Twelve babies on my Level II Unit...what do you think about this?

  1. Hello, all!

    I am a seven-month old nurse, for those who don't know me. I float between a Level II transitional nursery and a Level III Neo-ICU.
    The other night, I showed up at work for a twelve hour night shift and immediately began receiving pitiful looks from the staff. After two hours, I still couldn't figure out why. Finally, one of the nurses who was to leave at eleven said, 'I hope you brought your lunch tonight...' and rolled her eyes. I said, 'What is going on here? I have been getting looks from you guys since I walked in the door.' She said, 'Oh, nobody told you?' I was like, um, NOOOOOOOOO, could you be so kind as to enlighten me? Well, when she told me that I was the ONLY NURSE AVAILABLE TO STAFF MY LEVEL II THAT NIGHT and that they couldn't find any help for me, I almost started crying.
    Apparantly, because of the fourth of July holiday, some genius in management (I will decline to say exactly who) gave a few too many people off. PLUS three nurses who had been scheduled to work, including two for my unit, had called in sick at the last minute. (I KNOW that at least two of them called in because they went on vacation without telling anyone, as they have a tendency to do frequently and without warning.) Not to MENTION that nobody was available to be pulled from other units, which were also suddenly short-staffed for various reasons, including but not limited to those above.
    After another hour of fretting and calling the staffing office multiple times, it was finally decided that our section manager would come in to work. She had worked that morning and had gone home at three. It was now ten o'clock. We have no CNA's; two of them quit a few months ago and one of them is pregnant and works day shift only. Just as I began to breathe a TAD bit easier, because I know that six babies is horrible on our nursery (I had six about two months ago and I was just running ragged and praying that the babies don't get sicker than they are- it's really a quality and safety issue. With total care patients, as babies are, how can you give them what they need with only ten minutes per baby averaged over the evening?? Anyway, I figured with our manager working with me, I would get through it because she is organized and experienced...) it was then determined that she would have to go help staff our Level III across the hall, who had a one-to-one baby and was expecting a new admit from L&D any minute. Obviously, Level III was priority, because those babies were sicker and more critical, and I am not upset that THEY were adequately staffed. If it has to be one or the other, it's Level III all the way with me. However, I was...well...upset...to put it kindly, that I was ONCE AGAIN the only nurse available for the twelve babies on our unit.
    I am a new nurse, and have only been out of orientation for four months, but despite my natural lack of knowledge this seemed WRONGWRONGWRONG to me, though I cannot cite a specific rule or law to back myself up. At eleven on the dot, it was decided that a nurse from Peds would be pulled and a pool nurse would come in- one would come to us, with 12, and the other would go to Level I, who had 27 babies and two nurses.
    The nurse who came to my unit was a girl who graduated with me in December. We had both been hired in the NICU and began orientation, when, after four weeks of maternal/child and NICU dayshift orientation, during which we had about two-three babies each so that we could acclimate to the unit, she failed her NCLEX. She was already an LPN with adult M/S experience, and she was moved to Peds until she could successfully pass her boards. This was about six months ago. She had not set foot on my unit for six months, and also had gotten used to Peds, whose unit is run completely differently than my own, right down to the flowsheets. I was assigned the charge nurse duties, and between the two of us, we were supposed to get through the night.
    Well. Whatever hope I had of making it unscathed was shot to hell as I quickly realized that she remembered NOTHING about NICU or babies and had not a shred of knowledge that could help me in any way. It is not a personal thing- the girl is very sweet and I used to eat lunch with her all the time when we were orienting together. However, she needs a terrific amount of reassurance ALL THE TIME, and when I wasn't doing her work for her because she didn't know something or was panicking or couldn't remember what this or that meant, I was patting her ego and telling her how good she was doing considering the circumstances and that she should just stop worrying and do what she could. Priorities. Make sure they're breathing. Feed and change them. Medicate them. All the rest takes a back seat.
    Despite my attempts to help calm her and direct her care, she insisted on doing chart checks from eleven to four in the morning.

