Nurse/Patient Ratios

NICU_Nurse, BSN, RN · May 5, 2003

Sometimes our staffing is not as good as it should be, but usually we are okay. In our Level III, it varies from 2 RN's:1 baby (very high acuity- haven't seen this yet in the time I've been there) to 1RN:1baby (HFOVents, usually, or nitrous; very critical, unstable babies) to 1:2 (can be 2 vents, sometimes one is unstable, other is better) to even 1:3 (3 relatively stable Level III babies; this is unusual, but only happens when we are super-short on staffing). I've never seen a LIII assm't with more than 3 babies- at 3 we're already calling the staffing office and screaming. Even 3 "stable" LIII's, you're running your butt off most of the time, because they have qh assessments and vitals, q2h resp tx's, meds for sedation, abx, treatments, interventions, etc. If I get a 1:1 assignment I cringe sometimes because I KNOW it's going to be tough- the babies aren't assigned only one nurse for no reason! Critical care ratios typically ARE better, but you have to remember that the babies are sicker, and more care is involved. Just depends on the babies, really, but it's rarely a cakewalk. After working critical care for 18 months, though, I do have a little more control over the quality of care I give, and would now NEVER work on a floor unit like Med/Surg. Not happening in this state- 8-11 patients per nurse is just stupid and unsafe IMO. In our Level II nursery, we can have up to 6 babies before we are considered "over"full, but 6 babies with meds out the wazoo who are refluxing all over the place and refuse to eat is A LOT to handle. One night we had 12 babies and it was just me and another nurse who'd been pulled from Inpatient Peds, and had no NICU experience at all. It was a NIGHTMARE and I came home and my husband looked at me and I just fell on the bed and cried! LOL Staffing had said, well, too bad, we don't have anyone for you, and you're right on grid. Well, great, but the grid doesn't account for babies like this, or the fact that my assistance is in the form of a completely new nurse (and I'd only been out of school for 6 months!) who doesn't even know how to apply a blood pressure cuff to a baby, much less how to draw up and give meds she's not familiar with, or work the syringe pump, which they don't use up there, or feed a baby with a feeding problem, or start a new IV on those four babies who have all suddenly infiltrated. When we are at our limit, if it's mid-shift, we're screwed. Period. Staffing won't send anyone (they're all assigned) and we don't have anyone on call ever. We just have to work together and prioritize- maybe that baby doesn't get a bath, maybe the feeds go on pumps all over the unit, we just worry about the ABC's, feeding them, giving meds. It can get really hectic, but thankfully it's not all the time, unlike regular floors. I hear horror stories all the time and think, what are they THINKING, staffing a unit like that? (The staffing personnel, I mean) Hope that's what you wanted to hear. ;>) Neonatal nursing has it's benefits, and that can definitely be one of them. I wouldn't work anywhere else in the world unless I HAD to by circumstance, and it's for more than one reason. Good luck with your search!

Kristi

NicuGal, MSN, RN · May 20, 2003

We can have 4 feeders if we are pushed, usually 3 feeders. The vents get matched up with other kids according to their acuity. Sometimes it is 2 vents, or 1 vent 1 feeder or 1 vent 2 feeders or even sometimes 2 vents 1 feeder. We do have our 1:1's ...they are new admits until they are done, bad Osc kids, post ops, bad kids that are just bad, the occas chronic kid that has the trach and multilple other problems.

The rare 2:1...usually the charge nurse is paired with this nurse. Usually that kid ends up shipped out.

iceNICUnurse · May 20, 2003

We keep our feeders separate from the vents and cpaps.

So usually we have a lot of feeders if we are on that side. Upto 12 but we have 1 or 2 nurse Aids (not sure what it its called)with us.

We try not to have more than 2 vents per nurse but sometimes we have had 3 but then they have to be stable.

We try to have the occilator babies 1:1 and allso bad post ops and unstable others.

My unit is small and the only NICU in Iceland. Sometimes it it very buissy and sometimes nothing is going on. We dont ship anyone out exept for some of the heart surgerys and them we send to Boston Childrens, 5 Hour flight.

UTVOL3 · May 21, 2003

Thanks guys for posting in reply. Not exactly what I wanted to hear but still better than the "you take as many patients as we say you will take" we often get from our supervisors. Somebody is going to die as a result of this, hopefully it will not be on my watch.

NicuGal, MSN, RN · May 21, 2003

When I first started in our unit we we would take a row of kids....and whatever was in that row was yours...didn't matter if it was 2 vents, a trach and 2 feeders, it was yours. If you were in the isolation room (which could hold 4 kids) you got whatever was in there, be it 3 vents, fresh postops, whatever...they were all yours!

Things have much improved where I work over the past 17 years, and I have to laugh and roll my eyes when I hear some people in our unit complain about their assignment of 2 easy vents and a feeder LOL.

nell · May 21, 2003

Holey Cow! Some of your assignments are positively dangerous - either that or your kids aren't susceptible to NEC, IV infiltrations and other nasties that can be picked up early by thorough assessment. Also, your parents must not be as demanding as ours. I wouldn't want my baby in a unit that staffed so terribly.

Here in CA we have state-mandated ratios: a MAX of 1:2 in NICU (RNs only), 1:4 in intermediate care nursery and 1:8 in well-baby (RNs or LVNs).

Some hospitals try to get away with higher ratios, but an anonymous call to DHS will take care of that.

So far, my unit has never had a double-vent assignment. In a pinch, we've had double NCPAPs, but usually we'll pair the easiest of the growers with a vent if we can't staff 1:1.

NICUNURSE · May 27, 2003

I agree with Nell. I'm also a CA NICU nurse, and we have mandated 1:2 ratios. The 1:2 are usually feeder/growers, or you might get a more stable vent pt. with a feeder/grower. Every once in a while, if we get an admit in the middle of the night and don't have an extra RN, the nurses in the room will just absorb the pt. Meaning. one does the assessments, one does the meds, etc. But this doesn't happen often and is usually only for a matter of hours.

UTVOL3 · May 27, 2003

Sounds like you guys in Ca have great ratios. but I've heard the pay isn't the best, comparativley. of course I live in the southeast so its bound to be better than here.

bklynborn · May 28, 2003

Well here is something to think about ......the Hospital where I work announced today (via a note attached to the fridge in the breakroom,) that they were going to be "restructuring nursing throughout the Hospital" in the note it goes on to say how all RN;s will now have a patient load of 6 with an NAC. More NAC's will be hired and some of their shifts will be expanded to 12 hours...........more 12 hour RN shifts will be made available and some of the 8 hour shifts will be eliminated.......here is the kicker.....ALL OF THE POSITIONS ON ALL SHIFTS WILL BECOME OPEN AND YOU MAY PICK YOUR SHIFT AND DEPARTMENT ACCORDING TO SENIORITY.............boy is our Hospital buzzing!!!!!!

nell · May 28, 2003

NICUNURSE,

You are doing FEEDER/GROWERS 1:2? We are 1:3, but there is talk of dropping to 1:2 - we're afraid we'll be bored stiff...

AjaRN, I thought CA pay was better than all but the northeast. It's certainly pretty good in the SF Bay Area: I made a little over $100,000 last year (work full-time evening shift and am one rung up the clinical ladder).

UTVOL3 · May 28, 2003

$WOW$