Pregnant working in a very understaffed ICU

[alicestill]

Hi everyone! I am 11 weeks pregnant working in a very busy medical ICU. My unit has been very short staffed the last year and a half, but the situation has gotten severe in the last few weeks. It has gotten so bad that a nurse our ICU can get up to 5 patients per shift with all of them being vented, some of them on multiple pressors. To top it off, we only get an average of 1 PCA for whole the unit, sometimes none. Because the staffing is so bad, it's almost impossible to give any nurse preferential assignments. I find myself cleaning, repositioning patients over 300 lbs with sometimes minimal assistance. Because the other nurses are equally drowning in their own work assignments, I find it hard to ask them to do all the heavy lifting for me. I'm on my feet for most of the shift and often don't get time for breaks. I'm so concerned this will affect my pregnancy. Is it time for me to leave or find another area to work in?

[Sour Lemon]

At 11 weeks? Normal pregnancy? It's not likely...

I would quit from the workload, alone. Lifting 300 pounds alone isn't good for anyone.

[smf0903]

I wouldn't leave for being pregnant, I'd leave being in ICU getting 5 patients.

[guest769224]

Yes, it's time to find a new job and unit. That ratio is absolutely ridiculous for ICU and shows management doesn't care about their staff one bit, especially if it's been like that for so long.

[LovingLife123]

5 patients in the icu is completely dangerous. What is manager doing to rectify this? I'd be outta there like yesterday if anyone expected me to take 5 vented patients. I

[smf0903]

I ask this in all seriousness, how do you even find the time to chart?? 5 vents and patients on pressors...the timed tasks alone would fill the shift...Q2h turns, oral care, titration, outputs for pts on pressors...what in god's name do you guys do if someone goes in the crapper??

[EllaBella1, BSN]

Wait. Like 5 patients at the same time? Do not walk, RUN away from this place. I could never, and would never work in conditions like that.

I also do think you are putting your pregnancy at risk in this case. Your job is clearly very high stress- higher than a usual ICU. Plus that kind of lifting is way over what any OBGYN would say you can safely do, even in a normal pregnancy.

[Medic/Nurse, BSN, RN]

Pregnancy would not be a factor in my career decision making.

I'd be out of there fast. Fast like a bunny FAST.

300# patients q2 hour turns by myself or with minimal assistance and regular 5:1 patient ratios that are vented, titrating pressors.

Nope. I'm not capable of doing that job safely. Even if I grew an extra pair of arms and eyes - still not safe. I'm not that good at being a nurse. I know my limits. I respect my limits. I would not want my family cared for in those circumstances - I'd hope someone would raise the alarm in some way and get patients out of there. Wow.

1:3 ratios make me prickly. If it's a regular "thing" and patients are "sick" and the management solution is WORD based, I am planning an exit. 1:4 ratio better be a crisis issue (meaning a co-worker went home sick, disaster plan has been enacted hospital wide) and should be measured in hours. 1:5 in the conditions you describe, I am not sure I would clock in and take report the 2nd shift it happens. A solution must be found that safely addresses care - meaning call PRN or agency, let management work or divert or transfer out. No excuses.

Hard pass. Run.

As worried as I'd be about that job and being pregnant, I'd have a list of other critical concerns that basically run the alphabet.

I think you know what to do.

Congrats & Good Luck!

:angel:

[WestCoastSunRN, MSN, CNS]

No way. Totally unsafe. I've never even heard of such a thing. Good golly ... can't JCAHO or somebody do something about that craziness? That situation has got to be reportable, right? OP, get out of there --- and if this is a norm -- not a disaster response situation, someone(s) need to to lose their job over a fiasco such as you describe.

[RNNPICU, BSN, RN]

5 patients for an ICU, how is that even legal. I can see that on the medical floors. but in an ICU with your intubate patients? How many patients are intubated and on pressors? Many nurses work in "busy ICUs" and are pregnany, but your ICU sounds like they are using general floors ratios for nurses and that is terribly unsafe. How many patients are on CRRT? I have never heard of an ICU with 5 patients to one RN. All ICUs are busy and it seems like the census never decreases.... okay maybe like one day every 6 months, but most hospitals have ICU ratios 2 patients to 1 RN and if they are really sick 1:1.

[Here.I.Stand, BSN, RN]

I have 5 kids and never asked for preferential assignments beyond no active CMV or the like..

But there is no way in Hades that your work is acceptable -- pregnant or not. Seriously, that is multiple sentinel events waiting to happen!! (If you have time to notice sentinel events... dude.)

[Here.I.Stand, BSN, RN]

And forget patient safety for a minute (hey, your management has!!)....

I get q2 hr turns are important. But if help isn't available and I can't safely do it alone, it's NOT happening. You have to live with your back long after this job is gone. This may sound heartless because your pts didn't ask for staffing to be so unfathomable... but their skin is not as important to YOU as your back.

Hey I did just also think of a pregnancy specific concern... I was always told that as a low-risk mother, appropriate lifting was ok. I had children over 50 lbs who wanted to be lifted at home, so I was ok with appropriate lifting at work. (NOT saying 300lb helpless pt is appropriate lifting!!)

But with FIVE, cinco, V, funf, 다섯, IIIII ICU patients, I imagine it's near impossible to stay hydrated. Dehydration DOES increase your risk of preterm contractions.