What is a reasonable nurse: patient ratio in ICU?

subee, MSN, CRNA · Jul 8, 2020

On 7/1/2020 at 8:32 PM, A Hit With The Ladies said:
I'd say two patients per nurse, unless they're on something like a Rotoprone bed where one patient per nurse is appropriate.
Now, if the patient's family members are very annoying and won't let you do your work or charting, then it should be one patient to no nurse!

Don't have to worry about families visiting on a Covid unit:) Few staff want to actually be on that unit but that is one of the plusses.

TheGerb, MSN · Jul 11, 2020

Hi! I work on a COVID floor and rotate to a COVID step-down. We use a system with the primary nurse being the only person to enter a room (no EVS, no PCTs, no ancillary staff) with a team member from another furloughed area of the hospital serving as a PPE monitor/runner. We are required for all care of the patient and cleaning of the room. I really think I've been able to provide the best care with a 1 nurse:1 monitor:3 patients ratio on the floor or 1:0.5:2 on step down. I have worked at 1:0:5 on the floor and 1:0.25:4 on step down. Those ratios were very unsafe and just bare minimum care. Frequently I'm in patient rooms for over an hour with all of the bundle care with COVID patients. I can't speak to ICU ratios with COVID patients from experience. Now that we are getting more patients with COVID as their secondary dx, their sx are just really too complex to have inappropriate staffing.

IRN2011, ASN, BSN · Jul 12, 2020

Currently at my hospital we have a typical 1:2 with the occasional 1:3 ratios for ICU's. If a patient is a fresh hypothermia, is rotoproned, CRRT, or IABP/impella than they are 1:1 unless we are severely short, but they would go out of their way to tripple all the other assignments first before giving a second patient to that assignment.

Covid-19 units on the other hand are kind of the wild west (at least at my hospital). In florida, things are starting to up-tick a bit again... they converted three units to covid-19 stepdown/ICU's.. they are the only units that mix stepdown and ICU acuity.. mostly because what we find is when a covid patient is crashing, we don't have time to move them to a new unit. Stepdown nurses still treat the stepdown patients and the ICU nurses treat the ICU patients, the only difficult part is that unlike traditional ICU rooms in where there's only 1 patient in each room, they are doubled.. you can have two step-down patients in the same room.. one ICU and one step-down, or even two ICU patients in the same room (I feel for the patients.. I'd hate to be the step-down patient on high-flow or bi-pap and sitting next to a fully intubated and proned patient in the same room). in COVID-land, our nurses used to be 1:2 max for ICU and 1:4 for stepdown... however as we continue to get more patients and open up more rooms... we are now 1:3 for ICU and 1:6 for stepdown covid.

Kitiger, RN · Jul 12, 2020

When a hospital expands their COVID rooms, or opens up another COVID unit, do they then expect the existing nurses to cover that unit, too?

TheGerb, MSN · Jul 12, 2020

4 minutes ago, Kitiger said:
When a hospital expands their COVID rooms, or opens up another COVID unit, do they then expect the existing nurses to cover that unit, too?

At ours, when your unit transitioned to COVID, you transitioned, too. We had a number of staff who bumped their retirements up a few months when this happened and a few who medically were cleared to transfer to other floors or be furloughed, but for the most part, all of my coworkers just transitioned to COVID RNs.

NurseSpeedy, ADN, LPN, RN · Jul 12, 2020

On 7/1/2020 at 8:34 PM, NurseBlaq said:
Reasonable for ICU in general, I've always been told 1-2 max based on acuity. Maybe 3, but ONLY if 2 of the 3 are stable and possible transfers to lower acuity unit and it's a short night. As for covid, I'm interested too. I never took care of covid patients.

My uncle was a COVID19 patient. Floor, not ICU, for one week. First and only COVID19 patient in the hospital at the time. The night before he went to the hospital he felt like he wanted to die-the next day he entered the hospital-got a positive test that he was still waiting for with from the week prior I. An outpatient testing center-and was admitted with COVID19, pneumonia, and a few other unpleasant add ons. He spiked a 105 F. Fever that evening-was given meds to lower and the controversial hydrochloroquine regimen. He was release a week later. Took several more weeks to be tested negative and is still monitoring the aftermath of COVID19 long term. With this disease-who knows what ratio is safe? They can tank quick-floor to ICU-or can have it in the community and never even know it-complications should be considered.

the ICU was typically 1:2 ratio, when understaffed 1:3- step down 1:3/4. The floor-not going to lie-a total crap shoot1:6/7/8/10-whatever you got what you got-glad I’m no longer there’d to experience it-get agency requests multiple times daily. I have a different nursing job #1....#2 are you nuts??? How about paying the nursing staff there what they are worth first? Then you don’t need to bribe and agency nurse with incentives-I’m high risk anyway so I would have to decline anyway but still-staff nurses do not get paid enough for the crap they are dealt and then the agency nurse is paid more along with the agency fee-does not make sense.

TheGerb, MSN · Jul 12, 2020

8 hours ago, NurseSpeedy said:
They can tank quick-floor to ICU-or can have it in the community and never even know it-complications should be considered.

