by Kimbalou

In Ca. the ratio in a level 3 NICU is 1:2. Some Level 3 NICU's do not follow this and give us 3 babies because they say they are level 2 babies.
What does your unit do? Do you have 3 baby assignments in a level 3 NICU?
Some of these assignments are ok, but I've had some that are really not very safe because there is way too much to do.

How do you feel about this?

Re: 3 baby assignments

We can have three baby assignments if they are truly Level II and ready for transfer out. But that doesn't happen very often because we try to mix kids by acuity. So it would be unusual to have three true level II kids in the same room. We have our own large Level II, so true Level II kids don't stick around our unit very long. We're much more likely to pair a Level II with a Level III.

Re: 3 baby assignments

Only 1 out of the 3 babies I had recently was ready to go home...the other 2 were far from leaving...one still had a broviac with TPN and lipids. 2 out of the 3 were difficult to feed. They were not all truly level 2, that's for sure!

Re: 3 baby assignments

Needless to say I complained and the assignment was supposed to be broken up.

Re: 3 baby assignments

Consider yourself blessed if you only have a two patient assignment most of the time. I work in a 48 bed, Level III unit in the southwest US. We staff by a number matrix, rather than by acuity. We routinely have three babies; which can be 3 level 2's, 2 vents and a CPAP, a level 2 baby, a vent, and the admit, which is always fun. Our charge and transport nurse are not counted in staffing so at least one and sometimes 2 of them are available to assist, but they are helping all of us as needed with our rows of 3 patients. Day shift is staffed a little better and they will half the time have only 2 Level III babies, because "it is busier on days". We will soon move from an open bed unit to all private rooms and have been told that our assignments will stay the same. Needless to say, the staff has concerns.

Re: 3 baby assignments

Wow, that sounds really bad....unsafe too.

Re: 3 baby assignments

I have occasionally had 3 baby assignments in Level III, but that's usually due to a baby in another nurses's assignment getting very sick so it's changed to a 1:1 midshift, or already having 2 babies and getting a new admission. Routinely having 3 (truly level III) babies seems unsafe and unfair to the babies and their parents.

Re: 3 baby assignments

IYQYGR, I think we work at the same hospital in AZ. It's so frustrating because nobody in upper management seems to care that we all KNOW it's not safe. Where to go to get things changed??

Re: 3 baby assignments

Originally Posted by Kimbalou

Only 1 out of the 3 babies I had recently was ready to go home...the other 2 were far from leaving...one still had a broviac with TPN and lipids. 2 out of the 3 were difficult to feed. They were not all truly level 2, that's for sure!

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.

Re: 3 baby assignments

We can have up to four babies on the intermediate side of our level III NICU, and we can have up to three on our NICU side. It is rare to have an unstable kid in more than a two baby assignment, and our unstable Jets and Oscillators are 1-to-1 until the baby becomes VERY stable. I have had three kids with CPAP and lines before, but it's rare.