Sunday, October 02, 2011

between a rock and a hard place

OK I have newfound respect for ICU nurses after watching them for the past 9 days. One thing I have observed is about staffing. When you have a vented patient, and another patient, it must be hard to keep up. That seems to be the staffing I've seen - two patients. The thing is when something goes wrong with one of your patients you are screwed.

So I'm sitting there with my relative who is on the vent but stable. Her nurse gets another patient post op I guess, since we are in SICU. The patient arrives and within a half an hour I hear: "anesthesia stat to room ---". Its the person next door. He had to be intubated so everybody is scrambling around.

So now my relative's nurse has 2 vented patients, one of whom is unstable. Now you might think, the other nurses will pick up the slack, and they do, but they still have their own patients. So a burden is put on them. There is no "extra nurse" to pick up one of her patients. They staffed for what was there at the beginning of the shift. So her nurse struggles to keep up until they move my relative down the hall and she gets a new nurse. Thus is the juggling that goes on in the ICU.

That's part of why we can't get people upstairs, the tight staffing. Hospitals never staff extra for emergencies. They staff for what they have. Its understandable because they don't want to pay a nurse to do nothing, but this is all part of the delay in getting beds.

Another delay is waiting for doctors. They extubated my relative today. It took til 1 pm for the staff doc to come and say it was OK. Nurses are always waiting for docs to come to transfer patients, discharge patients, do procedures on patients. Its all so inefficient.

These factors play into people in ER, PACU and admitting waiting for a bed. I don't know what the solution is. They aren't going to have any extra nurses. Doctors probably won't get more efficient. So you are left with an inefficient health care system with no real solution.

On the positive side my relative is extubated and her and the baby both are looking good. Its been a long week...


rnraquel said...

I am so glad your relative is off the vent. And a new baby too? Wow.
I'm sure she needs and definitely will appreciate your support.

Nurse K said...

Her and *the baby*? Jesus.

medic.dan said...

I always thought there was standard staffing (at least there is at the hospitals I frequent)... depending on the hospital or acuity of unit, of 1.5 patients per nurse, and staffing according to the number of beds, not patients at the beginning of the shift... Is that not true everywhere?

CathRN said...

Medic Dan- in 15+ yrs of critical care experience of some sort, including 10 in various ICUs in several states, I have never once seen staffing based on beds. It's ALWAYS based on # of patients, and the acuity of those patients and the possibility of admits is very rarely a factor. Fresh open hearts used to be 1:1- no more. Very organized hospitals allow an empty "code bed" to be staffed as a cushion- very rare. Lately the push has been to give ICU RNs 3 patients, step-down RNs 4, and floor nurses 5. (that's jcaho staffing- reality is higher.). My hospital requires the ICU to be able to give up an RN to transport a pt who gets an IABP and is being sent for emergent CABG- in 3 years they haven't been able to do it once, which means the lab RN has to go and the hospital has no cath lab team for a couple hours. But the suits refuse to allow us to go on STEMI divert. We've gotten lucky so far... Madness, glad mom n babe are doing well. 9 days tubed post partum? Jesus. We know ER sucks, it's nice to see some ER understanding of the ICU variant of suckitude. Lazy folks are in all units, but things aren't always what they seem. Best wishes to your family.

rnraquel said...

Where I am, both in the PACU and the med-surg ICU, they have a nasty habit of sending staff home if census gets lower. Inevitably things get busy. In PACU there would be a bunch of add on surgeries. In the ICU there are codes on the floors, ER admits, etc. And the staff needed for these patients has gone home already. It is a challenge.

medic.dan said...

I stand corrected. I stopped by a local CICU last night and was amazed by the staffing. Very sad, but absolutely a testement to the strength and capacities of ICU nurses.