SICU Staffing

  1. I'm interested in finding out about staffing ratios in SICU's around the country. The unit I work in is 32 bed SICU and more often then not we must take 3 patients due to cut backs in staff. Our patient mix is general surgery, liver & kidney transplants, CCU overflow, Lifegift doners, TAAA 2nd day post-op, etc. I personally believe this is a dangerous situation to the patient and my license. If one patient goes very critical or codes or a new admission comes in, your other patients suffer and mistakes can be made. Any information or input anyone can provide would be appreciated.

    [This message has been edited by melange (edited March 25, 2000).]
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    About melange

    Joined: Mar '00; Posts: 1


  3. by   Ginger Wright
    I work in a hospital that has a 14-bed SICU and a 10 bed MICU. In both units it is rare that you will take 3 patients. If the charge nurse feels the additional patient would compromize the safety of the other patients, the admission is refused even if there is a bed available in the unit. If the patient can not be held in the ER or somewhere else then the nurse manager is called in(even if its in the middle of the night. The hospital also has varying degree of monitorerd beds so the less acute patient are not posted for the ICUs. The feeling seems to be that if the patient only requires a 3:1 ratio than they don't belong in ICU.
  4. by   WoodstockRN
    I'm on a 21 bed unit, we serve as the CCU with open heart patients coming directly to us from the OR (4-6 patients per day) and some vascular surgeries, and other random surgeries. We also get some medical patients if MICU is full. Our open heart patients are one-to-one nursing care for the day of surgery. We usually have two patients - no more than that.
  5. by   CYBERNURSE2000
    Hello Melange, I work in a 9bed S.I.C.U. We normally have a 1Rn to 2 Patient load. However,there are those days of short staffing when it goes to 3patients/RN. wE WOULD NEVER ACCEPT A 4PT TO 1RN ASSISGMENT. THAT WOULD JUST NOT BE SAFE OR TOLORATED!! Of course, that you would never get lets say 3 critically ill patients, you would usually get 1 critical and 2 that are pretty good nursing wise. However,I have to add it can also depend on who is making the assingments. (But that is a whole other topic,Heh! Heh!). I also do per-diems in the other units like CVRU/CCU/MICU and Hemo. Most of the time a 2/1 ratio applies. E.R is a totally diffrent world and PACU well, FORGET ABOUT IT!. There are no standards there. Well hope that helps. And let us all remember "THAT HE WHO MADE US WILL NEVER GIVE US A PROBLEM, THAT WE CAN NOT HANDLE OR CORRECT! AMEN!!
  6. by   hgy
    I'm working in a 14-bed Med-surg ICU with 7 beds each. For day shift, most of the times we have 1 SN to 1 pt, but on very bad days, we'll have to stretch to 2 pts (condition of pt may vary, may be 2 on vent). However, during nites, 1 SN will have to nurse 2 pts (unless censors is low). Heard that on very very bad days, the seniors have to nurse 3 pts at nite, but I've not come across that yet!
  7. by   hgy
    & yes, i forgot to add that we have only max. 2 AN per shift to floot around & recently, we have a group of very new & inexperience foreign aids. So in other words, we have to do all pt care & dr's orders ourselves!
    Is it the same elsewhere? Do u get adequate ANs / aids to help u?
  8. by   hrtrn
    In California we are protected by title 22 that puts ICU staffing maximums at 2:1. All open hearts are 1:1 until extubated or after 8 hours, all IABP's are 1:1, and patients on paralytics and inverse ratio ventilation are 1:1. From what I read we have excellent staffing compared to a lot of places. The ER has to hold patients if we are at max ratio and have no one to triage out.
  9. by   Jenny P
    I work in a 22 bed CV-ICU with fresh surgical patients. Our assignments are either 1:1 or 1 nurse to 2 patients. Intubated, multidrips, IABPs and fresh open hearts are all 1:1, as are any unstable patients. When the fresh surgicals are extubated and stable, they are paired, and we "fast track" our fresh hearts usually out the next AM; so the night shift usually has 1:2 for our fast tracks. We do not have ancillary staff on nights, but days and eves have a station secretary and an aide.
