Nurse: Patient ratios

Specialties MICU

Published

Hi,

I was wondering what kind of nurse: patient ratios you have in the ICU. Here in NM we try to stick to 2:1 (1:1 for the very ill), but I have also worked in TX where we routinely had 3:1 and in Baltimore where is was even worse! I would love to hear about the staffing in your state and units, especially with such shortages of ICU nurses. Thanks.

Used to be wiggle worm patients on balloon pumps were 1:1, fresh hearts, and anyone unstable or the promise of it. Not anymore. As was mentioned, managers pair up the time consuming patient with a less ill patient who will get precious little attention.

We don't do bilateral vents or CVVHD at my little midcities community hospital so guess I feel lucky there, Burt. It sounds scary. :(

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Specializes in CCU (Coronary Care); Clinical Research.

In our CCU, standard is 2:1, for fresh open hearts or unstable pts 1:1, hearts can be doubled if stable and/or after they are extubated, sooner if we are short staffed...frequently we have two second day hearts if stable (though not the ideal pair) IABPS /CRRTs are 1:1...last night we did have some 3:1 due to short staffing but we try hard not to have to do that, the only time we 3:1 pts is if they are overflows from the stepdown unit or we are short...

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Specializes in CCU (Coronary Care); Clinical Research.

In our CCU, standard is 2:1, for fresh open hearts or unstable pts 1:1, hearts can be doubled if stable and/or after they are extubated, sooner if we are short staffed...frequently we have two second day hearts if stable (though not the ideal pair) IABPS /CRRTs are 1:1...last night we did have some 3:1 due to short staffing but we try hard not to have to do that, the only time we 3:1 pts is if they are overflows from the stepdown unit or we are short...

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Our ICU is cardiac and medical combined, usually 3:1, almost never 1:1, only occasionally on days. Our SICU has way better staffing usually never more than 2:1. Acuity means absolutly nothing in our system

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Our ICU is cardiac and medical combined, usually 3:1, almost never 1:1, only occasionally on days. Our SICU has way better staffing usually never more than 2:1. Acuity means absolutly nothing in our system

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When I did the unit, it was 2:1 ratio. Fresh hearts where 1:1 until they were extubated or stable. Rarely, we did 3:1 if the patients were very stable.

However, even given good ratios, good benefits, the best pay in the area, a very supportive MD staff, flex schedules, a choice of 6, 8, 12 hour shifts and managers who try their best to be supportive (most are the type who will get out their and get their hands dirty) the nurses still leave in droves.

So, what is up with this?

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When I did the unit, it was 2:1 ratio. Fresh hearts where 1:1 until they were extubated or stable. Rarely, we did 3:1 if the patients were very stable.

However, even given good ratios, good benefits, the best pay in the area, a very supportive MD staff, flex schedules, a choice of 6, 8, 12 hour shifts and managers who try their best to be supportive (most are the type who will get out their and get their hands dirty) the nurses still leave in droves.

So, what is up with this?

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If you work in Pennsylvania or Arizona here are links for organizations working to achieve safe staffing laws. I California ICUs have had the 1:2 law for almost 30 years. Now working on all acute care units:

http://www.pennanurses.org/

http://cna.igc.org/saznc/letteronicu.html

http://www.calnurse.org/gr/aanestad.html

http://www.calnurse.org/gr/tenyearhist.html

The State of Victoria in Australia has ratios.

Anywhere else?

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If you work in Pennsylvania or Arizona here are links for organizations working to achieve safe staffing laws. I California ICUs have had the 1:2 law for almost 30 years. Now working on all acute care units:

http://www.pennanurses.org/

http://cna.igc.org/saznc/letteronicu.html

http://www.calnurse.org/gr/aanestad.html

http://www.calnurse.org/gr/tenyearhist.html

The State of Victoria in Australia has ratios.

Anywhere else?

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Specializes in Cardiac/Vascular & Healing Touch.
:confused: It's always a struggle in these ruff financial times & with the shortage of experienced RN's....I usually staff 2:1 sometimes 3:1 in my CCU if the pt's are moving out to the floor in the a.m. I have recently had a case of 4:1 when I had a nurse get injured on the job & had to go to the ER for tx. Suck it when I have to. Only for a few hours. Priority & TEAM work is a must. I am blessed to have a good team. :kiss
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Hi there. I am a nurse manager in Montana. Our hospital is trying to cut staffing ratios. I am looking for feedback. Currently we do 2:1 in the ICU and 3-4:1 for stepdowns. The new target HWPPD is 14.2. The lowest I have heard of is 15, and that blows our current ratios out of the water! I would love to hear from you to hear what your HWPPD are if you know. Thanks.

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:confused: It's always a struggle in these ruff financial times & with the shortage of experienced RN's....I usually staff 2:1 sometimes 3:1 in my CCU if the pt's are moving out to the floor in the a.m. I have recently had a case of 4:1 when I had a nurse get injured on the job & had to go to the ER for tx. Suck it when I have to. Only for a few hours. Priority & TEAM work is a must. I am blessed to have a good team. :kiss

what are your target HWPPD? My staffing is the same as yours, but of course with budget cuts:o they want to make changes. We had an efficiency expert :uhoh3: in and they want to get our HWPPD from 16 to 14.2. I think this is unsafe!

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