staffing

Luckily the cc units I float between are fairly flexible about 1:1 assignments. Fresh hearts are always 1:1 for the first 6 hours, CRRT, IABP are also 1:1. Sometimes a patient is just very critical and can be 1:1 if staff deem it needed.

I did work a travel assignment where all vented patients were 1:1.

This is a grey area. We are always arguing about it amongst ourselves. We have a decision tree thingy but it is so old it is pretty much obsolete. I wish we would make a new one.

Our 1:1s are -

OHS for the first 6-8 hours, or longer if bleeding/hemodynamically unstable

Sepsis protocol patients until stabilized

Any patient that is hemodynamically unstable on multiple vasoactive gtts

LVAD/RVADs

Any patient actively hemorrhaging

We argue about IABPs. We used to 1:1 them no matter what, now we don't unless they are unstable as we don't have to time the balloons ourselves anymore, etc.

That's about it. Pretty much, you have to be just about dead or a fresh post-op open heart to be a 1:1 where I work.

Not to derail the topic, but I'll never forget as a fresh aide listening to an ambulance report on the radio with an old ER tech. He said "Let's get the room ready." The first thing he put on the table was an unzipped body bag. "Saves time," he said. Sure enough, it saved time. I now return you to your regularly scheduled programming...

CRRT, oscillators, severely septic patients for first 6 hours (if you argue enough),

fresh hearts, IABP.

where I work ( a resident/ltc type setting) we do one to ones if someone is dying, ( no one shall die alone) even if family is there, to just add those special cares, and TLC- and if a resident is confused or wondering ect.. and needs the extra care. I take it you may be talking critical care though??

I meant WANDERING not wondering Jeech!

Patients being stabilized for organ harvesting in addition to others above

where I work ( a resident/ltc type setting) we do one to ones if someone is dying, ( no one shall die alone) even if family is there, to just add those special cares, and TLC- and if a resident is confused or wondering ect.. and needs the extra care. I take it you may be talking critical care though??

question for LTC 1:1s --

does your facility allow adequate staffing that these 1:1s are in addition to normal staffing levels, or does everyone else just get pulled and make up for the extra workload?

When I worked LTC, we occasionally needed 1:1 on a patient, but did not have any official policy for it, and never had additional staffing to cover it. Usually just lasted a couple hours until the patient stabilized or was sent out to hospital.

There is no fixed criteria where I work.

There are usually 10 nurses for 16 patients. Whoever is sickest is left single, the others are paired. Then the charge nurses assign the patients to the nurses. This system works the vast majority of the time.

I work high risk OB, 1:1 nursing care(hopefully!) Pt on MGSO4, Delivering Pt., PACU Pt., Pt getting an epidural and any critically ill pt requiring continuous fetal monitoring

In LTC where I work:

Only time that is 1:1 is if someone is physically combative with staff. And if they are combative with staff we have to get permission from the DON for the 1:1. If she says no then you deal with it. Usually if it happens during the shift ppl get pulled from somewhere in house to do the 1:1.

Usually our dying residents don't get 1:1, I'm in the room quite often checking on them, helping perform comfort cares with the aides and/or give ativan/morphine to keep them comfortable. Most of them have family in room 24/7 until death happens.

a doctor's order. and it can be on a patient that is fairly heavy, or never be written on a patient 10x as heavy as the rest. my unit is inconsistant and lacking common sense. they put patients in jeopardy without batting an eye-one or two nurses running their tails off while another 1 or two sit at the desk reading 3" thick novels--NOT kidding you. we will have patients that definately need to be 1:1s, and they will ''try to pair it up with something 'easy' (in critical care) so you don't get an ER or code'' yeah, well that's the whole point of a 1:1 isn't it, so you can care for the patient and NOT get an ER or code, OR NEGLECT the OTHER PATIENT. the majority of staff never question anything, just continue trunk to tail--those that DO question and try to make progress? *******.