    FIVE HOURS TO CHART CHECK SIX BABIES.

    Um, I'm feeling hysterical here, so will someone please tell me how this is possible????????????????????????

    (this is the sound of me screaming at the top of my frustrated lungs, much like the babies who screamed the night away, creating a cacophonous and in retrospect somewhat amusing soundtrack for the evening, until seven a.m. on the dot when they finally went to sleep...day shift came in and could only comment on how cute and precious they all looked, while I considered jumping from the window to a messy death on the sidewalk...but I digress.)

    The entire night I did not sit down once. I did not leave the unit. No break. No lunch. Nothing to drink, although I did once cup my hand under the faucet and drink what little water I could hold while running past the sink. No bathroom. I was a wreck inside, and amazingly, managed to hold it together and bust ass so that by six thirty a.m. my care was completed on my six babies, and I had a half hour in which I could devote myself completely to helping her finish all that she couldn't do, which included charting (she had only charted one set of vitals for a new admit in all eight hours at that point), starting an IV on a baby who needed stat medication and fluids, reviewing her flowsheets looking for meds that hadn't been given, and drawing labs (She couldn't do a heelstick for a CBC!) on five of her babies. One nurse came from Lev.III to enter orders into the computer for us at six forty-five, and another came to draw a CMP/Bili Panel/CBC etc. on another one of her babies, and one of the babies had no labs drawn at all, which brought on yet another pleasant conversation with a bunch of green-footed third year med students who couldn't understand why we 'f*cking nurses' hadn't been able to draw blood on their baby who was a near-term feeder-grower. Someone hand me a gun. I could go on for hours. I'm sorry, it seems that I have. Forgive me. I finally left at seven-forty and discovered that my car's front windshield had been smashed to bits outside the hospital because I was parked in the path of vandals (and only because the hospital had no parking availablity, due to the fact that employees who quit or DIED thirty years ago were not removed from the parking list, and thus their empty spaces sit forever unused on the slim chance that they will raise their worm-riddled corpses from the ground and drive to work just for the hell of it). Two-hundred and fifty bucks out of my tight wallet was the only thing I got after all of that. No, I must correct myself. To their credit, I got a call at eleven yesterday morning, disrupting my much-needed sleep after four days straight of working in hell, during which my section manager offered me overtime if I came in to work. OH. MY. GOD. I'm becoming a firefighter. It has been decided. Anyone want my new stethoscope? I just bought it but suddenly, looking at it makes me want to vomit. Thanks for listening.

    I can't even spell my own name. Look what they've done to me.

    Oh, not to mention that when I came home, my husband yelled at me and told me 'F*** you' about ten times when I refused to do anything but go to bed and sleep. I have a migraine.
    Last edit by NICU_Nurse on Aug 28, '03
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  2. 32 Comments

  3. by   SmilingBluEyes
    ((((kristi)))) OMG WHAT A TRAVESTY and what an AWFUL NIGHT...you poor, poor dear. I am so sorry. When the migraine is over, march on over to your nurse manager's office and have a LONG TALK.....also, fill out an occurence/incident report **YESTERDAY** very clearly outlining the insufficient staffing situation you were in. I shudder to think of what you were doing that night and what ever worse things could have happened....NO EXCUSE WHATSOEVER! Do it the report ASAP! Resolve NEVER EVER to let this happen to YOU AGAIN right NOW!

