Tell us about YOUR unit!

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    Hi! I was reading these threads and just wondering about everyone's different NICU's- how they're set up, usual census, capacity, unique features...let's share info about our respective units! No need to say where you're located, if that makes you uncomfortable! What things do you have or do that makes your unit special? What things would you do if you could to make it a better place for your babies? I'll go first. ;>) I work in what is considered the largest Level III facility in my area, in a large (very large!) teaching hospital. We have three nurseries in our hospital- Levels I, II, and III. I am currently floated between the II and III, but spend most of my time working in the LIII unit. Occasionally, I am pulled to the Level I which is attached to our transitional nursery by a central office space. Our unit is very bare-bones; no frills, small budget. Our turnover rate is very high!! Our level III can hold 24 babies easily, up to 32 if we cram them in. We don't have the O2 lines to hold any more than that, and usually have no more than 20 babies in the LIII at a time. Our transitional nursery is smaller, and can hold up to 26 babies before we have to start moving them out. Both nurseries are rectangular, with the babies lined up to either side. We are a sister hospital to the larger, community hospital down the block, and our units were originally located down there. They moved about 10 years ago, and a patient wing of the floor was remodeled (badly!) to accommodate the nurseries. We are adjacent to L&D, but it's a nice long walk through winding hallways to get there. Honestly, whoever designed this unit must have been truly thoughtless, because it is the most inconvenient design I've ever seen- supply closet and equipment room are off-nursery, way down the hall. We have a tiny lactation room with one rocking chair that is used for all three nurseries but can only fit one person. Our unit supplies are spread out all over the place- the T-connecters are on one side of the nursery, and the PRN adapters are on the other...that kind of thing. We have no facility for teaching parents- no conference room to speak of, and though we desperately need more patient education, if it doesn't take place at the bedside, it won't be done. We have a waiting room in ANOTHER WING of the hospital for parents and family, and it is pretty sparse. Our hospital, due to the demographic it serves (someone else's words, not mine!), offers no classes, etc. on anything related to babies other than Infant CPR, which is a requirement. We do not have the ability to care for ECMO patients, and certain cardiac defects, nor do we have the ability to house infants that need specialized surgery, plastic surgery, etc. We do take chronic vent babies, trachs, long-termers, etc. We are known for getting the babies with rare and serious infections that no one else sees, and we also have a great deal of drug-exposed babies. Our hospital has the only high risk antepartum unit in the state that has prenatal detox, so we get pretty much ALL of those kids. We also serve the underserved so almost all of our babies come with no prenatal care at all. I'd say about a third of these are the sixth or tenth in a string of children, and most of them come from moms who claim they didn't know they were pregnant, sat on the toilet, and pop! out came the baby. We have one lactation consultant who works M-F with only those moms who are having serious problems breastfeeding, but overall, our breastfeeding rate is horrendous. There is no unified education for the nurses, and knowledge ranges from extensive to nonexistent. This is not a criticism of the other nurses, but many of them don't even know how to work a manual breast pump. (This could be due to the lack of interest we get from moms...they are truly excellent nurses in many other respects.) Our unit looks very run-down and is probably no assurance at all to the parents who come to see their children. Our nurses, however, are top-notch, and come from all over the world with various levels of experience. Our unit is known for the place to learn the most, which also helps to explain the high turnover rate- people come, learn, and go! ;>) Sometimes, I wish I worked in a nicer place- certainly one that is more patient/family-friendly, but most of the time I feel lucky to be working with these particular babies, because their futures are so unsure because of poverty or family issues. The nurses on our unit are definately in charge, and are frequently responsible for 'policing' the many residents, students, and interns, as well as the respiratory team. We are in a constant battle with the RT's, as there is very little team communication, however, and we often fight over what is best for the baby. The RT's are responsible for ALL vent changes, drawing and running gases, etc., and we are not given an opportunity to learn these things at all here. (This makes me feel at a great disadvantage, and also has me worrying that I will not survive at another hospital, should I choose to move...) Ultimately, the RN's are in charge of the baby's care, but some of these decisions are made with little knowledge, which can be scary to a new nurse like myself. If you want to learn something, you are on your own, and I have spent a great deal of time studying this year (I graduated in December). More than I studied in school, and I'd thought that was absolutely impossible!! The best part about my unit is being able to reach out to willing parents who are lost and need guidance and actually see them try to make a difference in the life of their child. So what about you guys?
  2. 6 Comments so far...

