staffing needs in 5 bed ICU with telemetry from M-S floor

[otterridge]

I work in a small, 5 bed ICU unit in Virginia. I have only been an RN for 6 months, but I have 25 years of healthcare experience from being a MLT, Radiology Tech-limited and a CMA. There are only 2 nurses per shift, without a CNA or a unit secretary. It used to be that if we had only one pt, then both nurses were required to work. We also are responsible to watch telemetry from the adjoining Med-Surg floor, up to 8 patients. Recently, due to the financial crisis, we were told that if there is 1 pt, then only 1 nurse is needed. This has created quite a stir as you might imagine. Granted, we don't usually get severe trauma cases or MI patients, but we can be quite busy when we have overdoses, renal failure, resp. failure, r/o MI, ETOH withdrawals, pneumonis, sepsis etc.

Has anyone else experienced this type of staffing issue? Since I am a new nurse, I don't feel quite comfortable sitting with one pt, having to admin. meds, run telemetry strips q 4 hours on everyone, answering the phone, putting in orders, giving baths, changing linens, feeding pts etc.

Also, if the census was low, one nurse would be put on call. Now, if the Med-Surg floor needs us, we have to go to the floor and take patients. If the ICU gets busy, how are we supposed to give report on out patients and try & go back to the unit to help in there?

Recently, I was in the unit with no patients. I was watching 6 pts on telemetry. The PM nurse came in and right after, a GI bleed was admitted. The #2 ICU nurse was on the floor with 8 pts! Mgmt sent up an OB nurse (no offense) to be in the ICU. She would not do anything "dirty" so she wouldn't take any germs back to OB. The ICU nurse was in the room with the pt the whole time, so who was watching the monitors? No one! Why be on telemetry if no one is going to monitor them?

Thanks for letting me vent and any words of wisdom would be greatly appreciated.

[Nightcrawler, BSN, RN]

IMO no ICU nurse should ever have more than 2 patients, so if you are full you should have 3 nurses on duty, not 2. But that is not the point of this thread.

More to the point, I know that in my state that it is illegal to ever have only one licensed nurse on a unit at one time. You might want to check the regs. What happens if one of your patients codes? Are the M/S nurses ACLS? Our unit recently had to shut down due to a Noro outbreak, and even when we were down to 2 patients they still had to staff us with 2 RN's, and that is in a stepdown unit.

If the OB nurse is floating to you for the rest of the shift, then she should get just as "dirty" as the rest of you.

Good luck to you.

[labcat01, BSN, RN]

That sounds horrible to me. Will you be held accountable if something happens to one of those tele patients you are monitoring and you miss it while you are with your actual patients?I think you will be. I'd get out of there quickly! That's just my opinion.

[otterridge]

Nightcrawler, thanks for the info. Do you have any ideas on how to find out the regulations in my state for staffing? I don't know where to look for that except for maybe the Board of Nursing. Thanks.

[Spatialized]

Nightcrawler, thanks for the info. Do you have any ideas on how to find out the regulations in my state for staffing? I don't know where to look for that except for maybe the Board of Nursing. Thanks.

I'm with Nightcrawler on this one. Even at our lowest census, our unit, a tele unit, still calls for 2 nurses, plus a tele tech who watches us and the step-down unit. As for places to look, I would check the State Board of Nursing, your hospital's policies and procedures, I even think the AACN has guidelines for this as well.

Simply put, that situation is pretty dangerous, both your patients and to yourself. How can you safely turn someone who isn't exactly small with 1 person? Not going to happen easily, and the risk for injury skyrockets. It just sin't safe.

Good luck,

Tom