Published May 12, 2005
It seems that nursing is in dire straights world wide. It has been a standard in Australia that all ventilated children are nursed on a 1 to 1 basis. Occasionally if they have low accuities and are side by side we will double up.
Today at a meeting we were told that it is usual that American PICU nurses double up and we could do it too. We said that you guys can do it because you have Respiratory Therapists. We don't, the nurses do everything. Our administrators are trying to tell us that we can double up on 2 ventilated patients because you guys do it. Is this true? Do respiratory therapists exist and what do they do?
Thanks in anticipation
I work in the US, tennessee PICU, and we all have 2 ventilated patients to 1 nurse, it is very rare that I come in and don't have 2 patients as my assignment. The only patients who are 1:1 are fresh from surgery post-op heart surgeries or a child who is on a lot of drips and has a very high acuity of care.
We do have 3 respiratory therapists in our 22 Bed ICU, they give the breathing treatments and work with the ventilators, setting them up, doing every 6 hour checks of the vent. They are available in the ICU for extubation and codes, Ett retaping etc. Pretty much for a 12 hour shift though the nurses do the assessing and suctioning, I see them at my bedside 2 times in 12 hours. I don't really see them at all except for vent checks if my patient doesn't have any resp. treatments.
Hope this gives you some insight.
We always have 2 patients each in our unit unless there is a high acuity patient (Drips, unstable, etc). We have an RT assigned to our unit but they often are assigned to the peds floor also as well as sent over to the main tower to do treatments there too!! Our docs have tried in the past to get an RT assigned exclusively to our unit but no such luck yet. They do vent checks, give the treatments, assist with intubations, extubations, etc. We do most of the suctioning and retaping of the ETT's.
In my unit of approximately 24 patients, we usually have about 4 RTs and they are always available. The usual ratio is 2 patients to 1 RN, with the exception of new hearts or unstable patients.
They get assigned patients just like we do, though they usually have about six patients. We manage the patients collaboratively with the RT assigned to the patient.
I do not work in pediatrics, but the ratio is the same as in adult ICU. Rarely, rarely, rarely do we have an assignment of 2 ventilated patients and if we do it's only for a period of time when we are waiting for another staff RN to come in to take the second patient.
We have RT's specifically designated to critical care (ED, ICU). Our RT's do everthing related to the vent. While RN's can decide to make vent changes, we do not physically make the adjustments, we call RT. Docs, including Attendings DO NOT touch ventilators either.
RT's are on the unit for an entire shift and have assignments just like the RN's do but have more patients. RT's do vent checks, document vent values, occassionally suction patients and draw gases from art lines as a courtesy to busy RN's, they do all abg's when there is no art line, give respiratory treatments and CPT, do breathing trials, change tubings (even for patients not ventilated, but on 02), do tape changes, are in charge of airway during codes and are present during intubations (they do not intubate), and collaborate with RN's and MD's.
The only thing I touch on the vent is the alarm silence and 02 enrichment prior to suctioning. Doesn't mean the nurses don't know it, it's rather a continuity safeguard in patient care. Most times, the RT knows a patient almost as well as the RN does.
They are experts at what they do and they are an invaluable part of the critical care team.
No, not all places in the US do what your management tells you.
We're typically 2:1 unless the pt's condition makes it otherwise. I've taken some 3:1 assignments if they are the right pts and I'm feeling especially spry.
We usually have 1 RT who does Tx and vent checks, also runs most of our gasses after we draw them. But unless our census is high we often have to share that 1 RT with the NICU. That RT also has to accompany pts to CT, MRI, etc. so you can't always rely on them being close.
I have worked for 6 years in a PICU in Kentucky. We have a wide mix;
2:1, ECMO, fresh hearts, hemo dialysis, or very sick with q1 hr labs on vents
1:1, High trauma, 2nd day post op hearts, lots of drips, vent kids, one coming in on a crash & burn or a 20% burn patients
2:1, stable vents, of post op surgery
3:1, 3 TCU patients or 1 ICU & 1 TCU patient
We have a 26 bed unit with 2 RT on during a 12 hour shift and a minimal of 11 RN for a 12 hour shirt. It changes every 4 hour with the acuity of the patients. A stable pt may become unstable and end up a 1:1 or a 2:1.
Hope this helps out
I need information on how you trend DOWN your staffing in a PICU when the census drops to one or two, or even no patients. please include information on ancillary support staff available (ie. unit secretary, supply clerk, patient care assistant, RT) as well as additional responsibilities (ie code team, transport nurse) I need this info soon. please help!
We will pull RN to another unit or ED. We may send them home if they want to. We do this when the census is down. They will take a budget oin a heartbeat due to being so busy most of the time. We will also mandat a budget when no one wants one. It depend on the last date they were off. We do the same with all staff, RT, Secretary. Let me know if this helps out or you need more info.
Our staffing ratios depend on patient acuity. 2:1 for stable, ventilated or non-ventilated patients; 1:1 for unstable, q15min vitals and on occasion, we have 1:2 for the extreme cases (usually a trauma or med patient who is showing signs of herniating or brain death).
We have an RT assigned to our unit. The RT is responsible for the vents, respiratory treatments, etc. The nurses touch only the silence button, the O2 breath button, and occasionally, the FiO2 (if we are weaning and we had better tell the RT pronto).
I'm an Australian adult ICU nurse who is now in in a PICU in the New Orleans.
There is no way ozzie nurses can double up.Firstly,here you don't touch the vents.I can only touch the Fio2.I don't even give nebulizer treatments(i can but tha'ts resp therapists job).When patients are admitted from OT/Er and they require a ventilator the resp tehrapist sets everything up and attaches patient.We are allowed to suction but we don't tie ETT tapes,do trachy care.
Secondly,when you need you drips you scan an order down to phramacy and they draw it all up for you and send it up.
Everything is computerized and there'sfar much more virtual paperwork.
There obviously are pro and cons to both systems but you are expected to do alot more Oz.
Hope that sheds some light,the two systems are completely different
I don't work in the PICU, but I have friends who do. Most of the patients are 1:1, except in urgent staffing situations or stable kids preparing for transfer to the stepdown. Like previous posters said, stable vents can quickly become unstable vents. On average, in a 22 bed unit there might be one doubled assignment.
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