Nurse/Patient ratios

Specialties NICU

Published

I'm a nurse in a level III NICU that cares for both level II and level III babies. Over the past year, nurse/patient ratios have gotten absolutely absurd!! Our typical used to be 1:1 for jets/oscillators/very unstable, 1:2 for stable vents, and 1:3 for IVs and feeders. Only under the most extreme of circumstances would a nurse ever find herself with a 1:4 assignment. Now, 1:4 seems to be handed out very casually. Any kid not on a vent could be in an assignment of 4, including new admits from the previous shift. :eek:

This seems very risky to me. It is very frustrating for the nurses. After all, those little guys aren't still in the NICU b/c they are stable, able to wolf down a bottle in a minute flat, and no longer having A/B's, now are they? Yet, when there are 3 others in an assignment, how do you keep a close enough eye on all of them (and not pull all your hair out by the end of the shift.) UGH!! The lengths to which some hospitals will go to save a couple of bucks... :(

It can't be like this everywhere! (In fact, I believe it's cause for reporting a unit in CA, now that they have mandatory ratios). What are the ratios in the other units out there? (And where are they...'cause if this keeps up, I'll be packing my bags!)

Specializes in Nurse Scientist-Research.

Our unit is split up into 4 rooms which kind of reflect the level of care. 2 rooms for feeder-growers, one room for intermediate kids and one room for the sickest kids and admits (HFOV, multiple drips). The general ratios are 1:1-2 for room 4, 1:3 in the intermediate room and 1:4-5 for feeder-grower. I've had a 5 baby assignment and it will challenge your time management skills to the max. The only salvation is there is usually a tech present that can help with weight and feedings in the feeder-grower rooms as well as stock your carts with supplies and linens. I love it when they justify giving you an extra baby because it's just a standard "rooming in". Like you don't need a couple of hours to sit down and review and document all that stuff that might have already been taught but hasn't been documenting.

Our unit has 1:1 for any vent or post-op, NCPAP is considered a vent and also can be 1:1, however from time to time we may have a feeder grower with a very stable vent. NO is sometimes 2 nurses to 1 patient (just started NO). Most other assignments are 2:1 with some 3:1. We have 1 assignment of 4:1 that are vitals just q-shift. I work per diem at another local NICU that has much heavier assignments. 2 Other RN's I work with, work both facilities. They tell me at my primary job " No one here could even handle working at the other places". It's as if we should get some badge of courage for taking on extra heavy assignments? I will be very happy if I never again have to "Handle" that heavy of an assignment.

I'm currently working in a major NICU/SCN in Melbourne. The unit has three area which are corresponding to Level III, II and I. All baby who are intubated, on CPAP or unstable are in Level III room. All intubated babies, unstable babies (either intubated or not), newly extubated babies are cared by one nurse. Otherwise, nurses care for 2 babies in the level III room.

Newly admitted babies, babies for blood transfusion, babies required high amount of oxgyen (up to 50%), baby receiving TPN, EIUGR baby and servo temp control are cared in the Level II room. Ratio in this room is 1:3 ratio, therefore, it can be very busy in this room. I hate it when i have 3 babies; one is on TPN and hour feed, one is having A&B every 1hr and requires mult Abs and one is on bottle feed or breastfeeding required assistance. This have happened few times to me in this month. I don't cope it well at times as i come from adult ICU where ratio is always 1:1.

Finally Level I room is for feeder and growing babies, oxgyen dependant babies, and babies of Chemical dependant mother. Here, most of the time, nurses are caring for 3 babies. However, when there is shortage of staff, we have 4 babies and it is a shocker!!!

And the ACN (charge nurse) don't even put a hand on babies or give it a dam about helping...

therefore, i'm often thinking to go back adult ICU. It's just that i sometime don't think i gave a comphensive or holistic care to the baby and his/her mum and dad, sometimes, it just become a task-orientated job!!!

Specializes in NICU, PICU,IVT,PedM/S.

WOW! Have any of your hospitals read the NANN guidelines?? I guess they will when a lawsuit happens!

We take 2 vents/NCP. Sometimes three in the more stable rooms. In our ICN we have 3 grower/feeders. Maybe 4 if it is really short staffed. The Charge in NICU does not have an assignment, the transport nurse has a light assignment, the charge in the ICN has 2 pts. If we are really lucky we have a del room nurse that has 1-2 pts.

But I work nights and no matter what happens we all pull together and help eachother!

Specializes in Community Health Nurse.
Originally posted by TeenyBabyRN

I'm a nurse in a level III NICU that cares for both level II and level III babies. Over the past year, nurse/patient ratios have gotten absolutely absurd!! Our typical used to be 1:1 for jets/oscillators/very unstable, 1:2 for stable vents, and 1:3 for IVs and feeders. Only under the most extreme of circumstances would a nurse ever find herself with a 1:4 assignment. Now, 1:4 seems to be handed out very casually. Any kid not on a vent could be in an assignment of 4, including new admits from the previous shift. :eek:

This seems very risky to me. It is very frustrating for the nurses. After all, those little guys aren't still in the NICU b/c they are stable, able to wolf down a bottle in a minute flat, and no longer having A/B's, now are they? Yet, when there are 3 others in an assignment, how do you keep a close enough eye on all of them (and not pull all your hair out by the end of the shift.) UGH!! The lengths to which some hospitals will go to save a couple of bucks... :(

It can't be like this everywhere! (In fact, I believe it's cause for reporting a unit in CA, now that they have mandatory ratios). What are the ratios in the other units out there? (And where are they...'cause if this keeps up, I'll be packing my bags!)

TeenyBabyRN....the reasons you post are one of the reasons I'm speaking out about....patient/nurse ratios. Everyone of us has a voice. We just need to NOT be afraid to use it. I hope you will follow your heart and do what is best for your little patients. They are just starting out in life, and need their nurses to speak up about the care they need that is often shortchanged due to too many patients per nurse. :nurse:

Our ratios are much different. We have an Intensive side and a progressive side to our unit right now. We are in the process of getting a new unit where we will be combining patient types. The way it is right now is that we usually have 2:1 in Intensive and 4:1 in Progressive. We don't do Echmo or Nit Tx, so we don't worry about that. We don't have many surgeries, but those post op patients usually do get another patient assigned to thier nurse along with them. The only 1:1's we have are babies who are about to pass and are being "coded" at shift change. Our unit is a bit understaffed, but our hospital will not allow any more hires. I can't wait unit we open our new unit and we get really busy and short staffed.... We will then see what our ratios get to be like.

Try FIVE "feeders and growers" (with most in their own separate rooms) - and then if you are still bored, let's make some of them ISOLATION! And, lest ye forget, if you don't document it, you didn't do it - I pray that if any of my babies gets sick, I will be able to spot it in time!:eek:

Pretty much the same here. It all depends on acuity. The most I've ever had was 4 feeders and growers. On occasion I have seen as many as 5 feeders and growers to one nurse, but that isn't typical. Generally we have 2-3 babies a piece. Our L&D admission assignments are generally 2 baby assignments.

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