Charge and Resus --How does your facility do it?
- 0Jan 31 by HopefulRN2010Hello Everyone!
I work in a local level III NICU at a delivery hospital. Our current system is for our charge nurse not to have an assignment, or if she does, she usually only has one baby. And the charge is responsible for also attending deliveries (resus). Our manager wants to change it so more of the staff attends deliveries not just charge. Which I agree with, but the way she is going about it doesn't really make sense to any of us!
I was just curious what method other hospitals use? And do you like? Any suggestions appreciated. Thanks!
- 0Jan 31 by NicuGalWe don't usually go to deliveries since we always have an NNP, a fellow and 2 residents on during off shifts and a zillion people during the day, but if they need help it is the person who has the admit that goes. If they call for yet another person then it is the charge nurse. Our charge usually doesn't carry an assignment and our admit people usually only have 2 feeders when staffing let's us.
- 0Jan 31 by aerorunner80When we are ideally staffed, we have 18 nurses on including one charge who never takes patients and 1 flex nurse who ideally wouldn't take patients but may have 1 very easy patient. Sometimes the charge goes to deliveries and sometimes the flex goes to deliveries. Sometimes if it has been busy and it is just a walkover, a nurse with an assignment can go if it is an easy assignment. I have also gone to deliveries when I am first admit which is really nice.
Our policy is that even though we have a lot of people on every day (Attendings, Fellows, Residents, NNP's, etc) an RN has to be present every time the team is called over. Typically it will be one RN, one NNP, and maybe one or two med students or Residents who go over. If we are called over 911, then we have an RT, Attending, Fellow, NNP, RN (sometimes 2)...basically anyone who is available to go, goes.
This system seems to work out very well for us.
- 0Feb 1 by prmenrsWe had a charge who did not take an assignment (believe me, she was busy enough w/staffing and helping wherever needed), 3 "admits". 1st admit had the lightest assignment, and on down. You stayed 1st admit til you got a baby. You had to go to any hi-risk delivery, along w/an RT and the fellow. If the baby needed to come back to the unit, you admitted it. 2nd admit is not 1st admit.
Another hospital in the area has a dedicated transport team, but on occassion, we did transports. 1st admit hands off his/her pt to someone, goes on transport w/RT and fellow and other personnel as needed. (eg, twins).
On occassion, 3 admits was not enough. Healthiest babies went to the less acute nursery areas, thus creating another admit.
C-sections--Fellow or resident scrubbed in, RN and RT waited, checking things on the warmer obsessively and compulsively.
Our unit was a 40 bed Level 3 w/20 beds "ICU", and 20 beds "convalescing" babies. Assignments in ICU were 1:1 or 2:1; in the lower acuity 2 or 3:1.
In theory, all nurses were able to work all areas, including going to deliveries and transports; in practice, some folks were always in ICU, some were always in the other areas.
- 1Feb 1 by ckey01Our charge nurses do not take an assignment. They have a multitude of duties involved with staffing and admissions and help out around the unit.
We are a 107-bed Level III NICU so we get a lot of deliveries. Because of that we have a dedicated resus team that goes on all high-risk deliveries (accompanied by an RT, NNP, and sometimes a Fellow or Resident). They handle the entire admission process and the baby's first 4 hours in the NICU. They are then handed off to whichever RN is first-admit.
- 1Feb 1 by HopefulRN2010Thanks for all the suggestions so far! It sounds like most of you work in teaching or large NICUs! We are a small unit, only "supposed" to be a 15 bed unit. However, we have had up to 27. So we are MUCH smaller than the hospitals most of you work in! We also are not a teaching hospital, and since I work nights we do not have an NNP and the MDs on just on call. We go to all c-sections and any other "high risk" delivery. So for us going to deliveries is the biggest time consumer of our charge nurse. So if they want to separate charge/resus it just makes sense to me that they would at least give charge a baby. And then have a 1st admit like it sounds like most of you have. Thanks again everyone!
And Bortaz- We have to scrub in and catch for preemies; but for full term c-sections they place the baby in a sterile bassinet.