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    Hi Kristi, I have worked in nicu since Dec, on my own without a preceptor since april and I don't have as much info as you do, but here goes. We are a large teaching hospital, with level I-III nurseries. We are the only level III in our state. Our level I is on another floor and I have never seen it. I work in Level III most of the time, level II only when needed and I am the lowest in seniority because we are unionized. Our level II is adjacent to our level III and it is one big rectangular room, not enough room in there and the nurses have to walk next door for items in the pyxis. I'd guess it holds about 20-30 babies. Our unit was designed in the 70's and was already too small when the hospital moved into it from another location. We hope to expand in the future. Our level III or SCN as we call it holds about 60 kids but we usually cram in around 70. We have one large rectangular room separated by 3 walls to make 4 "bays". the wall is not enclosed at the end so you can walk to each bay through a small hallway in the back and they are all accessible through the front. I don't know if this makes sense. Our monitors are on shelves along both sides of the bay. We have one refrigerator in each bay -2 are for meds, 2 are for breastmilk. We have gray bins with supplies in all bays when there is room. We have a large room with 2 pyxis' and linen, blankets, formula etc. Outside in the hallway at the back of all this is our clean isolettes etc... and the nurse managers office. We have a conference room, and 3 lactation rooms . I work nocs and have not had to help a mom with this yet, we do have electric pumps for their use and we supply all the containers to store milk in. we have the lab do heel sticks, the residents get blood cultures, place radial art lines, intubate and everything else since I work nocs, and the nurses keep their eyes on their every move. We have nurses that have been there since 1964. they are hiring alot of newbies now because we are overcensus and have been mandated all summer. there is no limit to how often we can be mandated. so right now we are not too happy and there could be a strike. the rt's are great. the lab draws the gases and leaves them for the nurses at the bedside. the residents look at them if they remember. basically the nurses look at them and if we don't want a change we don't wake the residents, but we do show them the gas eventually. RT helps with intubation, bagging the baby, bringing over the equipment etc... they retape ETT and cpap prongs. they hook up humidification to the O2, check all equipment and on and on, they are great, don't know what I'd do without them, they are not responsible for changing any settings or looking at gases, so no fighting with rt's. We have babies on NO, though not many at one time usually and we don't do ecmo. we do bedside pda ligations, the nurses insert PERC lines after special training. we have a diversity of infants from moms with excellent care to little or no care. We do have sibling classes oned day a week, and cpr classes. the nurses teach routine care, I hope this helps, I am tired and have written too much anyway. Who's next?
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    OK, I'll be next. I work in a small community hospital with a Level 2, Level 1, and Well baby nursery combined. I have been working there since July of 2000 and started as a new grad. We normally staff with 5 'licensed' on nights, no unit secretary or CNAs. Legally, we have a 6 bed level 2, and 11 beds in level 1. I don't know how many we are licensed for in WB, but I have seen as many as 26.
    The unit itself is dexigned fairly well. We have a 5 bed 'admission and stabilization' area with a door to L&D and the 2 L&D ORs. then there is a halfwall and another larger area with 5 bedspaces. All of this is for the Level 2 babies. We can take CPAP, and short term vents, and baby greater than 30 weeks. Nearly all of our supplies are located in the back admission area --some of this is stupid because if you are in well baby and need a bulb syringe you have to run to the back of the level 2, if the well baby cart isn't stocked!
    Our level 1 is adjacent to the front of the level 2 nursery . At the back of the level 1 nursery adjacent to the admission area is our breakroom and lactation/visitors room. Yes they are combined. We have a table and microwave set up inside a cubicle in the lactation room. So if there are parents there we can't break in that room. The level 1 room has 7 setups for beds but we all hate that room. the temperature drops in the middle of the night, our babies freeze , and there is a really bad draft.
    We often combine the babies in the Level 2 room if we aren't too busy. Our level 1 takes all the Hyperbili babies, and hypoglycemia, etc from WBN as well as the preemie feed and growers, and Antibiotics babies.

    If you walk out the front of the level 1 &2 nurseries. there is a wide hallway, thsi is where the WB desk, formula supply closet, circ room, computer and pyxis are. WB is across this hall, and taht is where the linen cart, extra equipment are located.

