ICU nurses, Is 3:1 patient to nurse ratio a common occurence or am I just tripping? - page 10

*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... Read More

  1. by   overtonis
    I do think 3:1 ratio will be undoing of US based Nurses in ICU due to younger generation not tolerating that type of 'factory worker' mindset bestowed upon. What I think will happen is nurses will have to be brought in from foreign counties on much larger scale. Then not only will they keep 3:1 ratio but ICU nurses will also take over Respiratory Therapist (RT) role and manage the vents themselves - resulting in fairly significant savings for hospital. While I am on topic of how I see this all shaking out. I see hospitals as basically becoming large ICU settings as most tele and med surg patients will be taken care of from home with apps on mobile devices for communications between MD & patients and BP, glucose results and telehealth with skilled home care nurses.
  2. by   AuNaturelle
    On my unit currently, when we are short staffed we sometimes have 3:1 but usually it's 2:1.
  3. by   ddoosier
    I have been present during a code when we were slamming a Liter of epi. It was the 1st time I saw this during a code and of course I asked the rationale. The recorder charted on the code sheet the dosage/bolus. Pt was middle age and family was there. We did get a rhythm, but not for long...he passed. BTW, pharmacist was there and made the bag. Rather than criticizing, use some of your critical thinking skills and ask WHY would this be done. There is a rational. We see many things in a level 1 facility.
  4. by   Dodongo
    "Slamming a liter of epi" means nothing. If you don't know the concentration then you have no idea what the patient is actually getting. Was it 16mg/1000ml? 32mg/1000ml? 64mg/1000ml? If you don't have the mcg/kg/min and concentration then it's an anecdote with no real meaning. My hospital'standard (a 1600 bed level 1 trauma center - since this is thrown around so much) is 16mg/250ml with a "suggested" infusion rate of 0.1-0.15mcg/kg/min. Of course we go WELL above the suggested maximum dose during codes. What's there to lose at that point?
  5. by   akinaRN
    I work in a 16 bed SICU. We have quite a few swans, a few IABP's, but not ECMO or CRRT. Our ratio is 2:1 except:

    ~newly admitted DKAs (not all the time, but they're trying to make it a rule)
    ~Fresh open hearts (until extubation)
    ~or REALLY sick pts (but only if staffing allows)

    In the 16 months I've worked here, I've only had to take 3 patients maybe 2 days--no fun. If that was the norm, I wouldn't be here. 4:1?.....You couldn't pay me enough--that was the ratio on the cardiac stepdown I worked prior and I ran my legs off then with lower acuity pts.
  6. by   smarine123
    Look up Safe Harbor and get that number written down. You might need it. Refuse assignments when you know it is too much because once you accept them, they are yours! Compromise if you can, i.e. "I will take the three patients, but I want someone else to do all of their oral meds, their glucometer checks and maybe calculate the I/O at the end of the shift for me.
  7. by   smarine123
    And people wonder why the burn out for ICU nurses are 3-7 years!! Why doesn't someone call safe harbor??? What happens when JACHO is visiting? Do they fix these issues during that time? I am so curious! I can understand an occasional tripling but every day! NO WAY! SAFE HARBOR! Look them up, know who they are and what they do and use the number!

    In CA, they only have 2:1 ratios because it is now a set standard in that state. We, in other states, have to fight for legislation to pass that will support that in whatever state you are in! Get a petition going and attend the meetings at the capitol when the nurses associations meet.

    Good luck!
  8. by   Yammar
    Worked an HCA facility where we often had staffing issues and worked 3:1 ratios. It was not all that bad. What makes it dangerous to me was navigating the annoying families. When you add that third patient you also add another family with their questions, concerns and multiple BS. I would gladly take 3 patients everyday if I could avoid the crazy family members and their 50 billion phone calls a day.
  9. by   Z71RN
    we have 3:1 ratios in icu. it is pretty much the norm and the unit is set up for that ratio with the number of beds. i worked in the unit for 1 yr and ran my butt off. it was really bad when we were full and had a bunch of low sick patients, esp. when you unit manager is awol and the assist manager is pretty much useless cause she is always having to do "pi projects".
  10. by   kourtrn12
    In the icu I work in we only rarely do 3:1 if we have one icu pt and two PCU pts or all PCU pts waiting for beds. 3:1 ICU pts is ver very unsafe in my opinion
  11. by   Go-GetterRN
    Quote from Dbb82
    Honestly, sometimes 2:1 is hard enough, these patients are unpredictable, but 2:1 is appropriate. However, 3:1 is unsafe IMO. Even if you have a pt that is a q4 hour vs, he or she can be a "dinger' or very needy. Sometimes I find myself in that pt's room than in my critical patients. A pt like that can take up your whole time, and next thing you know... your other patients are tanking. And who is going to get blamed if something happens to your other patients? Yep... You... and only you... I understand that there are a lot of staffing shortages and budget cuts going around, but it is unsafe for our patients and is a disaster looming against us and our licenses.

    On top of that, in our hospital, we have no techs or secretaries at night.
    I just searched for a thread talking about being tripled every night and this sounds exaclty like my unit. Though it happens more often to us night shifters in my ICU since we have a slower shift, it still doesnt seem right. Ive been tripled once before with a q30min Stroke scale on one pt, q1hr FSBS on the other, and the other pt was intubated but was off sedation so constantly on the call light. None of these were extremely sick or unstable pts and were all pretty easy to care for but what if pt#2's blood sugar was 5 for 2 hours bc i was busy caring for my other pts? Or pt#1 had a massive bleed from the clot buster? I'm honestly a little scared for my license when I think about all the possible scenarios..
    Anyways, I've been in this ICU for about 9 months and Im thinking of switching to a diff unit in a larger where I worked as a tech before i graduated..where nurses never get tripled AND they have a tech every night. The only reason I would stay where I am is because we see it all and it is great experience for whatever the future brings(NP/CRNA/neither?) Does anybody think Im completely crazy for staying or do you think I'm right to stay for the experience?
  12. by   SCBlueICU
    If I was you I would definitely explore my options Go-Getter. I just wouldn't feel right condoning that kind of on the edge care by staying. Sounds like you deserve a better unit to work on. We are 3 to 1 rarely, and they are usually a stable bunch. 2:1 is the standard with 1:1 when necessary due to acuity.
  13. by   Ilovethe80s
    I am 2 weeks off orientation in an SICU and I see tripling happening all of the time. We have a high turnover rate with nurses and the morale is horrible. I'm scared when the day comes that I'm assigned 3 patients. I don't think it's right. I've heard a charge nurse make the statement about a nurse being upset that she was tripled , "well, their not really bad patients." I don't care if the patients are considered good or bad; it's just not right.