Nurse/patient ratio in ICU...what is yours?

[nitronymph]

Ok, ICU nurses. Need your input. What is the nurse to patient ratio in your ICU? Our ICU is small, only 8 beds. We are out of date of most of our equipment. We RARELY do CVP monitoring. There is not cardiologist on staff(neareast one is 65 miles away), no neurologist or neurosurgeon(only orthopedic and general surgeons), and only a pulmonologist once or twice a week(just says the service is offered). We do have lots of ventilator patients usually due to COPD, pneumonia, etc. Drips include nitro, dopamine, dobutamine, levophed, insulin, propofol, amiodarone, epi, lidocaine(don't think our docs who think they are specialists know of too may more). Lots of older septic patients, all post op ortho pts x 24 hrs, many general surgical patients needing close monitoring...these are our patients. Most of them are very, very sick patients, but many of them are what we call "fluff"...there just because of who they are or the family wants them in ICU or the doc is trying to make a few extra bucks. Regardless, we are the patient care nurses, the telemetry techs, the unit secretaries....we do it ALL. Normally, our nurse/pt ration is max of 3 per nurse. If we had 5 patients, staffing would allow 3 nurses. Granted it, there were many times I felt guilty for calling someone in on the occasions that the pts we had were mostly "fluff", but because of the other "hats" we wore, I would call them in. Our CNO says the chg nurse is suppose to be with the tele monitor at all times. It is kind of difficulty to roll a 300 pound 2 person assist patient alone (when there are only 2 nurses) and have the charge nurse hold down the desk. Well...they have now decided to save money(no raises this year for anyone, either) to have 6 pts on days before the 3rd nurse is called and 7 pts on nights before the 3rd nurse is called. The other night the "seasoned" nurse had to respond to a code and leave the newbie(6 month ICU nurse that needs throwing back to MS floor) alone with all the telemetries and patients (6). Sounds UNCOOL!!! What do you think? Just looking for input from all of you out there. Thanks!!!!

[Caffeine_IV]

Sounds unsafe. I work on a large unit and staffing is usually 2 patients per nurse. Sometimes it's 3 but usually one in the mix is "floor" ready.

[I_See_You_RN]

2:1, max 3:1 but that is rare and usually due to a nurse calling out sick last minute, or extreme bad weather. If you only have 2 nurses on then I think Code Team should be deferred to another unit. What if two codes occurred at the same time?

[detroitdano]

Medical ICU. We do a lot of pulmonary stuff as well, some people aren't even really ICU critical, just need the monitoring due to whatever procedure they'll be getting.

2:1 max.

[frumpter]

We are 2:1. We are a small, community hospital as well, with a 12 bed ICU.

[meandragonbrett]

I fail to understand why facilities continue to use ICU RNs to watch monitors. It's a waste of resources and finances.

[SICU_Murse]

Usually AT LEAST one nurse per shift is 3:1 in our ICU. I think this is really unsafe, even if one of the patients has orders to move out. According to other nurses on my unit (havent looked it up myself) NJ law prohibits ICU nurses being assigned >3 patients.

[mooremds]

Usually AT LEAST one nurse per shift is 3:1 in our ICU. I think this is really unsafe, even if one of the patients has orders to move out. According to other nurses on my unit (havent looked it up myself) NJ law prohibits ICU nurses being assigned >3 patients.

Wow, must be really nice to have your state mandate ratios. I wish Texas did. In our ICU we usually do 2:1, sometimes 3:1, not too bad; our floor nurses have it rough. They often times have 7:1 and I've heard of them getting 9:1. I dread the day I'm floated and they're short staffed and I have to take 9 patients.

[Agrippa]

Just a fyi regarding CVPs...

1. There is no correlation between the CVP level (i.e., low, normal., or high) and the

state of the measured intravascular volume (pooled correlation coefficient = 0.16).

Therefore, the CVP is not a reliable marker of intravascular volume.

2. In response to volume infusion, there is no correlation between changes in the CVP

and changes in cardiac stroke output (pooled correlation coefficient = 0.11). Thus,

the CVP respons

Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid

responsiveness? Chest 2008; 134:172-178. [Link to Abstract]: PMID #18628220

[RyanRNBSN]

Our ICU is very similar to yours. We are 5 beds with almost identical patients. We staff with 2 RNs... primary care, no unit cleark, etc. just as you do. If we are full (5 patients) the on-call physican must decide what patient is "floor ready" in the case of an admission. Anywho, potentially our ratio could be as high as 3:1 for one of the RNs but usually is 2:1 as we do our best to keep one bed available at al times. However, it has been a concern for many of our seasoned nurses who may feel uncomortable leaving a new ICU nurse with a full ICU when they respond to a code or trauma (traumas which can last up to an hour or more to stabalize the ED patient) and the most seasoned ICU nurse is to respond the codes as they are the "code leader" in our facility. I guess I really have no advice, other than your department is not alone.

[ICU, RN, BSN, B.S.]

I work in a MICU/SICU. We usually are 2:1.....can go to 3:1 on nights (which I do) but I think that is very seldom. And Obv you wouldn't get 3 vented pts.

[Maghunter]

I work in a large mixed ICU. We NEVER have 3:1. That's just crazy. The charge nurses do a really good job of mixing one vent with a non-vent pt most of the time. Heart pt are 1:1, as are very septic or post core pt on hypothermia protocol. I am still new, so they try to give me one vent and one easy pt, but that doesn't always turn out that way. The other day I had two pt. One an acute MI and the other SIRS with ARF. Both were pretty stable at the begining, but by the morning I had the SIRS on pressers and my MI was very unstable. (they should have cath'd her right away, but the doc wanted to wait i.e. sleep) Let me just say that was a busy night. That's the way it goes in the ICU though. Pt are in the ICU because they are SICK. And by sick I mean unstable. They can change quick and you need to have the staff to handle it. That same night on the two pods I was working we also admitted acute resp failure, an alpha trauma, post v-fib arrest starting hypothermia, drug overdose, and another resp failure from the floor. We had started the shift with only one open bed, so all the admits meant pt had to be transferred out to make room. BUSY! If we would have been understaffed or 3:1, it would have been a danger to everyone.