Question regarding minimum staffing


Hey all! I am hoping someone can guide me in the right direction regarding safety policies.

I work in a 10-bed ICU. Administration is trying to implement a 1 RN in the unit unless there are more than 2 patients. What I mean is 1 RN and that’s it. No aide, no other human body back in the unit. I understand not paying a second RN be back in the unit but having literally no one else is absurd in my mind. Number 1, there is no one to watch monitors if I would be in a room with a patient. Number 2, we get combative alcohol withdrawals/overdoses. We have had nurses assaulted by other staff (I won’t go into that here but suffice to say it was not pretty). Irate family members, I can name a hundred scenarios in which having a lone staff member is unsafe.

Administration does not get this. We have one charge nurse that covers the unit and 3 med surg floors, so they can’t possibly be at our beck and call. The charge nurse is also the medication nurse for caths if we have a STEMI, so in essence they can be off the floors for a couple of hours if we have a STEMI roll in. We don’t have nighttime pharmacy so we are mixing our own gtts and overriding non-profiled medications, so we would literally have to call to have someone come back to witness a controlled med that hasn't been profiled yet by pharmacy (wastes as well).

We can go literally hours in the unit without seeing another employee. I don’t fault the charge or supervisor for this at all, they run their butts off every shift. I just don’t see how putting 1 RN in a closed-off unit is safe by any stretch of the imagination.

I already told my husband that if they implement this he can expect me to lose my job because I will refuse to clock in. But there are people working there that don’t have that luxury—this job is not our primary source of income, most people working the unit this IS their income.

It really ticks me off that our administrators don’t seem to have even the little sense that God gave an ant. In my eyes, this is a train wreck waiting for a time to happen.

Any advice? Thoughts? Directions in which I can get basic safety requirements? I’m in Ohio. I’m trying to find something to help us plead our case.

(And before you ask, yes I have applications out at other facilities.)

I appreciate your input! ❤️?


451 Posts

Specializes in ED, med-surg, peri op. Has 6 years experience.
1 hour ago, smf0903 said:

It really ticks me off that our administrators don’t seem to have even the little sense that God gave an ant.

Umm what?

unfortunaty we see this time and time again, non medical staff making dumb decisions. It’s not till something drastic happens that they listen. Count yourself lucky you can leave.


838 Posts

I wouldn’t agree unless there were 2 RNs. You noted some definite safety issues When are you suppose to break or even go to the bathroom? You leaving those 2 patients alone for 30 minutes? For a code, are you it? How’s that going to work? No way. Not safe, not even with a nursing assistant.

RNperdiem, RN

4,572 Posts

Has 14 years experience.

Time to update your resume and start looking around for jobs. I am glad you have the process started.

I would just accept that you don't have the power to control what the administration thinks unless you are in a position of power yourself. As a staff nurse, probably not,.

Specializes in Retired. Has 41 years experience.

Oh I had that job! But it was 1979 far, far back in time when ICU meant bring out the leeches because we didn't have a hell of a lot else. Can you get any help from your state board since they know the health and hospital code better than your administrator.


1,577 Posts

Have you broached the topic of safety issues with your unit manager? That is completely unsafe. What if somebody codes? What if you need to intubate?

I cant even begin to understand why someone would think this is ok, and why your nurse manager is remotely ok with this.

I’d be out of there quick.

Specializes in Nephrology. Has 33 years experience.

Is the medical director of the ICU aware? I worked acute dialysis at one time for a company that wanted us to dialyze patients ALONE in an unused section of the ER, nobody else there. Our administrator ( a non RN) was ok with it. The first time I was called in to dialyze in that situation, I called the medical director of our program and all of a sudden they found a different space for the patient to be dialyzed where other staff were present.


844 Posts

Apparently this is coming from above our manager and she doesn’t agree with it. But they’re going to do what administration forces/tells them to do.

Our unit is set up weird so even our supply room is outside of the unit. Technically, we can’t go grab a snack for a diabetic or a sheet from the supply room without leaving the unit. The nurses at the other end of the hall are WAY down the hall and even if we screamed for help they probably wouldn’t hear us.

As a temporary thing I think everyone is going to refuse the assignment if there’s not another person back there. We’d rather lose our job than put a patient or ourselves in danger.


