Nurse/Patient Ratio

13/02/04
Can anyone give a guide or standard, if it is written, for safe nurse/patient ratios for:
1. ICU patients
2. HDU patients
3. CCU patients
NUM Level 5 (NSW) Metropolitan

13/02/04
Our practice is 1:1 for intubated, dialysed, IABP'd, and VAD patients. Our HDU patients are normally nursed at a ratio of 1:2, and at a push 1:3. From my experience with CCU, their nurse to patient ratio is 1:2 for acute patients, and 1:4 for subacute patients.
CNE Tertiary Referal Metropolitan ICU

13/02/04
Tough one really...
ICU 1:1
HDU 1:2
CCU 1:3
Cleared for ward 1:4
but in many ways I define them in reverse: look at acuity as the ratio of nurses required to manage the patients you have, or in terms of hours of nursing care, and then turn the numbers into virtual ward labels for the patients to make the data managers happy! i.e. 2 patients requiring 1:1 care = 2 ICU patients, 4 patients requiring 1:2 nursing =4 HDU patients.
Are these numbers "safe" - who knows what safe means when we know there are units around the world that manage 4 ventilated patients with one RN? The question is does it meet the standards of care of our peers (Australian ICU's of comparable acuity) and can we afford it at federal, state, AHS and institutional levels...

Director Level 5 Rural ICU

17/02/04
A position statement on intensive care nursing staffing is published in Australian Critical Care Volume 15 Number 1 Feb 2002. Also, the Williams and Clarke methodology is described in appendix G in the AHWAC report The Critical Care Nurse Workforce in Australia 2001-2011.

ICU Area Coordinator
Tertiary Referral Centre Metropolitan NSW

17/02/04

Therese Clarke and Gavin Leslie wrote a report on this issue which may be available from ACCCN??? In any case either an article or position statement (or both) based on the report was publshed in Australian Critical Care. A search on the authors might help.
Regards,
NUM Tertiary Referral ICU Metropolitan

17/02/04
ok, the can is open....some of our peers overseas nurse 4 ventilated patients yes, but, some have respiatory technicans as well. Whilst some nurses could easily look after a number of ventilated patients at once, you must consider, stability of patient, planned
activity for the patient for the shift, capacity of individual nurses as well as the overall unit load, some in charge nurses are smoother than others................... we all know a long resus can occupy 2 or 3 nurses for several hours....... so please don't forget the 1 patient that needs 2 nurses.
Planning 1:1 for ICU patients is good as a guide, flexibility must rule, yet I know how ICU nurses hatte to be deployed whilst many others never cop it (eg labour ward nurses with no labouring mums are left alone, OT, ED)

NUM ICU Level 5 Metropolitan

17/02/04
absolutely - I wasn't even limiting the discussion to our "peers" with RT's! ;-)
I agree that the 2:1 + patient cannot be ignored - we haven't even considered the number of available medical staff too - in my unit with no registrar the overload state is easier to reach than in units with a senior and junior registrar to bolster the numbers!
Re deployment - the info re OT, ED & LW staff is interesting - however we are part of a bigger picture and as long as the hospital workload is balanced fairly, and that educational requirements are not sacrificed, we do need to do our bit!

Director Level 5 Rural ICU

17/02/04
If you look at the JFICM standards, particularly document IC-1 "Minimum Standards for Intensive Care Units" an ICU should be able to provide "a minimum of 1:1 nursing for ventilated and other similarly critically ill patients, and nursing staff available to greater than 1:1 ratio for patients requiring complex management (e.g. ventricular assist device)." If you don't acheive that you shouldn't be accredited as an more than a level 1 (NSW level 4) ICU. HDU and CCU are a bit more nebulous as, for example, a septic patient on inotropes counts as HDU in some units (1:2) and ICU in others (1:1). A simple rule of thumb is that if the patient needs less than 1:2 nursing he or she should not be in an (Australasian) units.
I don't think it is reasonable to compare this in any way with, say, a major US unit where a respiratory tech does all the airway, ventilator and tube management, a cardiac tech looks after the other monitors, a renal tech runs the RRT and all the nurses do is wipe the patient's bum and do paperwork. I don't know many Australian ICU nurses who would enjoy that environment (and know a number included my wife who have hated it and resigned!)

Staff Specialist Tertiary Referral NSW Metropolitan

18/02/04

The best paper I have read regarding a proposal for staffing requirements is from Therese Clarke and Ged Williams; the other paper may be of help and they have an evidence-base!
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CINAHL Williams G. Clarke T. A consensus driven method to measure the required number of intensive care nurses in Australia. [Journal Article. Equations & Formulas. Research. Tables/Charts] Australian Critical Care. 14(3):106-15, 2001 Aug. (37 ref) AN: 2001097302 NLM Unique Identifier: 21897496.
CINAHL Clarke T. Mackinnon E. England K. Burr G. Fowler S. Fairservice L. A review of intensive care nurse staffing practices overseas: what lessons for Australia? [Journal Article. Review. Statistics. Tables/Charts] Australian Critical Care. 12(3):109-18, 1999 Sep. (122 ref) AN: 2000000792 NLM Unique Identifier: 20255746.

CNC Tertirary Referral ICU Metropolitan