Low census = Crappy staffing, true everywhere?


We have 2 units which all staff float between. The main ICU with 10 beds and a "step-down" with 8 beds. We normally have 2 pts per nurse. And a secretary. No Techs, no CNAs and our managers do not do any pt care.

When the census drops, to say 6 pts in the main ICU, we loose our secretary. This is a locked unit, we have to open the doors for visitors and phones ring off the hook. All order entry is done manually and doctors are constantly asking us to print them stuff.

The staffing is based on whether the pts are "ICU" status or not. We can have 2 really sick pts, or 2 stable pts and it's just the same to them.

It doesn't have much to do with acuity.

The other day we started with 4 pts between myself and another RN. Between noon and 8 pm we transferred out 2 and received 5 adms!!! And we never qualified for a secretary, because we never got to 8. I was charge and both my pts transferred out at the same time we were getting adms. I couldn't help! It was so crazy. Nobody was able to put in orders or make charts. The paperwork was piling up. Sick pts: a post code, and Trauma One, a confused and drunk CVA, an AMI who was pulling everything off.

But we never qualified for more help. We called in one nurse, who had to take 2 adms and had another nurse who was going back and forth between our unit and the ER where she was working as "helping hands".

If I have my 2 pts and am charge, and the other two nurses have 2 a piece, who is supposed to be doing the secretary's work??

I guess I'm just wondering if it's like this everywhere? And do you have any suggestions about how to deal with this? (It has been going on for years...)

Sun0408, ASN, RN

1,761 Posts

Specializes in Trauma Surgical ICU. Has 4 years experience.

This wouldn't be an HCA facility ?? My last unit was like that, hints to why it was my last unit. I left after more than a year of promises. No, it is not like that everywhere.


46 Posts

Where I work, we have 11 ICU beds, plus we monitor telemetry for the hospital. On the night shift, we are 4 nurses, no orderly, no managers, no secretaries, no body! Plus, if there's a code on one of the other units, ICU answers the code, so 2 nurses leave the unit leaving only 2 nurses for 11 patients and all telemetry monitoring. Now THAT is unsafe practice ;-)


215 Posts

Specializes in CCU, CVICU, Cath Lab, MICU, Endoscopy.. Has 14 years experience.

Wao....am so sorry for these unsafe conditions and NO not every place its like this. My hospital ICUs it's always 2patient to 1 Nurse, and some times 1:1, the Charge never has patients and always have a nurse asst that it's responsible for all ekgs, blood glucose checks and other nurse delegated responsibilities. My advice is when you go for an interview be ready with your own questions like nurse: patient ratios, total icu admissions, door to balloon time, i personally ask very many details like their performance improvement projects and such. Funny because i always end up quizzing them more than they do, and they always end up extending their offers. I also stick with large hospitals i encourage you to do the same, unless you are in a royal area then sorry.....good luck