Re: 3 baby assignments

We never have three babies if we're in the unit ..... all those kids are real sick/unstable and are either 1:1 or 1:2.

In the step-down intermediate unit we always have three. Three of these kids is manageable though. They are on full feeds, no IVs, etc.

Re: 3 baby assignments

So RainDreamer, if all the kids in your unit are "real sick/unstable," and the kids on the intermediate side are on full feeds and off IVs, where are the rest of the kids? Kids who still have IVs, O2, etc, but aren't unstable? I'm curious because in our Level II we are always 3 to 1, and this can range anything from stable full NG feeds (not much work) to labile hood box oxygen, HAL and Lipids, etc. Lots of our Level II kids are still on fluids, antibiotics, labile nasal cannulas, etc., and I'm wondering if these kids are 3 to 1 other places or 2 to 1. Just curious.

Re: 3 baby assignments

Originally Posted by littleneoRN

So RainDreamer, if all the kids in your unit are "real sick/unstable," and the kids on the intermediate side are on full feeds and off IVs, where are the rest of the kids? Kids who still have IVs, O2, etc, but aren't unstable? I'm curious because in our Level II we are always 3 to 1, and this can range anything from stable full NG feeds (not much work) to labile hood box oxygen, HAL and Lipids, etc. Lots of our Level II kids are still on fluids, antibiotics, labile nasal cannulas, etc., and I'm wondering if these kids are 3 to 1 other places or 2 to 1. Just curious.

Oops, sorry about my other post, it was kinda hurried. We have an "intermediate" level nursery that's in between the unit and the step-down. Those kids are stable, but still have IVs, running fluids, can even be on HFNC, etc. Those kids are 1:2. Really any kid that is deemed "ICU status" is a 1:2.

The only kids with IVs that are in three baby assignments are those that just have a saline lock for abx.

Hope that made more sense!

Re: 3 baby assignments

It's not unusual for our stepdown nursery to be staffed 1 nurse to 4 babies. We try to keep the ones with IV's, TPN, HFNC in the NICU, but if we have had many discharges, some babies are transferred who wouldn't usually go just yet. The problem is that these babies take more time, and sometimes the charge nurse arranging the transfers forgets that. We do try to keep a nurses aide in the stepdown. That can make all the difference on a busy shift. I still think 1:4 is an unsafe assignment, but according to management, it's OK.

Our NICU is usually 1:2, but can be 1:3 if the babies are deemed to be Level 2 babies. That's the decision of the previous shift, and sometimes I wonder what the charge nurse was thinking! BTW, I'm a charge nurse.....

Re: 3 baby assignments

Thanks for the input everyone. We have had lots of 3 baby assignments lately where 1 or 2 babies will have running IV's! Yesterday a nurse had 2 babies plus got a new admission. The other 2 babies were fairly stable, but one was on a nasal cannula and unpredictable with brady's. It's just not right. The charge nurse just says "Well, the break relief nurse or charge nurse should be able to help..." Yeah, that's if they're not too bust running their a** off like everyone else! ugh!

Re: 3 baby assignments

Originally Posted by NeoNurseTX

If they're difficult to feed, then I guess they're nippling... so it sounds more like level II.

We get 3 baby assignments here and there but it's usually NC or CPAPpers. Last time I had one it was a mess...my CPAPper got intubated and a sepsis workup, one kid nippled and had an ostomy bag always coming off and had a broviac, and thank goodness the other kid was just on autopilot but I still had to nipple her.

No, out of the 2 difficult feeders, only 1 was nippling. The other was gavaged and kept throwing up!

Re: 3 baby assignments

Our Level II consistently has 3 patient assignments and sometimes has four. If you have two, you are up for admit for sure (while keeping your two patients) and can also be asked to admit if you already have three. It is totally expectable that all three or four of your kids could have HAL and lipids running, IV meds. You could easily have a labile hoodbox or one or more nasal cannulas thrown in there. I think three of these kids is very manageable most of the time...unless all your parents are there are that same time. Admitting with 2-3 other babies is....difficult....a lot of the time.

Re: 3 baby assignments

I work in a Level III NICU, and yes we will have 3 patients if they are Level II acuity. IE - grower-feeders, no respiratory support more than high-flow nasal cannula, TPN, IV abx, etc. And if you kid hits the crapper and no one is on-call, other staff helps with cares of the less acute patients. I have had crappy assignments but if they are unsafe I will complain to the charge, and we are encouraged to report unsafe/unfair assignments.

Re: 3 baby assignments

If the babies are all feeders, I have had 4 baby assignments. Once I had 5 babies, which was ridiculous, but there wasn't any staff, we all had 5 babies. Three babies is common on my unit, that is either a vented baby or a baby on CPAP with two feeders.

Re: 3 baby assignments

We very rarely get three babies per nurse. I guess I should consider myself lucky . We are mostly 1:2 or 1:1. My unit is good at staffing for admits and usually the admit nurses are only assigned one baby and we usually have on-call staff just in case.

Actually, I almost think two vents/CPAP kiddos with lines are easier than the nipplers who take forever to eat--and then need linen changes because of emesis....