41 Posts

Has 1 years experience.
1 hour ago, Undercat said:

Can you get any help from your state board since they know the health and hospital code better than your administrator.

I somehow found this quote both humorous and fairly sad at the same time...!:-):'(

To SMF0903-

Somehow the general public needs to be made aware of this f'dumbass move by the PTB (that's Pigs That Be).

Try explaining that you have to pee to your patient's family, or that you haven't eaten for 11 hours... and their loved one will be left to fend for themself if/while you do so, or you have to resupply by leaving the unit.

If I were a family member and my loved one was compromised by such a dangerous and selfish policy, I'd rain holy hellfire down on the POS that instituted that garbage, and NOT the nurse...but that's because I've been a nurse and know how this stupidity works.

Ask your PTB how you are supposed to accomplish said maneuvers. Ask your PTB if they are willing to hold it as long and go without eating as long (in solidarity with you of course). Ask the PTB to give you their home phone number so the family will have someone to call when they get there and their is no staff on the unit (said pee, food and supplies) and monitors are going off..You could leave a little sign on the unit that says "Back at ..." (with a little clock and all)..If you need assistance, please call xxx-xxxx". After all, all y'all are a Team....

Good God, as much as I miss the act of nursing, I thank God that I don't have to put up with this garbage any more.

I hope things work out for you.

Specializes in orthopedic; Informatics, diabetes. Has 11 years experience.

We have a safety reporting system and any time there is an issue that we feel is a safety issue related to understaffing, we can submit it and it goes to risk management. Is there anything like that where you work?

canoehead, BSN, RN

6,837 Posts

Specializes in ER. Has 30 years experience.

I've worked at a hospital where both the labor nurse and the ICU nurse were sometimes alone on their units. It was understood that the supervisor was their backup and their break relief. I worked labor and delivery there, and our manager said that in an emergency, hit the code button, no matter what that emergency is...irate family member, impending delivery, whatever.

I did a few years as supervisor there as well, and we'd end up stuck on OB, while ICU pulled a smart med surg nurse for an hour to get through a crisis. Or the second ICU nurse went down to the ER to stabilize their pending admit, and brought them up once they got orders. It worked, but only because the supervisors were comfortable taking over in any department, and the staff would help each other in a pinch.

I think leaving the unit for supplies is asinine. Most medical crises require getting supplies. And what about position changes that require two people? Would they consider a secretary overnight? Or CNA ? Give them a few incident reports and back strains to start them thinking.

Specializes in ICU.

Nope nope nope. I only read the first paragraph and skimmed the rest. I'd check your laws for staffing ratios at the very least.

1) We had a dry spell this summer. We follow a strict staffing ratio, and one night our census was so low that it left one RN (a new grad, nonetheless) and one CRN (who is a bada** RN but had only been in the CRN role for two weeks at this point). They had a code and it was pretty devastating. There wasn't even resources to even begin the code appropriately. Thankfully, the patient was fine, but it really opened admin's eyes to the potential dangers. Apparently they were turning a patient and couldn't hear the vfib alarm on another patient at the nurse's station. When they left the patient's room and heard the alarm, they scrambled to start a code.

2) Our critical care unit consists of a 14-bed intensive care unit and an 8-bed progressive care unit. The PCU hss a minimum of 2 RNs and usually one tech. These patients are still VERY ill, in that they'll be downgraded to PCU a day or two after extubation and stay in PCU for a week or so. We are allowed to have feeding tubes and drips. Sometimes our patients are a "wait to intubate" ED admit, that they keep PCU level overnight until the pulmonologist can intubate in the morning. We RNs each have a 4-patient team (My team last week was two Afib with RVRs, one post-heart stent who kept having long runs of vtach with reperfussion, and one with respiratory failure satting a sustained 82% on continuous BiPap). It's TOUGH. Sometimes the other RN is JUST as busy, and often our aide will "float" to ICU to clean a stool or turn a patient. If my patient goes downhill, and the other RN is doing a med pass down the hall and our aide is in ICU, I'm pretty screwed. It's happened before and it will happen again. Sometimes I'll call my CRN on my cell and holler for them. This unit is L-shaped too, so there's many places you really can't yell for help. The two RNs and one aide make me nervous, I can't imagine one RN!!