Staffing Ratios getting thinner - "its the economy stupid!"

[Redneckmedic63]

So I know this is re-hashing old discussions - but what trends do you guys see in PICU staffing right now? What nurse/patient staffing ratios is your unit using, and what are some of the criteria used to match patient/staff/ratios? What constitutes 1:1 vs 2:1 vs 3:1 or even 4:1 in your PICU? Needless to say, I think MOST hospitals are stretching their staffing as thin as possible. Have you seen problems or events in YOUR PICU regarding staffing? I have meetings pending on this subject - would be VERY interested in hearing your feedback! Thanks, as always!!!!

[NotReady4PrimeTime, RN]

Our unit still attempts to staff 1:1 as much as possible. We have a very high acuity (cardiac surgery, neurosurgery, solid organ transplants, ECLS/ECPR, critical airways, trauma, burns) on our unit most times and as a result, the patients are too sick and too busy to be doubled. Our ECLS patients are 1:2 as are some of our sicker cardiac surgical and transplant patients, at least initially. Our overtime costs are staggering because we don't have enough nurses in our staffing pool to provide this level of care without the use of overtime.

When patients are doubled, the criteria are not always clearly delineated. They're usually (but not always) extubated; they may be on vasoactive meds and have multiple invasive lines; they may be experiencing withdrawal from their narcotics and benzos; they may be complex transplant patients that require close obs (and a gazillion meds) but who don't fit the criteria for transfer out of the PICU (transplant patients are 1:1 for 24 hours on the inpatient units but can be doubled for days on our unit). Or they may be on high-flow nasal cannula O2 and don't meet transfer criteria. Or they may be trached and vented and all the trach/vent ward beds are full. A lot of times the nurse is far busier with two stable patients than if s/he had the sickest patient on the unit.

So far we haven't had to resort to 3:1 except for breaks.

[littleneoRN]

4 to 1? I hope this is just a laugh and not the truth in any PICU unless they are kids waiting for beds on the floor. Even our peds med-surg floors are 3:1--or 2:1 or 1:1 if they have a trach/vent in their assignment. Our step-down from the PICU is 2:1 or 1:1 and the PICU only occasionally pairs kids. They do have a very high acuity level, so I think this is warranted.

[Redneckmedic63]

4 to 1? I hope this is just a laugh and not the truth in any PICU unless they are kids waiting for beds on the floor. Even our peds med-surg floors are 3:1--or 2:1 or 1:1 if they have a trach/vent in their assignment. Our step-down from the PICU is 2:1 or 1:1 and the PICU only occasionally pairs kids. They do have a very high acuity level, so I think this is warranted.

I should clarify that anytime we have done 4:1 it has involved floor kids/Peds overflows that had no beds. But 3:1 is not that unusual, and can often incude vented patients...