgery.

WHAT! Jesus, I would cry and curl up into the fetal position if I was at 7:1. Our unit is mostly 1:1, 1:2... on a bad night when we're short staffed can be 1:3. When we have a really bad trauma who is unstable as heck, we have them 2:1 or even 3:1 (especially with MTP- mass transfusion protocol with the Level 1 transfuser). Any patient that is on MTP, on CRRT, or in a rotoprone bed are always at least 1:1 depending on their acuity.

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Specializes in ICU, Postpartum, Onc, PACU.
Jesus that's terrifying!! I'm in ireland, here we are ideally 1:1, or 1:2 at a push if they aren't vented or are stable, or there's some kind of in-hospital emergency. Mech vents are ALWAYS 1:1...

Wow!! That would be ideal! I need to go back there for good next time haha xo

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Specializes in ICU, Postpartum, Onc, PACU.

I would see what my options were for asking a higher up person what the deal is (in the most polite way, so far). That can't be right. However, I'm at a facility now that never staffs appropriately as a rule, so there are places like that out there, even in California. However, even this place wouldn't do that. xo

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Specializes in ICU, Postpartum, Onc, PACU.
"Acuity can be defined as the measurement of the intensity of nursing care required by a patient. An acuity-based staffing system regulates the number of nurses on a shift according to the patients' needs, and not according to raw patient numbers."

Using the Acuity Based Staffing Model to Determine Nurse Staffing

Yes, but the way I'm reading it, that doesn't seem to address her main question...Unless the patients are chronically vented or live on a vent (and even then 7:1 would be scary) I haven't yet seen a situation where that would be appropriate or even tolerated. I haven't been everywhere though and obviously it happens or we wouldn't be discussing it here, but that seems dangerously unsafe to me , unless she's leaving something major out of the initial post. Acuity staging is there for a reason, after all. To protect us! :) xo

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Specializes in ICU, Postpartum, Onc, PACU.
Yes I am having a tough time transitioning from a 12 bed neuro ICU at a large state teaching hospital where the ratio was never more than 1:2 except in very rare circumstances, like once in the year and half I was there, to working in a 10 bed ICU in a small community (for profit) hospital. We have no admins and 9 times out of 10 no techs. More often than not, the ratio is 3:1, if not 4:1, sometimes having a vented patient on one side of the unit and other patients on the other side, with no RT in the unit listening to the vents. Often one of the patients is a step-down boarder, which is manageable when they are independent, but many are total care and with no techs it's impossible to provide good ICU care to the really sick patients when the unit is flooded with boarders. Usually there are only two or three nurses on the unit, even when it's full or it's not full but admissions keep coming in. As I said I'm having a rough time with this transition and often feel that it is not safe for patients. Was I just spoiled where I came from and I should just get used to this because it's how it is? Should I move to CA?

You will still run into problems here in California (per my other posts I'm at a place now that never has a charge or float and there are only ever two nurses in the ICU; something I'm not used to at all). The chances are slimmer, I would say, here in CA, but there are bad hospitals everywhere. I'm used to sharting RTs with the rest of the hospital and only at the bigger teaching hospitals I've been to has there ever been one assigned only to ICU. We're "not allowed" to mess with the vents, but usually call the RTs if there's an problem. Granted, at least here the patients aren't super sick at all, which, while annoying for an ICU nurse, is a blessing since we don't have staffing to care for them if we did get them. It does happen every now and then though, and it's bad. That's what I get for being a traveler though ;-) xo

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