staffing issues

[Feldner]

Hello, I was wondering what were the staffing ratios in other hospitals, including ancillary staff. I work in a 16 bed ICU/CCU as a RN, for the last four years. The hsopital, previously a not for profit, was recently bought out by a for profit hospital chain. They have cut our PSA/CNA totally out from 3-11 and 11-7. I work 7p-7a. We get a unit secretary if our census is at 5. I would as well as everyone else in the unit rather have a PSA from 3-11, than a unit secretary from 11-7. The unit manager seems to totally ignore this fact. Ratio previously was 2:1. Now, at 3-5 pts, we get 2 RN's, 6-7 pts, 3 RN's, 8-9 pts, 4 RN's, etc. Last night we started out with 8, discharged one to the floor, and admitted 2. We started out with 3 RN's and they called in 1, for a total of 4. The one they called in is 76 years old, which I, being charge had to wind up babysitting along with her and my patients. {retirement age is a whole other thread}. By 0430, I was in tears. Everyone is looking for another job. One nurse left her resignation under the managers door. I was just wondering, have I been living in a fantasy world or is this reality. I am seriously contemplating going back to school. Thanks for input.

[ICU_floater]

Our unit tripples. This is because there isn't enough staff period. Management DOES try very hard to find people but there isn't always someone extra to work. We only have a secretary, no assistant. Two nights of the week we work without the secretary. Asside from myself, 14 months is the most experience of the night staff. so I'm trippled, in charge with no secretary serving as preceptor for 3 other nurses who are new. Now THAT is bad.

Long story short. I'm not saying it's right the way your staffing is, I'm just commenting that it's common where I work. Because it's so exhausting, our turn over is VERY high, hence the newbies... the older staff knows better;)

[luvtheOBX]

We often triple also. The nursing supervisor will say its because we have several patients to go out (PCU or medical patients) then within a few hours when there are ICU patients in the ER or someone needs to be transfered in they miraculously find beds and now we are tripled with ICU patients! It drives me crazy that they staff us like the census doesn't change in a 12 hour time period.

[Hoozdo, ADN]

We are never tripled. There are no CNAs scheduled at all in the ICU. 9 out of 10 shifts we don't have a unit clerk. We like to have a free charge nurse to help answer the phones and resource.

If I had a choice between having a CNA and a unit clerk, the answer would have to be a CNA. If I were on dayshift, that answer might change!

We have RTs tripping over themselves, but most are too lazy to even retape the pt's every day. Perhaps I should put them to work answering the phone.

[VivaRN]

Tripling used to be a "once in a blue moon" deal, but is becoming more and more common. The other day it was 2 nurses, 6 patients (1:3)... in order to admit a patient coming in, they moved the most "stable" (ha ha) pt. to the floor. No one is going to take 4! :uhoh21: Even though we had beds available.

Everyone gets upset with each other trying to find staff. No one wants to come in. Staffing has no one. Their agencies have no one. Being understaffed with high acuity has already resulted in one lawsuit.

The CNA (when present) hangs out in a room watching TV. You have to page overhead to find him and then he acts all upset over being bothered. Please.

Clerk? What clerk?

I figure if we are doing the job of the nurse, the tech and the clerk we should be paid the combined salary of all three.

Hospitals need to realize that you can't admit patients to make $$ if you don't have enough nurses to care for them.

Who thought this was a good idea?

[Creamsoda, ASN, RN]

In our ICU, we are usually 1:1. Its a 24 bed ICU, so we may have from 2-5 nurses that are doubled, but never 3 patients. 5 nurses doubled would be a bad day in staffing. We always have a unit clerk to answer phones even on nights. We dont have any CNA's or LPN's though. Its all primary care. I work in Canada in a unionized province, so that may help make a difference.

Just curious about what type of patients you would have when you have three? Are they all ventilated? On pressors? Or are they fairly stable?

Yikes, I couldnt even imagine.

Cher

[VivaRN]

Just curious about what type of patients you would have when you have three? Are they all ventilated? On pressors? Or are they fairly stable?

Yikes, I couldnt even imagine.

Cher

We do our best to make it fair. Maybe one unstable, two fairly stable. Vents/pressors notwithstanding. If someone is stable on pressors they count as stable. If that makes sense. Though sometimes there is no nice way to divvy it up.

[nrsang97, BSN, RN]

In our ICU we rarely tripple. One night the agency nurse was trippled while I was singled with a VERY unstable patient. At 11p two other nurses came in and I transferred my VERY sick pt to a surgical ICU since there were no more neuro issues. This is a VERY rare occurance on our unit. Most of the time we refuse to tripple and mgt understands.

Usually we are 2:1 but there can be quite a few 1:1 patients. When I left yesterday morning there were 4 1:1 patients in our 16 bed unit. We had 2 SAH/IVH pts with pressors,vented,EVD,Camino,etc. We had one gift of life pt ( a absolute must single), and one who was SVT to A-Fib with RVR to A-fib to who knows what rhythm. We ended up with 10 nurses. None of those pts could be doubled.

So I have to say that our staffing is pretty good most days. But some days we have had to double those patients, which really sucks.

[Indy, LPN, LVN]

We double, we don't triple that I've seen.

[meandragonbrett]

CVICU.....Post-ops are 1:1 until 7-8 hours post op. 2:1 is normal ratio. Sometimes 1:1 and sometimes 1:2 nurse. No nursing assistants. Unit secretary round the clock. Divided into two units each unit has a charge RN and then a free floating charge RN who manages staffing, admits, etc.

[RNperdiem, RN]

At my Level 1 SICU we have 16 beds( 2 conjoined 8 bed units), a secretary on both sides, a charge nurse with no assignment, and usually a combination of 1:1 or 2 patients to a nurse. Most days and evenings we have a CNA(new addition in the past year), and if no CNA, then a stock clerk.

Our stock clerks are hard working and have many years experience and can locate anything. Our CNA's are typically highly motivated nursing students.

[nursenpnk, RN]

My unit has just experienced new staffing grids due to a new CNO, so we have limited resources regarding secretaries, unit stockers and assistants. We are also supposed to triple pts if possible the most stable. However, with all these new staffing issues we are constantly playing musical pt and sending people home only to be called back in to help with a new admission. It is a mess and many nurses are leaving the unit, including myself. I started in the MSICU after nursing school, went through a very rigorous orientation and then started working nights, where resources are very slim. I just don't feel as though I can get support from my charge nurse or other nurses when we are a packed unit and we have triple assignments. I have also decided to explore the world of PICU after my experiences in the MSICU. I think restrictions on staffing is something that is becoming rather common unfortunately :-(