Nurse: Patient Ratios

sapphire18 · Jan 21, 2012

I have never had to take 3 ICU pts and while I guess it does happen rarely, I have not seen it since I started in my current ICU 9 mos ago. I'm not sure why you would jump to finding a new job right away from the info you have posted. I do think that ratio can be unsafe and I would think that if your hospital uses the float system they could pull someone from the ER, step-down, or a floor to help out by tasking, but not necessarily taking a pt assignment.Good luck.

MomRN0913 · Jan 21, 2012

I have taken 3 ICU patient MANY time. It seems to be the average ratio in the ICU I used to work. Depends how sick too. 1:1 was generally unheard of except for a balloon pumps.

The patients you take care of are obviously sicker, but once in a while 3 patients as long as a city is balanced well, is not a reason to go out and find another job. Sometimes in nursing it ends up like that.

As long as it is not a regular thing, It sounds like a well staffed ICU.

BelgianRN · Jan 21, 2012

It hapens regularly in my ICU. We hardly ever have staffing to give 1:1. So when acuity needs 1:1 it means the other nurses have to chip in and work harder. Generally during the day we have 1:1.5 - 1:2 during the evenings 1:2 - 1:2.5 and during the nights it's 1:3 and 1:4. So nights can be horrible when a patient needs 1:1 which automatically means the other nurse goes 1:6. And our ICU is one of the top ICU's in terms of acuity and complexity of pathology.

It's workable but it means we don't have any spare time to do a little extra. And the less acute patients tend to suffer as they'll see us storm in/out of the room only doing the most needed things. As a result nothing is 1:1 to begin with. Unless a patient keeps coding or a nurse really can't leave the bedside. Once you get experienced at juggling multiple patients it will go a lot easier. At least here we tend to spare the younger/less experienced nurses and make sure the more experienced ones have more patients.

Circejane · Jan 25, 2012

We have several acuities in our CCU, which is a small 6-bed unit. True CCU patients, Intermediate, and Tele Overflow. These acuities are assigned "time frames". One CCU pt. is considered to take 6 hours of a shift. An intermediate is considered to take 4 hours, and a TO two hours.

We will sometimes have one CCU, and Intermed. and a TO, or even a CCU and two Intermed. Never 3 CCU pts. for one nurse. That said, we sometimes have pts. that should be 1:1 and we'll have an intermediate as well, which can be a little hairy.

aei09a · Jan 25, 2012

"I'm not sure why you would jump to finding a new job right away from the info you have posted"

I guess I know that right now I am still too new to receive 3 pt's, but soon enough it will occasionally happen to me too, and it just feels incredibly unsafe. Thats why I'm trying to figure out if there are any options out there I can try to impliment onto my floor, or if I should try to move on to a new job, as much as I like a job- I like my license more and I just know it's not right to have these really critical patients 1:3.

Thanks for all the feed back from everyone- I am trying to make a decision on what to do.

meandragonbrett · Jan 26, 2012

To the OP....just remember the grass probably won't be greener on the other side. This is a problem in critical care and it has been. No unit can 100% promise that they don't have occasional 3 patient assignments unless if they use agency or they have a resource/float nurse that will come into staffing when needed.

sapphire18 · Jan 26, 2012

As unfair as things can get, when you gain experience and confidence in yourself, you won't be constantly in fear of losing your license. Get insurance, and remember you can always refuse an assignment if you feel it is unsafe.

nursenotamaid · Jan 27, 2012

Generally 1:2. 1:1 for sick patients.

We also go 1:1 for patients who are particularly needy, "VIP", patients who have a lot of road trips that day, very restless or too tasky. We 1:1 *all* patients who need isolation - contact or otherwise, all post-transplant patients and all patients who are transitioning to comfort care to be able to best manage symptoms and support the family. All patients with devices like IABP or CVVHD are singled. Patients who are crashing hard or who have needed the Level 1 in the past 24 hours get 2 nurses assigned to them.

We never, ever, ever, ever have more than 2 patients, regardless of acuity. We also staff 2 charges nurses to the unit at all times who do not have assignments. We have 1 nurse who is dedicated to doing the admission paperwork, orienting families to an ICU environment and helping to manage manipulative or needy family members that may be obstructing our ability to work. On top of that, we have float nurses who are extra RNs without an assignment that cover an assigned 3 nurses to help do turns, baths, road trips, transfers, codes, whatever... they also make sure we get our breaks. 2, 20 min. breaks in the first 6 hours of the shift, 1 hour long lunch break and at least 2 more 15 minute breaks before we leave.

Needless to staff, our staffing is phenomenal.

nursenotamaid · Jan 27, 2012

In California, our law *mandates* that no ICU nurse will ever have more than 2 patients.

sapphire18 · Jan 27, 2012

I need to move to CA. Guaranteed breaks? Guaranteed 2 hours, 10 minutes of breaks??! And no admission paperwork...gotta say, that all sounds like a dream come true. I might even get bored. (lol)

maloneys · Jan 27, 2012

I work night shifts only, and we ALWAYS have 3 patients. We also dont' have an orderly at night.

Think I need to move to California, sigh.....