    Take care of yourself and do something REALLY GOOD for yourself...like a LONG hot bath and some nice scented candles or a shopping spree at your fave dept. store, honey you EARNED it!
  4. by   NannaNurse
    :kiss Kristi...that is for you honey....sorry to hear of your 'living nightmare' at work. If it were me...I would have called everybody and anybody...not just 'staffing'.
    (and they wonder why less and less ppl are coming into the 'wonderful world of nursing')
    If I were the parent of one of those precious babies and knew that only 2 nurses were there....one of whom shouldn't have been there.....I would have been throwing a ring-tailed fit and calling state and my attorney!
    How dare the hospital to put you in jeopardy, not to mention themselves!!!!!!
    Since you were the charge nurse, you should have ordered the other nurse some assignments and not to sit all night charting. I would definately write up a report of that....uncalled for!
    Hope it goes better for you and you let them know that you WILL NOT TOLERATE THAT KIND OF TREATMENT AGAIN.....they are risking the lives of those babies and a damn good nurse!
    :angryfire :angryfire :angryfire
  5. by   joyrochelle
    ABSOLUTELY my sentiments as well.


    You *are* a goddess....please do what you can to ensure that that doesn't happen again...if at all possible. I know the NICU that I work contingent on is very short staffed and screwy as well, although we never have that many babies....it's obviously a smaller unit. But man, that was a night to define strength wasn't it???


    what the heck was up with your pi$$y pant'sed husband? grrr.

    men make me angry at times ya know?? they can be so selfish....



    {{{{{{{{{{kristi}}}}}}}}}}


    much admiration---joy
  6. by   NRSKarenRN
    {{{{{{{{Kristi}}}}}}}}}}

    Baptism by fire shouldn't be happening in the 21st Century.
    While the fire is still in you, copy the above post, edit for sucint details and turn in to Nurse Manager.

    Per Smiling Blue Eyes Quote:
    "fill out an occurence/incident report **YESTERDAY** very clearly outlining the insufficient staffing situation you were in. I shudder to think of what you were doing that night and what ever worse things could have happened....NO EXCUSE WHATSOEVER! Do it the report ASAP! Resolve NEVER EVER to let this happen to YOU AGAIN right NOW! "

    Know that you have the right to refuse an unsafe assignment BEFORE getting report , can leave with license intact, but may not have a job to return to.

    Search your soul---is this just a fluke or is staffing crisis the norm?? Someone needs to be held accountable and it shouldn't be you! Years ago ,we had med students who acted as CNA techs to assist us on nights as part of their learning....something to consider, let them walk a mile in your shoes. Consider if this is a safe facility to work in.

    Wishing smoother sailing, er nursing, ahead.
  7. by   ERNurse752
    (((((Kristi)))))
    OMG!!!! That is insane...it would be horrible for a nurse with years of experience, much less a relatively new nurse like yourself! What if one the babies started going bad, and you were the most eperienced person there? No matter how good you are, that would be BAD!
    I agree with those above that you should write an incident report, and have a nice chat with the manager, or someone higher up if you get nowhere with the manager. That can't keep happening. It's not good for the babies, and it's not good for you.
    Maybe your husband should come follow you at work one night so he can see what you go through...grrrr...
    Did you tell the residents about the night of hell you'd just gone through? I would've told 'em in no uncertain terms exactly what had happened, and that they could f*** off!
    One of my friends from nsg school works in a Level III NICU. Their max # of babies is supposed to be 30. Lately, and a few times in the past, they've been taking ***60*** She's interviewing for a job in a new Immediate Care Center as a result...
    Stories like this make me gag on those nurse commercials...
  8. by   nell
    Oh Kristi! What you describe is OUTRAGEOUS! I have quit jobs for much less than the nightmare that you describe (had quite a few jobs until current not-perfect-but-as-close-as-they-come one).

    That you got through the shift without anything bad happening to a baby is miraculous and a testament to your excellent nursing and organizational skills. Also, no one from the evening shift was willing to stay even part of a shift?!!!

    My blood was boiling as I read your post.

    Your hubby doesn't have a clue, either. He is definitely not matured into a fine wine - I think he's turning into vinegar.

    I was hoping that your location "LA" was Los Angeles, in which you would have some recourse as here in CA we have legally mandated (Title 22) staffing ratios for ICU (1:2), OR (1:1), NICU 1:2), intermediate nursery (1:4) and well-baby nursery (1:8) Those are licensed nurses - not techs or aides. Maybe there are some kind of staffing standards in Louisiana? I did a quick search and found some for nursing homes and school nurses, but not hospital nurses.