    We do not have residents or med students. We have 1 neonatologist and 2 nnps that work with him. They are not in house unless we have a vent baby or a imminent delivery of <36 weeks. Our neo works in a regular pediatric clinic. there are only 3 peds practices in the town and the other practices turn over any baby that grunts one time to him!!! (Which we don't mind!!!) Our neo is awesome, a great teacher and excited about the NICU growing-- we only opened the Level 2 part less than 4 years ago.
    RT is not designated for the nursery. RN's do all basic care, draw ABG's, etc, in the level 2 side. They just assist with intubation (if they can get to the nursery in time) or set up the vents, cpap or oxyhoods, and then come by and sign the clipboard off that the equipment is OK. Lab is not allowed to do ANY blood draws on our L1 & L2 babies, and we normally do all blood draws on our WB. We have to walk our labs down to the lab which is a pain in an emergency or when we are short staffed.

    We started a neonatal transfort team in May of 2001. We have 2 lactation consultants from the health department that work monday - friday 8-5. I think the county breastfeeding rate is 80% at 6weeks old since they started their "breast is Best" program. We are located outside the largest Marine corp base in the nation so a lot of our moms are young, but most have prenatal care.
    Our nearest level 3 is about one and a half hours away, and they don't do NO or ECMO. The nearest that do NO or ECMO is 2 1/2 hours away.

    We have a great team spirit and are hoping to grow a little more. We do hire new grads and have a 12 week orientation program. With the base, we have a high turnover rate-- the nurses either have been at the hospital for 10 years or more, or less than 3 years. OK I think that is plenty long...... Who's next?

    By the way, I LOVE my job!!!
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    How fun! I'll share.

    I work in a 61 bed unit with level 2 and level 3 babies. There is a level 1 upstairs in the postpartum area that holds a handful of babies. I've never floated there...it's once in a blue moon that one of us floats up there. Usually if PP's census is high enough to need help, then ours is too and we won't spare anyone. Most of our nurses work both sides. A few only do the level 2 side, though. It's all the same unit, with the same charge RNs and manager.

    31 beds are on our level 3 side and 30 are on our level 2 side. On the level 2 side your assignment will be 3 or 4 and on the level 3 side it will usually be 2. Sometimes your will only have 1 if you are first admit or if your baby needs really intensive attention. Our level 2 and 3 sides are separated by a desk/secretary area that has our Pyxis, med fridge, fax machine, copy machine, etc. Our charge RN desk is there as well as the area for the MDs and NNPs to sit and chart. Syringes, needles and alcohol wipes are in this central area, though we have several large stands with drawers out in all the care areas that hold syringes, alcohol wipes, linens, etc. It's a JCAHO no-no to have our syringes out there, so they get taken away when it's JCAHO season. (we're so compliant aren't we?) We have a supply room that has our diapers, linen cart and a supply Pyxis that has IV tubings, transducers, procedure trays, etc etc. There's a stackable washer/dryer in there for washing our sheepskins, isolette covers, and snugglies. Our MA's do all the restocking and wash our sheepskins, etc.

    Both of our areas are basically one large room with bed spaces along the walls and along "islands" that have the basic suction/O2/monitor set-up at each bed sapce. We never cram in more babies than we have bed spaces for. Each side has 2 isolation rooms that more often than not end up being quiet rooms for a sensitive vented or drug withdrawing baby.

    Admits always come in to our level 3 side. They are usually there at least a shift or two (unless we're busy and need the level 3 bed), even if they are a big R/O sepsis baby. We do just about everything, but transfer babies that need ECMO or immediate surgery, and also cardiac cases. We always admit babies to warmers. If it's a micropreemie, it stays on a warmer for several days to a week or 2 even, until it is stable. Then it goes into an isolette. That's one downside, because our little guys need the isolettes the most, sooner.

    We are a private hospital, rather than a community hospital, so we don't get many drug-exposed babies. Our clientele is usually middle class with insurance. We are NOT a teaching hospital, so there are ZERO medical students, interns or residents poking around. We have an MD and sometimes an NNP as well on 24 hours per day. We only have 7 MD's and a handful of NNP's that write orders and rotate call nights. Such a small group of MD's and NNP's is nice.

    We draw all our own labs, and take them to our lab, that's right next door. Our ALS nurse (or NNP or MD) can do art sticks. We draw our blood gases ourselves, and the RT's run them in the ABG lab that's right in our unit.

