Acuity

Patients in the ICU are inherently sicker than the general hospital patient population. Nursing allocation is mainly determined by the acuity of the patients. This is essential for you to understand as a new nurse. Whether you are working on "the floor" where patient acuity is low and there is one nurse to five patients or you are in the ICU where the ratio is 1:1 your patients care will be determined by how many patients you have to care for.

When I was a new nurse I worked in a long term care facility. It is an unfortunate lie that these patients are low acuity patients awaiting discharge to home after their rehabilitation. Almost every night I would take care of 25-30 patients with one to two aides. More than half my patients were very high acuity needing tracheostomy care, suctioning, g-tube medications, IV medications, blood sugar checks with insulin shots, TPN administration, and on, and on, and on. My nights left me constantly petrified I would miss one of my patients medications.

No federal laws are in place to protect patients from staffing shortages. In some states, laws state that long term care facilities must have at least one registered nurse in the building to administer  higher level care that LPN's are not legally capable of doing. Examples of this are administering IV medications or starting an IV.

It is likely that wherever you begin your nursing career you will experience a severe nursing shortage that will have you taking care of too many patients that desperately need a 1:1 ratio. Be cognisent of the issue at hand and know that this is not your immediate supervisors fault but rather a breakdown of the system.

In any case patient acuity is a large part of your life now.