staffing

ICUenthusiast · Jun 1, 2011

Only 1:3 when they're not ventilated, walkie-talkie telemetry status patients (we d/c open hearts directly, and sometimes tele floors are full and we have to hold onto a tele patient for a shift). Can be a very busy shift, but it's usually low-risk overall.

Fresh open hearts are 1:1 for 24 hrs. Sometimes, if they are in just really bad shape, they stay 1:1 for over 24 hrs. IABP are always 1:1. CRRT are always 1:1. And so forth.

ICU-RN2007 · Jun 5, 2011

I'm in CA too & a lot of the time I can't imagine having 3 ICU status patients! I give all of you that do get 3 patients a lot of credit. Our fresh hearts are 1:1 usually for the shift they come out on & that night. After that it depends on how stable/unstable they are... usually 1:2. IABP/CRRT are always 1:1 on my unit.

suanna · Jun 5, 2011

Fresh hearts are 1:1 till at least 3am. Usualy 1:1 until the morning of 1st day post op. IABP, CVVD, are always 1:1. Of course, all our VAD patients are 1:1- we don't do transplant, so a VAD patient is never a bridge to transplant but a salvage patient waiting to transfer to somewhere that does transplant. Our CCU is 1:1 or 1:2 depending on acuity. Our SICU/MICU is the same but can triple if there are floor patients without beds to transfer to. Our progressive units are at most 1:3.

whynursing · Jun 5, 2011

My manager feels a IABP can be tripled and they sometimes are.............and she has no idea what the care of an IABP entails and what could go wrong.. She is all about staffing #'s and not acuity!!!

ICU-RN2007 · Jun 6, 2011

My manager feels a IABP can be tripled and they sometimes are.............and she has no idea what the care of an IABP entails and what could go wrong.. She is all about staffing #'s and not acuity!!!

IABP tripled?? I can't even imagine! Yes, sometimes they are pretty "stable" but the thought of what can go wrong!

ckh23, BSN, RN · Jun 6, 2011

I think it depends what setting you work in.

I work in the STICU and we try to keep the ratio 1:2 as often as possible. Usually the only time we get tripled is if we have to make room for a trauma. The only patients that are mandatory 1:1 are liver tx for the first 24 hours. Our CRRT's are not 1:1.

However I used to work in a community hospital ICU/CCU and 1:3 was the normal ratio.

meandragonbrett · Jun 6, 2011

Yep. 3 patients all the time. Doesn't matter if there is IABP, CRRT, or vents. CABG, Valves, etc are "1:1" until extubated per the policy but it never happens.

matthewrn03 · Jun 7, 2011

ok to the person who said their IABP's are tripled??? ***** how can you possibly assure the integrity of the pump and maintain correct timing with 2 pumps, nevermind 3??? your manager is an idiot and clearly wants people to die. I don't care what Datascope says about their new pumps , the timing i frequently off.

littleneoRN · Jun 8, 2011

I just can't understand how true ICU care can be provided to three patients by one nurse, even without IABP, CRRT, etc. How can you manage a vent, sedation, drips, and frequent assessments, much less charting and family updates/support on three critical patients? My experience is all NICU/PICU, so the population is different. But even the adult med/surg floors I did clinicals on were 3 or 4 to 1 on days.

Biffbradford · Jun 9, 2011

I forget the exact circumstances, but I was mandated once (short staffed) in my CVICU to stay over into day shift from nights, handed 4 patients with the rationale that I would transfer one out and be _only_ left with three. :confused: :uhoh3:

RNChristy · Jun 10, 2011

When I worked in the CCU, there were times that we would have 3 patients if the other 2 were stable. I have refused a 3rd patient before and was very glad that I did because one of patients, that I was supposed to be transferring out (and was getting flack for not transferring out), actually went bad (had to take for stat CT Brain- neurochecks q15mins, replace Foley stat, send cultures, start IV Decadron stat) and ending up being almost 1:1. My other patient that I had received earlier from the ER was on a drip and unstable and they were trying to give me another ER patient. Luckily they pulled another nurse to our unit because the second ER patient was also unstable and I was not going to risk my license. Our IABPs and CVVHD were always 1:1. How can a supervisor/manager think that you can do more than one patient when you have an IABP or CVVHD? Have they never taken care of these types of patients before? That's sooo unsafe for the patients!!!