PICU - What are your patient staff ratios?

[wendyw2]

Hi all

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

[koleaga]

Hi

Is this is the USA and may i ask where as iwould love to come there is it is a 1:1 ratio most of the time.

Thanks

[kimmie518]

Most of our kids are 1 nurse to 2 kids. Usually vented, stable, but still busy.

We also do these configs too:

2:1 - Not too many of these.

1:1 - Fresh transports (if intubated). Cardiac kids- they stay 1:1 until extubation.

1:2 - Both can be vented and on drips. If the kids got an ETT, they will be on at least a Versed drip. A lot of times you'll have a vented kid with a "floor kid".

1:3 - Usually all floor care kids, just waiting for a bed. I was told when I was hired that you would not have a vented patient in a triple, but I have seen it (granted the vent kid was trach'd and awaiting to be d/c). We've been seeing these more often.

Our RT's do all pulm meds, vent checks, changes, set ups, extubations, sometimes cpt/sxn if the patient needs it when they're in there.

[RNNPICU, BSN, RN]

Where I work you are either paired or a sick 1:1. The Respiratory Therapists do a lot - help suction, make vent changes per MD orders, do vent checks, are there for intubation, extubation. They are incredibly helpful

[kessadawn, BSN, RN]

in my picu, nearly all nonintubated patients are a 2-patient assignment, and that includes stable, established trachs who are vent-dependant. exceptions might be a really sick busy hem-oc kiddo with lots of blood products, labs, antibiotics, etc. or that rsv baby retracting so hard he's turning inside out, and you just know you'll be tubing him soon. all intubated patients are a single patient assignment, and most patients on crrt are too. the travelers who come to my facility say we are a rarity when it comes to our ratios. maybe it's because of the way our unit is set up. 24 private rooms, nurses stations in the far corners of the unit, if you're in a room you can't always hear the vent in the next room alarming unless in real doggone quiet. makes for a good time when these kiddies like to pull out their trachs!!!!

[koleaga]

where do you work?

[kessadawn, BSN, RN]

i work in akron, ohio.

[sagreeg]

Hi there

I read a few of your comments and staffing ratios. Is there anyone out there who can direct me to something on 1:1 nurse patient ratio. I am looking for a tool to calculate this ratio, or better yet, Need to justify 1:1 in the critical care setting. Studied the NEMS, but this does not tell me that the nurse patient ratio is 1:1.

Please help

[pcicurn7]

i think it all depends on your staffing. If you have the ideal number of nurses, then your kids who are intubated and on drips would have a 1:1 ratio. When we do 2 patients to a nurse, they can both be extubated, or one intubated/one stable. We never do 3:1 ratios...i think that would be very unsafe in the ICU setting. I personally have never had 2 intubated patients at the same time, but i guess anything is possible if we were short on staffing. typically, the assignment is 1 extubated/1 stable, 2 stables, or 1 sick intubated pt per nurse.

The other thing to consider is that not all PICUs are the same. I have visited other PICUs at big hospitals...and their patients would go to our floor, not the icu. And, vice versa...if one of our chronics come through their ER, they would be prompt to transfer them out of their hospitals and into our icu.

As far as RT goes...they are usually a phone call away, they come and check on our patients a few times per shift. The nurses do all the suctioning, most vent changes, ETT taping, etc. If we need them for any of these things, its pretty easy to get them to the bedside. I actually like that we can do these independently and not have to wait until a RT comes by, and that if we need them, they come pretty quickly. Its a good system, IMO.

[sagreeg]

Hello Iris

Thanks for that info. We have very good staffing levels, but I was looking for a specific tool. I have something from way back in 1993, and this was mainly 3 criteria out of five for a 1:1 nurse/patient ratio. I understand that when patients are extubated, and all very stable post cardiac surgery these patients are normally transferred to a HDU, but there is no HDU at this moment. The Cardiac ICU is a 8 bedded unit, only adults, Paeds are in a separate unit.

ps. What is IMO? Pardon my ignorance

i think it all depends on your staffing. If you have the ideal number of nurses, then your kids who are intubated and on drips would have a 1:1 ratio. When we do 2 patients to a nurse, they can both be extubated, or one intubated/one stable. We never do 3:1 ratios...i think that would be very unsafe in the ICU setting. I personally have never had 2 intubated patients at the same time, but i guess anything is possible if we were short on staffing. typically, the assignment is 1 extubated/1 stable, 2 stables, or 1 sick intubated pt per nurse.

The other thing to consider is that not all PICUs are the same. I have visited other PICUs at big hospitals...and their patients would go to our floor, not the icu. And, vice versa...if one of our chronics come through their ER, they would be prompt to transfer them out of their hospitals and into our icu.

As far as RT goes...they are usually a phone call away, they come and check on our patients a few times per shift. The nurses do all the suctioning, most vent changes, ETT taping, etc. If we need them for any of these things, its pretty easy to get them to the bedside. I actually like that we can do these independently and not have to wait until a RT comes by, and that if we need them, they come pretty quickly. Its a good system, IMO.

[pcicurn7]

no worries...

IMO: in my opinion :)

[PIVputterinner]

I work in a PICU that has 33 beds. We take care of 2 ventilated patients most of the time. We do have respiratory therapist but usually there are 3 RTs for 33 patients. They take care of the vents, but the RN's usually take care of the airways, blood gases, and aerosols for non vented patients. One of the reasons we can do this is all are ventilated patients are sedated, and hands are restrained. Patients that are un-stable or require q1hr labs are 1:1 care patients. Sometimes when we are slammed with admissions we triple stable patients. No one likes doing that, but it can't always be helped.