Out of ratio and dirty rooms a ok!?

[Chaotic Mind]

A memo recently came down from our ICU manager stating that if a patient needed to come from a med/surg, ER, OB, OR, etc unit stat that it would be okay if we were "briefly" out of ratio and that we could put them in a dirty room and "work around it." I've never had to deal with something like this and to say the least all the nurses are TICKED OFF. The reasoning on why this was okay is that it was "best for the patient to get them into the ICU as fast as possible." Like an ICU nurse having 3 patients, one of which is obviously crashing, is somehow okay. Who do I need to contact to report this. I have a copy of the memo. Location is California. Thanks for any help.

[sauconyrunner]

The first person to start with is your Director of Nursing.

[sauconyrunner]

Second person wold be the Infection prevention person for your hospital, since the dirty room is a clear No-No.

[wooh, BSN, RN]

Well an ICU nurse with 3 patients, one crashing, is better than a med-surg nurse with 5+++ patients, one crashing.

But the room not needing to be clean will change as soon as someone catches something in a room that wasn't terminally cleaned.

[Bec7074]

Does your hospital not have a rapid response team that can head off those situations? Those crashing patients need ICU care not just a room in ICU. Intubations and line insertions can happen anywhere, and pressors/ACLS drugs can be given anywhere as long as the nurse is able to do so. To me, that sounds like a better alternative to stabilize patients while a room can be cleaned.

Just my two cents...an ICU nurse with 3 patients, 1 crashing IS worse than the med surg scenario in the previous post. The other 2 patients may be stabilized, but still require diligent ICU care. Patients on pressors, dialysis, and rotoprones can be considered stable and like hell you'd want 2 of those and a crashing new one.

[wooh, BSN, RN]

Just my two cents...an ICU nurse with 3 patients, 1 crashing IS worse than the med surg scenario in the previous post.

Until one of the nurse's other patients starts heading downhill, and isn't caught because the nurse is hanging onto a patient so the ICU nurse doesn't have to take a triple. At which point we've got another patient that's going to need to go to ICU because it wasn't caught when less intervention would be needed.

But what do I know, silly me thinks that floor patients need some dilligent care too.

[VictoriaGayle]

Both situations are bad, all patients need diligent care, and that is hard to provide if you have a wacky ratio going on.

The hospital should be responsible for making a plan of action that will prevent either scenario from occuring.

It's not about which is worse. Both are bad for the patients.

[herring_RN, ASN, BSN]

Rather than plan to provide sufficient nurses your manager is planning to violate the safe staffing law -- Nurse-to-Patient Ratio

I would contact your hospitals infection control officer too. Often this position is held by a nurse.

Here is where to report this -- District Offices

[Lynx25, LPN]

Dirty rooms? Gross. Who in the heck comes up with this stuff?

[Esme12, ASN, BSN, RN]

california law aside.

i know i'm going to get flamed for this........we all know that there are patients that can be transferred out of the icu at any given time(usually)....right? those patients while in icu are a 1:2 ratio in the unit but suddenly become a 5:1, 6:1 the moment they leave the icu doors. so, technically there are patients that can be tripled. in your hearts, you know that some patients can easily be a 3:1 ratio for a short period of time.

there is nothing in the rule book that says a nurse, any nurse, can't wash a bed and side tables to accept a patient from the floor that is unstable and better cared for by the skill and expertise of a critical care nurse. unless the patient had a communicable disease process like tb washing the bed can be done quickly, and properly. i have washed many a bed as a nurse, manager, and supervisor.

while it isn't optimal to have more than 2 patients in an icu...there are times that the patients are stable enough that a third can be taken while waiting for the on call nurse arrives. this requires team work of the whole unit (which usually happens when an unstable patient arrives) to care for all the patients. although not optimal it can be safely done.

a patient requiring icu level care is safer with the icu nurse period that a floor nurse that lacks the training to deal with critical care patients and meds. what an icu nurse can do in her sleep.......a floor nurse really struggles if she knows how to help at all. the icu nurses special training and skills is what makes her/him special.

the problem with saying this is that the senior management/administration slowly creeps the amount of time before relief comes to a greater and greater amount of time.....and the emergencies turn into "routine" admits.....and the situation will escalate to unsafe situations.

if the management could just be trusted to do the right thing.....such a shame. give them an inch they'll take the mile.

now....this is in califiornia? report them!

nurse-to-patient ratio

district offices

[Gypsy_Nurse]

:redlight: California will have a hayday when they find out...

[applewhitern, BSN, RN]

I have worked in ICU's where we had to take 4 patients each. I have worked med-surg floors where we took 8 patients each. I would much rather have an unstable patient in the ICU as soon as possible because at least there you have them on a monitor and can easily see the b/p, rhythm, etc., where on the "floor" you cannot. True, you can intubate anywhere, but the point is to get them stable before they get to that point. If we had to keep an unstable patient on our floor, it would be a pain because the floor does not have ready/easy access to certain meds, or anything else needed, aside from a crash cart, of course. I would rather be a patient in a quickly-cleaned room with all the benefits of an ICU environment, than one on the floor, if I were going south.