    For teaching, we have a conference room where we hold parent CPR and "understanding your preemie's cues" classes. Lactation nurses are on during the day (we have several-- the hospital does several hundred births a month) to help our mom's breastfeed or get them set up with a pump. We have a pumping room with 3 pumps. We have a milk fridge with freezer on each of our sides.

    There's not a whole lot of outright disagreement (secretly, yes) between our RT's versus NNP's versus MD's versus bedside RN's as to what to do for a baby. Once in awhile, but not often. In the end it ends up being the MD's decision and they rarely if ever disagree with each other (that we witness anyway).

    Nurses are never on the admit list if they have a vented baby and the first admit nurse usually only has one baby. There's always esceptions, though. Everyone pitches in to help when a nurse gets an admit, especially if it's a tiny preemie. Someone is writing v/s for you, while someone is getting your IV fluids ready while the ALS nurse is putting in lines, while someone else is telling Dad what's happening. Still another nurse will do your other baby's feeding or labs or whatever if you are busy with an admit. Teamwork at its finest during a hairy admit. And just let there be a code... everyone fights over getting to help out.

    I'll stop now, I think this is long enough!
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    Well KRVRN, I want to work with you! I wan to brag, but I honestly can't think of anything to brag on.

    We lump everyone on one big room not matter your status, so you can have a vent and a feeder/grower together. No big innovations, radical interventions, neat programs or even classes!
    We have residents that scare me and some that don't.

    I do think it intersting you keep the micros on the warmer beds so long. I admit them right to a humidified isolette. I hate having them "on stage". I can only recall a handful of babies we kept on a warmer that were exteremly unstable, such that most did not survive.

    My dream NICU would have NO med students.5 small rooms with 6 babies a piece in it, no CRAMMING! They would be laid out in a circle.Each room would have at least 3 RN's This room would also have a parent lounge/rest area and a lactation lounge equipt with bottled water and snacks. There would be a corner for charting and rounds. In the center of the hub would be the docs area, the secretary and the med, supply rooms, so everyone has an equal distance to walk.
    We would have a LC there everyday who would also dram up and distribute feeds t the proper baby. We would have weekly parenting classes, CPR and support groups. We would have a PT/OT/Play therapy person daily for our long termer.
    *sigh*
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    My turn, my turn... I'm a new RN, so bear with me...
    I work at a Children's Hospital with a Level III NICU. Because we are a children's hospital (no L&D) all of our babies are refered and transfered into our unit. Most of the babies we get either need sugery, have some sort of syndrome that no one has ever heard of or the refering hospital just doesn't know what else to do with them! I believe we are a 30ish bed unit and have been at capacity as of late! We have four large rooms on the unit, two small isolation rooms (for one pt. only) and then one room that's outside of the unit and down the hall a bit. The really sick babies are admitted to our largest room where we do ECMO, etc. and are there until they're a little more stable or we need the space. Then they're transfered to the room next door where the kids are still sick (vents, HFOV) but a little more stable. Then we have two rooms on the other side of the unit, where most of the 1:2 pt. are or the pt. who are stable but just awaiting surgery. Then we have the room outside of the unit, which I refer to as our step down unit. 1:2's, stable, feeder/growers, just waiting to go home. Each room is set up the same way, with bed spaces along each side of the wall. Each space has a monitor, O2 hookup, etc. Also, we do all of our charting on computer, so there are usually enough computers for each nurse to have her own to chart on.
    We are a LARGE teaching hospital, so we have three attendings, some fellows and even more residents. We also have a team of NNP's who have their own pt. (most of the preemies). Then at the same time, we have RN's like me (in a 6 month new grad program that are being precepted) and sometimes nursing students who are there to "look but don't touch!" We also have a team of 3-4 RT's on the unit.
    Supply wise, we have what is called "The Crib" which houses all of our unit supplies. Then in each room, there is a cart (similar to a mechanics tool box) where we keep supplies we use often (IV stuff, IV tubing, alcohol, lab supplies, syringes, etc.) Each of the rooms has a cupboard for pt. meds and then a fridge for meds and breastmilk/formula.
    We draw our own labs and then send them to pharmacy through on of those vacuum delivery systems in the wall. We draw blood gases and give them to the RT's to run.
    Outside of the unit, we have two parent rooms where parents can wait (if their child is coming back from surgery) or pump if their breastfeeding.
    The nurses have a breakroom on the unit, the RT's have a lab on the unit and the residents have a room on the unit.
    We have a staff of over 100 nurses on our unit and from what I've heard, they don't float that often. We have 3 ICU's in our hospital and those nurses cover each other for floating. So the NICU, CTICU and PICU nurses would float within those three units and then the rest of the floors cover each other. The hospital has a seperate transport team (they bring us our babies).
    Not really sure how they decide who gets the new admits, but I think it depends on how critical they are. Something kinda different is how we do our schedules. We have a 6 week schedule which include three pay periods. So when you're hired, you schedule yourself how you want and according to the unit needs for those 6 weeks, and that schedule repeats itseld every 6 weeks. So for every holiday, execpt x-mas and new years, if it's your day to work, then you work. Then we have a committee who does the x-mas/new years schedule according to what we request off. With so many nurses, this seems to work wonderfully.
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    Our unit has a high ceiling and ceiling-to-3-feet-from-the-floor windows along one side. Very open and bright – lots of glass walls, you can see from one end of the unit to the other. It consists of 3 large rooms we call bays. Each bay has six bed spaces (though the side bays were only designed for 5 – even though assignments are typically 3 pts…). The middle bay is the largest and contains our IV, intubation and chest tube carts but no fridge or microwave and ONLY ONE SINK. This is usually where we admit babies and where we usually keep vented and CPAP kids. The two side bays each have a glass-walled isolation room and a “kitchen” area with fridge and microwave. The nurses’ station with med area and offices for Mgr, social worker and case mgr. are along the wall opposite the windows. We are licensed for 16 beds but have had as many as 22 kids. There are plans to increase the beds to 20-24 soon, so it won’t be so spacious much longer.