How about paying the nursing staff there what they are worth first? Then you don’t need to bribe and agency nurse with incentives-

Agree. Patients tank so quickly and wobble back and forth. We use ecarts as an early warning monitoring system where I'm at, and the majority of my patients the past few months have had higher ecarts than we normally will keep on the floor.

Re: pay, not all hospitals did this, but we received $22.50/hr hazard pay for a while on top of base and differentials. We ultimately reduced this because our system has lost $3mil in revenue due to COVID and just doesn't have the funds to continue paying staff nurses at that level. We do still receive a smaller COVID bonus pay.

KR · Jul 12, 2020

4 hours ago, TheGerb said:
Agree. Patients tank so quickly and wobble back and forth. We use ecarts as an early warning monitoring system where I'm at, and the majority of my patients the past few months have had higher ecarts than we normally will keep on the floor.
Re: pay, not all hospitals did this, but we received $22.50/hr hazard pay for a while on top of base and differentials. We ultimately reduced this because our system has lost $3mil in revenue due to COVID and just doesn't have the funds to continue paying staff nurses at that level. We do still receive a smaller COVID bonus pay.

That is awesome that they were able to do that for a little while at least. What is ecarts?

NurseSpeedy, ADN, LPN, RN · Jul 12, 2020

9 hours ago, TheGerb said:
Agree. Patients tank so quickly and wobble back and forth. We use ecarts as an early warning monitoring system where I'm at, and the majority of my patients the past few months have had higher ecarts than we normally will keep on the floor.
Re: pay, not all hospitals did this, but we received $22.50/hr hazard pay for a while on top of base and differentials. We ultimately reduced this because our system has lost $3mil in revenue due to COVID and just doesn't have the funds to continue paying staff nurses at that level. We do still receive a smaller COVID bonus pay.

Hospitals where I am are screaming for agency nurses to meet their staffing needs (I get the emails all the time), yet their staff nurse base pay was $17/hr less than the agencies prior to COVID19. It’s a slap I. The face to see an agency nurse hired for a contact at a higher rate and they are paying the agency on top of that higher rate. It just leaves staff nurses with a nasty taste in their mouth when they are working short and being put at risk and told that they cannot afford to pay them more-but when they absolutely cannot find staff nurses for the shift they have to resort to paying whatever they have to in order to get an agency nurse to come into what they know is complete chaos.

I cannot risk working in acute care due to pre-existing lung and autoimmune disorders-it doesn’t stop the agencies from calling, texting, and email bombing me though...

Kitiger, RN · Jul 12, 2020

9 minutes ago, NurseSpeedy said:
It’s a slap In the face to see an agency nurse hired for a contact at a higher rate and they are paying the agency on top of that higher rate.

Do the agency nurses confirm that they are making more?

Back when I worked in the hospital as an agency nurse, the hospital nurses thought I was making more than them, when in fact, I was making less than them and my agency was taking almost half what the hospital had to pay for me.

That was back in the olden days.

KR · Jul 13, 2020

Last time I worked agency (local) I was making about $6-$7/hour more but what staff doesnt realize is THEY could CHOSE to be agency too. Plus I got u benefits and the average benefit package is worth I believe an estimated $6-$8k. Not to mention the hospital doesn't spend weeks or months orienting us, nor do they pay for my ACLS, BLS, PALS, CEU, etc and most importantly we are there TO HELP..... The rates for ICU & LTAC agency went up $10/hour the year after I got injured, because staffing is critically short. 20 years as a RN, back as a new grad, if a hospital offered u a signing bonus u ran, because u knew it was a nightmare. Now big hospitals systems r offering $5,000 to new grads to 2 years and $10,000 to over 2 years experience. My city has 2 450ish bed hospitals (one a level 2 Trauma), and a 3rd that is horrid, maybe 150 beds. We have 4 NURSING PROGRAMS graduating new nurses twice a year. If they would treat core staff appropriately (higher pay, listen to their concerns, safer ratios, etc), they wouldnt need to bribe nurses to come work. Pennsylvania is supposed to be one of the lowest paying states in the country, travel recruiters love to remind me of this, but at least the area I am in the cost of living is relatively low compared to most of the country.

I have been staff, local agency, & travel agency. I just wish NURSES in general would team up and work together and LIFT EACH OTHER UP, the profession is harder enough as it is. I will say in 9 years of agency I only had issues with the Daytime LTAC Supervisors dumping on agency, but they did that to their one per diem too. I just went in with a positive attitude & genuinely made a difference. Money always came up and I tried to point out to staff the above mentioned items, but most did not want to hear it.

Just my two cents.

NurseSpeedy, ADN, LPN, RN · Jul 13, 2020

46 minutes ago, Kitiger said:
Do the agency nurses confirm that they are making more?
Back when I worked in the hospital as an agency nurse, the hospital nurses thought I was making more than them, when in fact, I was making less than them and my agency was taking almost half what the hospital had to pay for me.
That was back in the olden days.

I did agency work up until 2 years ago and I was also staff for a year before I went PRN (no pool at that hospital). My fellow coworkers started at $22/hr. I was an LPN first so when I got my RN I started at the max for matching experience which left me at $27/hr. Went PRN a year later and lost the benefits for $29.25/hr. Went agency (owned by the company that own the hospital) and made $39/hr as base. My state is known for crap pay and the floor I worked on had more agency than staff.