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Discussion

Icu patients

I've been in the ER for 3 years, 1 of which has been spent at one of the busiest trauma centers in my city. In general, when we get ICU patients, charge is pretty good at keeping the ratio 1:1 or 2:1. I realize downsizing ratio depends on many factors, such as how busy it is, how many acute pts there are, staffing, and who is charge.

But yesterday I had an ICU that coded within 10 min of being there. Charge was there and was well aware. There is one other nurse in our area with a total of 8 pts. I'm stuck with this sick pt, and no extra relief. The other nurse is busy with her pts. So my 3 pts sat there for hours without attention, and it sucks because that ultimately looks bad on me. Luckily I was already caught up when the ICU pt came in.

I know this has to happen a lot, it's the nature of the ER. How do you handle it? Any experiences feel free to share.

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    We divide the pts up as there are usually at least 3 other rns available. The charge may pick up those pts, depends on who and the situation.

    It's very rare in my er to go 1:1 and still keep your other pts but has happened.

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    I've had it happen. How did I handle it? I just prayed that my other patients remained stable until I could get my ICU patient up to the unit.

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    Where I work, it really varies, depending on the charge. Some are better in helping you when you have a critical, 1:1 pt, some are not so great. With some you don't even need to ask, others if you don't ask for help they'll just assume you got it (which is stupid. assume I don't have time to come asking for help!).

    It could be really frustrating when there's no standard behavior.

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    How big is your ER? Just wondering mostly. I have worked in a small rural hospital and large ones as well. I have found the bigger ones have been much better at trying to share the wealth. But I have been in a similar situation. I worked at an 11 bed ER with 3 nurses on and it was a super busy day and my really sick pt coded. You do the best you can and hope that the other patients are not that critical. In my case I had already assessed them and most of them could have been seen the next day. One reprieve that we have is that we only have one doctor so if they are busy with a code the other patients are not really being seen and the ER kinda comes to a standstill. Another option is to move to California.

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    If it's a soft ICU, we'll sometimes stand pat with that patient and 3 others.

    If it's a legitimate ICU player, we'll go 2:1 or better right out of the gate.

    A lot of ED patients are very stable and can tolerate being ignored for an hour. The trick is knowing who's who.

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    Thanks for the replies. Like you said, sometimes you're just too busy to go to charge and request more help as your titrating your drips! This is a CA hospital by the way. Big 44-52ish bed ER depending on staffing. I guess it all depends in that! Thanks for the validation though

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    Where was your charge in helping with those other patients?

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