What happens in your NICU when you are short staffed? - page 2

Our unit has been chronically short staffed forever. However, lately the situation has gotten really,really bad. Last week the RN's had assignments ranging from 4 ICU babies each plus admissions to... Read More

  1. by   RN4BABES
    Quote from sparkyRN
    Our unit has been chronically short staffed forever. However, lately the situation has gotten really,really bad. Last week the RN's had assignments ranging from 4 ICU babies each plus admissions to 8 special care babies without any NA/extern help. And I'm talking sick and tiny babies. And the charge nurses are often taking a full pt. load too. Fulltime nurses already have to work a mandatory OT shift. What does your unit do as an incentive to get nurses to come in when they know they will be slammed with a high pt. load/acuity? Do you have incentive or crisis pay? Do you use agency or travelers?

    Wow, I live/work in Canada. I notice it is quite different where I am than from what I am reading here! Are you all unionized? We have something called an "unsafe workload" form that we must fill out if our assignments become insane/unworkable and it gets shipped off to our union rep so she/he is aware of the situation. We have to think of our nursing licences!! More often though, our unit manager has got her "finger on the pulse of the unit" and encourages overtime (sometimes doubletime for fulltime staff), agency workers and will shower us with pizzas p.r.n. We work like a big team so no babies get "ignored". Our admission nurse almost always has an assignment. (usually not a vented babe though.) A typical assignment would consist of 2 vented, stable babies or an unstable vent with a grower. Our hospital has been dubbed "the hotel" I hear from other nurses who work in other places as the assignments are maintained at a do-able level. Sure, we get short-staffed but somehow we all pull together and get through it all. Being from an area where big loads of snow get dumped on us every once in a while, we have to deal with "no-shows" too. In that case, we close our unit to outside admits and ask people to do part shifts or whatever they can until people can make it in! I have never even heard of mandatory overtime!
  2. by   sparkyRN
    We are not unionized. There is really no recourse when we are slammed with high census and acuity. You can't and wouldn't want to refuse an assignment--that would be abandonment. Everyone is great about helping out and working together. However, how much help can you be with 4 ICU babies? It's not like you'll have any extra time to help the nurse with 8 special care babies do any of her feedings. After a several weeks of working like this, there's not many people who want to come in and work extra. What's kind of scary is that this is our regular staffing pattern...we haven't been hit hard with the flu (yet) so we are not understaffed because of illness.
  3. by   RN4BABES
    Quote from sparkyRN
    We are not unionized. There is really no recourse when we are slammed with high census and acuity. You can't and wouldn't want to refuse an assignment--that would be abandonment. Everyone is great about helping out and working together. However, how much help can you be with 4 ICU babies? It's not like you'll have any extra time to help the nurse with 8 special care babies do any of her feedings. After a several weeks of working like this, there's not many people who want to come in and work extra. What's kind of scary is that this is our regular staffing pattern...we haven't been hit hard with the flu (yet) so we are not understaffed because of illness.
    So, out of interest's sake, has anything "bad" happened due to your staffing shortage? Just hoping some wee thing doesn't have to die because he/she wasn't watched closely becasue of lack of staff. You know how quickly sepsis can attack!!
  4. by   t2000JC
    I am still really curious on how one feeds and assesses eight babies, no seriously, i want to know t
  5. by   RN4BABES
    Quote from t2000JC
    I am still really curious on how one feeds and assesses eight babies, no seriously, i want to know t