    We have to float to well-baby nursery and they have to float to NICU as well as MAT/PEDS. WBN has had as many as 50 babies crammed into their 2 large + 1 small + 1 admit rooms. We have about 400-450 deliveries/month. Administration keeps trying to do mother/baby, but our clientele doesn’t want it. Normal assignments are 8 babies:1RN or 12 babies in an RN/CNA team – which is in violation of the law in our state which mandates a max of 8 well babies per licensed nurse… Since our population is older and many are recent immigrants, our “well-babies” usually have a lot going on: labwork, chemstrips etc. Having to float to WBN is about the only thing I don’t like here.

    We are a non-profit community-based hospital. We have a Neonatologist onsite 24/7. Most of our Neos are wonderful, all are tolerable. For the most part, they trust our judgment and even seek out our opinions on care. They change diapers and NEVER leave babies uncovered or in disarray.

    We try to keep vented babies 1:1. Most of our assignments are 1:3 as we mostly have growers and sepsis kids. A group of nurses rotate as charge and the charge nurse doesn’t take an assignment unless there is no one else to take an admit. Most of us pitch in and help with admits or crashing babies. We do HFOV but not NO or ECMO. Lab does the draws unless we want to or can’t wait for them to come. We draw gasses and RT runs them. We have a few nurses on each shift (we do 8 hrs) that put in PICC lines.

    Most of our clientele is highly educated and fairly well off but we see a wide social spectrum. Our parents tend to be older too. Lots of IVF. Breast-feeding is the norm and we have Lactation consultants available. There are 2 “parent rooms” outside the unit where moms can pump (or they can pump at the bedside) or rest and parents can reserve one of the rooms to stay in at night if they want to. Sometimes a baby will “room in” there on his/her last night – particularly if going home on monitors or with O2.

    We have no storage for things like isolettes and bililights – they end up in the hallways or in the basement (everything into the basement when JACHO comes). Our lounge is tiny – don’t know what the designers of our building were thinking of. Nursery/NICU has more nurses working on a given shift than L&D or MAT/PEDS and they each have several and much larger staff rooms.

    For the most part, our staff are a friendly team. We have frequent potlucks and know what’s going on with each other’s kids/spouses. Our manager is extraordinary. She has a great sense of humor and an open-door policy. She has a very difficult job (administration thinks all we do is burp and diaper babies…) and tries to keep everyone happy. We have very low turnover and those that left for sign-on bonuses or greener pastures at other area hospitals have all come back.


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