Staff ratio, dangerous situation

[Salutations]

I am a fairly new nurse (this month will be 1 year), but I am starting to notice things in my unit that concern me. As a for instance, this week:

3 ICU units in the hospital, each 8 beds. My unit had patients (one code bed for the hospital). Three nurses staffed, which meant that two of us only had two patients. One nurse went to CT with one of her patients, and the other nurse left to get blood. Neither gave me any type of report on their remaining patients. Alarm goes off in one room, I see that he's on levo, so I brought the doppler in with me to confirm no pulse. Thankfully, the charge nurse saw me pulling the crash cart, and a nurse from another unit heard my call for help.

My question: Is it really safe to have only 3 nurses in the unit, and how do I keep another nurse there with me when both were carrying out stat orders?

[psu_213, BSN, RN]

In my mind, it is not that it is a dangerous ratio, just a combination of circumstances that lead to a dangerous combination. So the first nurse left for CT. Did the 2nd nurse have to leave right then for her blood? If it could not wait, was there anyone else who could have gone to get it? If she had to go, and there was a "free" charge, she should have been in your area of the ICU when both other nurses were off the unit. Finally, if those nurses are going off the unit, they must give report to whomever is covering them.

Like I said, not a staff problem, but a series of errors (really on the part of the other nurses) that lead to a potentially serious situation.

[amoLucia]

Good job done!! Sounds like you kept your cool and responded well. You were also able to recognize a problematic situation which hopefully will be avoided in the future because of your concerned awareness.

Kudos to you.

[nurseprnRN, BSN, RN]

Wait-- why is a nurse leaving a critical care area on an errand to get blood? Any transport or porter or CNA or even a volunteer can do that.

It can't be because a nurse has to check the unit number at the blood bank-- two blood bank personnel can do that there with their own numbers and procedures, and then after it's been delivered, two nurses check it against the pt armband at the bedside.

Good grief, I got my hospital to stop that foolishness more than 35 years ago. "Because that's our policy" or "We've always done it that way" isn't a rationale, is it? The rationale has to do with patient safety, and this has no impact on patient safety.

There's your first step. Get that policy changed. Do it now. (And I agree c everyone else above.)

[Esme12, ASN, BSN, RN]

Do I understand correctly that the charge nurse has no patients? If that is the case then she isn't doing her job. Those other nurses needed to plan the time better, notify someone to help cover, or had someone else get the blood...like the charge nurse. You should not have been left alone.

[xoemmylouox, ASN, RN]

What a scary situation! It sounds like you handled it well. I don't think the ratio for staffing was the issue, but more like poor planning on the part of the other nurses. Be a leader and discuss changing a bad policy or starting a new to prevent this happening again.

[Been there,done that, ASN, RN]

Nurse patient ratio is not the question.

Team communication is the problem. No nurse is left alone on the unit PERIOD. All nurses on duty are given report on the patients and updated when any one nurse leaves the unit.

"Alarm goes off in one room, I see that he's on levo, so I brought the doppler in with me to confirm no pulse."

What alarm? The cardiac monitor? Why would you waste time searching out a doppler to confirm pulselessness?

[Salutations]

Thank you all for chiming in. My unit has been going through a lot of changes - the ICU director and nurse manager were just replaced, and the CNO was replaced a few months ago. The suggestions are great- we currently get our own blood as we have (some days) one CNA for the three units. We also draw and bring up our own labs. The charge nurse usually does not have his/her own patients, and that was the case. Unfortunately, the report I normally receive is "no drips are going to run out while I'm gone, no calls out."

The doppler is kept on the crash cart, which was just outside the room. My grabbing it may have wasted 10 seconds. You're right though, Been there,done that, I should have started bagging/compressions right away. I'm still learning, and know that it will be a career-long process.

Any other suggestions that I can bring to my conversation with the nurse manager? What is the typical ratio for the ICU? I know I'm new, but I tend to feel a little overwhelmed with 3 patients on vents/drips, which most of our patients are.

[nurseprnRN, BSN, RN]

Why would you waste time searching out a doppler to confirm pulselessness?

I'm thinking perhaps that it's because a lot of levo will result in such vasoconstriction that getting a peripheral pulse can be difficult. However, that's why the goddess gave us carotids and femorals and (our own) fingertips. So many devices can be unnecessary if you have, like, enough actual nurses.

[applewhitern, BSN, RN]

I have to chime in and say that I, too, don't understand why "only the nurse" can go get the blood. That said, it is that way at my current hospital, too. Leave your ICU patients to go several floors down to get blood. Makes no sense, but they don't see it that way.

[neuron]

It seems to me that it is common sense to give report on your patients. If they truly cared, then they would have given you report and follow up on their patients or made sure they're looking after them and 'all' was done in an event such as this. When you leave your duties to another nurse, maybe the nurse either needs to be reprimanded or possibly lose her license. Sounds like a bunch of bu**-covering.

[nurseprnRN, BSN, RN]

I have to chime in and say that I, too, don't understand why "only the nurse" can go get the blood. That said, it is that way at my current hospital, too. Leave your ICU patients to go several floors down to get blood. Makes no sense, but they don't see it that way.

Ooooh! More than THIRTY years ago I moved and went to be the day charge nurse in an ICU/CCU that had that rule. I was astonished. I argued that yes, the lab person has to do a check of the stamped requisition at the blood blank to dispense the right blood product, which can be done with another lab person, and the RN has to do the bedside armband check with another RN to be sure it's the right blood / right patient, but the means of getting it between there and here was absolutely immaterial. The university hospital I used to work in sent us our blood in the pneumatic tube system, for gawdsake. I also mentioned that if somebody in my ICU were needing stat blood, s/he did not need to have one less RN off the unit making a blood bank run.

I wrote up a policy and procedure for aides or ward clerks to go get blood, they implemented it, and that was the end of that foolishness. I strongly recommend you do the same.