    Me too!! I hope you guys use slow bolus feeding??
  6. by   Gompers
    Quote from t2000JC
    I am still really curious on how one feeds and assesses eight babies, no seriously, i want to know t
    I've never had eight babies, but there have been nights I've ended up with six. In units where babies are all kept on the same feeding schedule, I can see this being a problem but our kids are usually on different ones. Even if I have six q3h feeders, two might be 3-6-9-12, two 2-5-8-11, and two 1-4-7-10. Then again, I've had four or five babies due on the same hour. I just start a half hour early, and end a half hour late if I have to. At least a couple of those kids will have a tube and those feedings can just be NG'ed, leaving more time to bottle feed the others. The most important thing is that each baby gets an assessment and is fed within a half hour of their scheduled time. If there are more NG feedings that night, and not as many PO attempts, there's not much I can do about it. I still consider it safe nursing care. It's once in a blue moon this kind of shift happens, though!
  7. by   NoCrumping
    Quote from t2000JC
    I am still really curious on how one feeds and assesses eight babies, no seriously, i want to know t
    Everyone gets done late....... I have had to do it many times. You start from the minute you get there, and dont stop til the minute you leave. You'll skip the "trial" nippple feeds, the cuddling etc. Meds, hands on vitals, and feedings with an NG on a pump if feasible. Period!!!! Let's just say you are glad that you really dont know... lol
  8. by   sparkyRN
    Just like you said--you start early, finish late, do the essentials, double-check yourself along the way and pray.
    I had 8 babies Sunday night. They try to assign an assortment so no one has 8 PO feeders. I had 3 PO q3h, 1 PO q4h, 2 OG bolus q3h with attempts at PO qofeeding (afraid those fellas got only one try on my 12 hours)and 2 continuous OG feedings. And baths and weights were done. 3 had PO meds and 1 IV abx. Taught one mom how to give a bath. Another young new mom who was in several times and so willing to learn and me without any time to teach .
    I swear we must be surrounded by guardian angels!
    So far no major or tragic incidents in the grand scheme of things. But....there are those things you know wouldn't have happened if you just could have been right there to pick up on them. For instance, I had an IV infiltrate because I couldn't assess the site closely on my non-critical baby becasue I was constantly around the corner dealing with my 450 gram and 600 gram babes on ncpap. grrrrrr.
  9. by   sparkyRN
    Here's hoping I'm in ICU tomorrow...I'll take 4 of them to 8 feeder-growers any day!
  10. by   RN4NICU
    Quote from sparkyRN
    I had 8 babies Sunday night. They try to assign an assortment so no one has 8 PO feeders. I had 3 PO q3h, 1 PO q4h, 2 OG bolus q3h with attempts at PO qofeeding (afraid those fellas got only one try on my 12 hours)and 2 continuous OG feedings.
    I am worn out just from reading that.
  11. by   mac23
    Wow 8 babies. I can't imagine. Do you guys have techs? Our unit does and a while ago we really had to sit down and justify them being there or our director was going to let them all go. I'm glad she kept them around. I saw her point though, before we changed a few things they really didn't do anything but stand around all night (the director came around on several occassions and was very disturbed by this). Now they can take vitals, feed babies, prepare feeds for the next shift, help take babies to procedures (only if they are in Room Air), help out the unit secretary, stock the linen cabinets, draw labs (heelstick) on babies over 1000 grams, give baths, etc. It makes it nice to have them around. Our unit usually feeds all babies at the same time. We have an hour and a half to get the babies done. We give our babies 20-25 minutes tops to PO feed after that it's down the tube. When things get busy we have a charge nurse and a stabilization nurse that can help out with assignments (feed, start IV's, assess etc). Also the other nurses are very good at helping if their assignment isn't too heavy and they are done early. We encourage our parents to come around during feeding times so that they get used to being able to feed their baby long before they are ready to go home. The rare occasion that you have 4 babies usually it's only one or two people that have 4 baby assignments and usually if they have an NPO baby they will include it in that assignment or a continuous feeder. The worst it's gotten has been having a float that refuses to assess the babies, then someone may have to assess all the babies and give all the IV meds in the room (we have 9 babies per room) but the float will feed and do vitals. I'm finishing up my clinical requirements for NNP school now but I feel bad for ever complaining about my assignments. :uhoh21:
  12. by   fergus51
    No offense Sparky, but I would not want to work there or have my baby there.
  13. by   Gompers
    I think it'd be harder to have 8 babies in the newborn nursery than 8 in a Level II or step-down NICU. The 8 in the nursery would most likely be off monitors and PO ad lib, not to mention needing to go out to their mother's rooms, etc. I know that when I have 6 kids in our step-down area, at least all of them are on monitors. We also have at least two staff members (2 RNs, or 1 RN and 1 RT) in each area (12-14 babies) at all times. Plus you've got NG tubes and scheduled feedings in the NICU, with less PO ad lib kids, so you can at least formulate some sort of schedule for each shift. I don't think having more than 3 kids with IVs is safe, though, because sometimes that can take up so much extra time. Everybody does hourly IV site checks, I'm assuming?

    One thing that really helps is not having every kid on the same exact feeding schedule. I know that on plenty of nights I'll have 3 q3h feeders, each due on a different schedule. It's great because only one baby is due each hour so I can spend plenty of time with that baby and its family while the others sleep. So even when I do have 6 kids, the chances that all 6 are due at the same time are extremely rare.

close