    Do you get premium holiday pay? We get double-time, and that pretty much takes care of holiday staffing problems (except on Easter which even Catholic hospitals refuse to make a holiday).

    Do you have a union? That's where we get our "assignment despite objection" forms that at least give us some protection if something happens to a patient because of inadequate staffing. I read somewhere on this forum that some facilities have staffing ratios built into their contracts.

    Too many people who don't do NICU don't understand that it is not just a job of tasks such as feeding and diapering babies, but that the LARGER part, and the part that requires the nursing skills (and time) is the observation, assessment and mentally collating that information. Prmenrs is SOOOO right with her signature: "Never trust a 35 weeker."

    Kristi: you'll be in my thoughts all day today as I'm printing out your post and taking it to work today. You should feel a wave of love and support from the west at about 6:00pm.
  9. by   tonicareer
    hey i'm just in prereg now but i know this is illegal my first degree is in education and i know daycare centers don't allow these kind of ratios for healthy babies so it is really bad. if there is a lawsuit you would be the one in jail or lose job/license they will act all innocent like they are unaware. you must document in writing and tape record conversations cause they will lie, lie , lie. i hope you write back and tell us the follow up. I would definitely look elsewhere for employment they are destroying your health, marriage and career.
  10. by   caroladybelle
    Kin you direct me to your husband's direction - so ah kin take ma southern Daddy's brickbat to his obnoxious self?

    Maybe an anonymous tip to the local authorities should be made in regards to the facility.
  11. by   NicuGal
    I hate to use the mandate word, but in this instance it would have been justified. You had an unsafe situation and those girls on the previous shift should be ashamed to leave you like that. Especially the previous charge nurse. Was all of your management called? They should have been. Our supervisors have been known to call management and tell them that they need to come in, and if they refuse, then it is documented.

    In our level 3 we will take up to 4 kids each if we have to. Couldn't the other unit have picked up kids? You are lucky you are allowed to have LPN's ...in our hospital if we aren't allowed, and if they were floated to us, we would have to do all their meds, assessments and charting!

    Hopefully this won't happen again to you. Make sure you write it up and keep a copy for yourself. Send one to your manager, the DON and the nursing VP. Cover your butt.

    Hugs! Oh yeah, and I would have told those residents to draw their own blood...in my hospital we actually don't have to if we really want to be pissy about it!
    Last edit by NicuGal on Jul 6, '02
  12. by   BadBird
    Hats off to you. I would definately fill out an incident report. I might let it slip how interesting it would be to send a copy to the news.
  13. by   dstout-rn
    I feel for you Kristi as a NICU nurse those Level II's can be more work than the Level III's any day. Definaltely do an insident report, and next time refuse, refuse, refuse!!!!!!!!!
  14. by   ktwlpn
    I finally left at seven-forty and discovered that my car's front windshield had been smashed to bits outside the hospital because I was parked in the path of vandals (and only because the hospital had no parking availablity, due to the fact that employees who quit or DIED thirty years ago were not removed from the parking list, and thus their empty spaces sit forever unused on the slim chance that they will raise their worm-riddled corpses from the ground and drive to work just for the hell of it). Two-hundred and fifty bucks out of my tight wallet was the only thing I got after all of that. No, I must correct myself. To their credit, I got a call at eleven yesterday morning, disrupting my much-needed sleep after four days straight of working in hell, during which my section manager offered me overtime if I came in to work. OH. MY. GOD. I'm becoming a firefighter. It has been decided. Anyone want my new stethoscope? I just bought it but suddenly, looking at it makes me want to vomit. Thanks for listening.

    Krsiti (there. I can't even spell my own name. Look what they've done to me.)>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> LOL! I see your sense of humor remains intact....Worm riddled corpses rising from the ground would sure solve the nursing shortage....ROFL!!!

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