Lunch breaks in ICU.

[IvesRN]

This thread is about what do ICU's do for lunch breaks, how do you determine when who goes and who covers your patients. I work in a 24 bed MICU and we have a charge nurse who does not take patients, our staffing is 2:1 for the most part with frequent 1:1 patients. I was asked by my director to look at revamping our lunch break coverage due to an increase in falls on our unit from time to time. Currently we have 45 minute lunch and we assign a "break buddy" whom you report off to when you are leaving the unit for anything such as lunch or transporting a patient to ct-scan. This "buddy" then watches your patients while you eat. This works well but there really are too many nurses off the floor at once during peak lunch time. I have come up with a few possibilities with my colleagues working with me on the floor but I am looking to see what other ICU's do across the nation. I thought maybe I could learn something and get some ideas. Thank you in advance. Hope to hear from you!

[sapphire18]

I work in a small ICU; we give report to 1 or 2 other nurses to go to lunch. Mostly we eat in front of the monitors with a view of all the patients (I work nights; days can't do this). Also 98% of our patients can't/don't get OOB. If it's a confused or EtOH pt, they are restrained and sedated if they're a high fall risk, since they're also connected to various tubes/lines/wires. Can't remember ever having a fall in my year of working here. I would suggest putting a limit on how many nurses can be off the unit at any given time though- like 2 or 3, depending on how many nurses are working at the time, and acuity of the patients.

[IvesRN]

Thank you sapphire18. Out acuity is usually pretty high and most patients do not get OOB. However we are getting more and more telemetry overflow during low census in the ICU and high census on the telemetry floors. I will take your advice and see what we can do. Thank you so very much. I think our increase in falls is in direct correlation with the increased number of telemetry patients we are seeing who are very ambulatory and so forth.

[ICUPrincessNurse]

We're 36 bed and we report off to our neighbor for a 30 minute break or when we go off the unit for procedures. We also have a charge nurse with no patients and usually (when we're fully staffed) two resource nurses with no patients. If our patients are THAT sick, we'll have the charge or a hall lead (resource) watch our patients so they can stay at the bedside and monitor them very closely. If mine are higher acuity or at a higher fall risk I'll have multiple people listen out and make frequent fly bys to make sure everything is kopasetic.

[IvesRN]

ICUPrincessNurse thank you for the input. I like the idea of having resources nurses on the unit that don't have patients and are able to help with watching others patients and assisting with things. Thanks again.

[thth21]

I work in a MICU at a large trauma center. We usually have a designated break nurse to break everyone/take pts on runs for CT's/MRI's/whatnots. The break nurse will also help with new admits/unstable pts on the unit. I think it's a much safer option, especially if there are a lot of high acuity pts on the unit.

[IvesRN]

Thank you thth21. I am finding a lot of MICU/SICU's practice this where they have an extra RN that does not have an assignment and can then cover staff while they go to lunch or on road trips with their patient. I personally like this idea, but whether my director will justify the staff or not is another story. The only thing I can do is present it to him and see what happens. Thank you so very much for your feedback!

[meandragonbrett]

We have 3 float nurses that do breaks, lunches, and help travel as needed.

[Filly]

I work nights in a 30 bed unit and we eat where we can see the nurses station and rooms (like the dictation area), so we can watch our monitors and go do whatever is needed for our patients. My food gets cold a lot, but it's a lot easier this way. Our charge does not take patients so he/she is usually available if we do have to leave the unit for some reason, but we very rarely report off for breaks. Our breakroom is fairly far away from the ICU, and I personally am not comfortable taking breaks there.

[IvesRN]

Thank you very much for your response and information regarding this sensitive topic for us nurses.

[wanderlust99]

Break nurse or help all nurse that is not the charge nurse. It's not safe to cover 4 Icu patients. Something bad will eventually happen if it hasn't already.

[Medic, RN]

I work night shift in a 16 bed Surgical-Trauma ICU. We have a couple of techs (usually EMTs) that really watch the patients while the charge nurse rounds on them frequently. The techs know to notify the charge nurse or us (our breakroom is in the icu) for any acute changes. If it's a sick patient, the charge nurse will watch them. We usually have 8 RNs plus 1 charge, plus two techs. There is no definitive policy. The charge nurse just uses his or her judgement.