  10. by   Julie F
    Right now, I'm a contract worker at a Houston regional medical center and staffing is HORRIBLE. It is not uncommon to have 3 pts. especially on night. My worst day....a comstantly Vfibbing pt on an IABP[I defib'd 47 times in a 12 hr shift] and a new, very unstable fresh TAAA. Oh did I mention the VF'er was on CVVHD too !
    It's not uncommon here to have 3 pt's on isolation and all with multiple devices. The ONLY pt I've seen on a 1-to-1 was a bi-vad pt.
    .........and they want me to renew my contract......I think not. 4 weeks left and counting.
  11. by   LBauer007
    I work in a 16 bed neuro/SICU and our ratio is ALWAYS no more then 2:1 and on occassion 1:1 and rarely 2 nurses to 1 patient but it has happened. i thought it was the law ( maybe only in California) that the ICU ratio was 2:1 at the most... I am shocked and sympathetic I have really bad days with just two patients.
  12. by   sockov
    in California.. title 22 makes it only 2 patients to 1 nurse max. There are times the patient is 1:1. ( I miss California!)
    I work in upstate NY now (temporarily, soon to return to California!!), and I work In the major trauma hospital for western NY and in the SICU. The staffing has always been 2:1, or a fresh liver transplant is 1:1. (or a real sickie is 1:1).
    I think the title 22 law should be made for every state for patient safety, (and nurse sanity), and the ratios lessend for the floor nurse. I will never do floor nursing again with the unsafe ratios. If they try to start to increase the patient load in ICU.. that is the day I quit nursing!
  13. by   PhantomRN
    Where I work the load is also 1RN per 2 patients, unless it is a fresh CABG or very unstable then it is one on one. I was thinking that all ICU's were alike, with staffing I mean, I am glad I read this thread. I think I will stay right where I am.
  14. by   CC NRSE
    WOW, ... Jenny P. I want to come work with you!!! And Julie F, sure does sound BAD, I'm afraid that would have been one contract I would have broken!!!! I guess I really con't say much though. The unit I work in is almost as bad. But it is a little easier for me, I've been there almost 3 years. We seem to take 3 patients on a regualr basis. Never enough staff. It's nothing for us to accept fresh CAB's along with two other patients or another fresh CAB!!!! Very dangerous I know. That's why I am considering leaving. I love my job and the group of docs I work with but it is getting very unsafe. Now they are starting to admit whatever comes through the door to our (heart/vascular)unit. I don't mind taking other kinds of patients but I don't think it is appropriate with a fresh heart. (our rooms are separated by curtains, set-up like PACU) The bad thing is, we work so hard to get people out (to make beds for the hearts that day) and they will fill the bed with a code or admit from ER then we have to run to get the patient moved before the heart comes. Between 2 beds monday I had 5 patients!!!!! 2 were hearts from the day before (moved out) a fresh CAB, code from the telemetry floor, (lateraled over to ICU once stable) and finally a good old GIB that died later that night!!!!

    Sorry, I know this is long just blowing off some steam!!!!

    As far as a 1:1, that's something I've NEVER seen at this hospital. However, we do have a bivad but have never used it. The day they get brave and use it, it will be a 2:1 ratio (doctor,nurseatient!!!!) We have never used it so I'm not sure anyone there would know how to take care of it!!!

    Also forgot to add, we don't have a tech, and only one secretary we share between 4 units (what has turned into basically one big unit.) We spend ALOT of time taking off orders and putting labs in the computer. (even with 3 patients and fresh hearts!!!) THis is on day. At night, they NEVER have a secretary.
    Last edit by CC NRSE on Aug 8, '01

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