Primary care in the NICU

BittyBabyGrower, MSN, RN · Apr 7, 2005

With our primary care, if the primary comes in at say 7p, and an eves person has the baby, the eves person keeps the baby until 11p and then the primary takes over. Sometimes the eves person will say...here take your baby :chuckle esp with the chronics. The person who has the baby on the primary shifts (7-3 3-11 11-7) keep the baby until the next shift, no 4 hour shifts unless you want to. We also have associate nurses, one on each shift, so they together plan the care of the baby and do the teaching etc (but teaching is EVERYONE'S responsibility, regardless if you are an associate of primary). We don't come in on our days off for anything, we just take the baby when we are there.

We also have a few rules..

1. You can primary after 1 year of working, you can associate after 6mo.

2. Night people need a co-primary on days so that someone is around for rounds, etc.

3. Only one associate per shift, unless it is a chronic kid, then you rotate among yourselves. Play fair.

4. If there are more than one primary on the same shift in the same room, the kid that is the sickest or most chronic will have it's primary assigned first. You need to get together with others and rotate yourselves in and out.

BabyNurse513 · Apr 7, 2005

1. You can primary after 1 year of working, you can associate after 6mo.
QUOTE]
Just curious, why one year? Does this rule apply only to new grads or any new person?

fergus51 · Apr 7, 2005

We have the one year role for new nurses only (not nurses with previous NICU experience who are new to the unit) so that they can get a greater variety of patients and that should provide them more opportunities for learning. We don't ever make a person take a new assignment in the middle of a shift because the primary is there and we don't make primaries come in on their days off for any reason. We also don't require a day shift primary to match a night shift primary. We're happy when anyone wants to be a primary and try not to limit them.

BittyBabyGrower, MSN, RN · Apr 10, 2005

What fergus said...you don't want to tie someone down with a primary when they still have so much to learn and see. I did forget to add that the experienced girls can take a primary after 6 months.

We just recently add the day co-primary because things weren't getting passed on from rounds and d/c rounds.

NoCrumping · Apr 10, 2005

1. You can primary after 1 year of working, you can associate after 6mo.
QUOTE]
Just curious, why one year? Does this rule apply only to new grads or any new person?
The rationale for this, we were told at my facility, that they want new nurses to get used to taking care of all kinds of problems first, and not just those problems your primary has. Makes sense, when you think about it.

pat m · Apr 13, 2005

thank you all who answer about primary care in NICU . If anyone else has more to offer please I will take everything

pat

Gompers, BSN, RN · Apr 13, 2005

thank you all who answer about primary care in NICU . If anyone else has more to offer please I will take everything
pat

Look back in this forum over the last year or two. There's at least one long thread about primary care in the NICU with lots of great advice, especially regarding staffing issues. Good luck!

BlueYYsRN · Apr 24, 2005

What is the role of associates?

Gompers, BSN, RN · Apr 27, 2005

What is the role of associates?

We don't do "day primary" and "night primary" on our kids - we just have ONE primary, and it's totally voluntary. It's first-come-first-serve, so if you like a baby but it already has a primary signed up, you can sign up to be an associate. This means that if the primary isn't there and it works out for assignments, they'll give you that baby if possible. It's just another way to have more continuity. We can have up to 8 associates for each baby.

sparkyRN · Apr 27, 2005

We've tried primary nursing and it doesn't work for us. Our unit is big, and most of the nurses have to rotate between Level II and III-except some of the older ones who only do Level II. When you work a stretch of shifts back to back you will have the same assignment unless a baby is transferred. Your next time back at work you could be anywhere in the unit. The nurse updates the careplan at the beginning of every 12hr. shift on her assigned babies and will initate it on any admission she gets.