What happens in your NICU when you are short staffed?Register Today!
- by sparkyRN Feb 8, '05Our 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?
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- Feb 8, '05 by NoCrumpingI worked in 2 NICUS, one was a "PALACE" , THE other a SH*t HOLE. tHE PALACE PAID DOUBLE TIME for any hours above your regular requisitioned hours if you were part time, and of course above 40/8hours. They brought up a cookie and snack cart for every shift when we were over census, wich was since about 8 yrs ago. You NEVER had more than 2 iv's to maintain, never more than 2 stable vents. We had a real charge nurse/asssistant nrse mgr too, they NEVER took assignments. The sh*t hole, well the opposite, of course. An actual assignment one day: 2 vents, one was an oscillator, both with blood on the way, a post op due in an hour or so, a cpap w/ q 2hour feeds,and, still, I was up for an admission, which i was told we were expecting a 28 weeker, that I would have to admit......I am getting sick just thinking and typing about that day...I left 2 days after, this happened everyday to all the nurses.the charge nurse had an assignment everyday... A guy who worked there told me : "when you walk in here, you check your nsg license at the door, cause you never know if you will leave with it" so true. And yet, with these rediculous census and acuity numbers, they refused to close to transport. The neo one day EVEN TOOK A BABY IN THAT HAD BEEN HOME FOR 2 WEEKS.WE ALL JUST WANTED TO JUMP OUT THE WINDOW.....we are working dangerous as it is, then you break rules and take in a kid home for 2 weeks?????? Both of these places were major regional perinatal centers, doing upwards of about 11,000 births a year... And to top it all off? I left the PALACE, moved to another state, and started working at the sh*t hole. It sucks to be me............
- Feb 8, '05 by t2000JCwow, i guess i can't complain about my assignments ever..HOW does one feed EIGHT SCN babies???? and their parents! and they can all have a bad change that could be so subtle that sometimes i'm afraid to miss it with four growers...t.Last edit by t2000JC on Dec 23, '05
- Feb 9, '05 by BabyNurse513When we got really busy at my last hospital and staffing was not good, they offered an overtime bonus. On top of making time and half, you also received a $400 bonus for every 4 hours of overtime you did. So if you worked an extra 12, that was $1200 in bonus money. Of course it was taxed and overtime was considered anything after 80 hours and we worked twelves and considered full time at 72 hours so you had to work an 8 hour shift before you even saw time and half or a bonus but it still got people do to overtime. Once when we were really desperate, they asked nurses from another NICU in our health system to come and so overtime and some of them did. There was some crazy bonus they go for that but I am not sure what.
- Feb 9, '05 by KRVRNFirst of all, we have our ICN separate from our ICU. ICN babies can be on a NC or have an IV, but the IV can't be going at a fast rate and they can't be having excessive A/B's. So there would never be a situation where you would have 3 or 4 ICN babies AND be up for admit.
When we're short-staffed, we usually end up putting as many ICN babies as possible in 4 baby assignments. All ICU babies are in 2 baby assignments, and the nurse may still be up for admit as long as the 2 babies are not too heavy. They will not put a nurse with even one vent up for admit, NCPAP is okay though. We all know that sometimes a 2 vent assignment is more stable and easier than a NCPAP assignment or an admit, so we all pitch in to help our busier coworkers. The charge nurse may take an assignment, but not always since she is probably frantically calling staffing for more nurses! We also use registry nurses and we may get a nurse or two floated down form PP to work with ICN babies if PP isn't too busy (they usually are, though). The staffing office will then go about calling everyone at home... if we are really in deep, they will be authorized to offer crisis pay (DT), which usually gets nurses to come in. We don't have mandatory OT.
If they still don't have enough staffing and we're getting close to a shift change (most of use do 12hrs, but there's a few 8hr people), or we have nurses in truly unsafe assignments (a 1:1 baby in a 2 baby assignment for instance), they will call the manager and all the leads and ask them to come in. If it's day shift, they are usually already there and will come and help (most of them keep a set of scrubs with them for just this reason!). This can get us an extra 3 or 4 nurses. If our unit is close to full we will close to outside admits, but if our problem is merely not having enough nurses, we don't generally close. But usually not enough nurses=unit is hoppin' full!
- Feb 9, '05 by KRVRNRegarding what NoCrumping said about the neo taking in a baby that's been home for 2 weeks... Apparently the way our insurance/HMO, neonates p to 1 month old can be readmitted to the NICU (versus going to a peds unit)! They're usually r/o sepsis or hyperbili babies under about 2 weeks old, but one time we admitted a 3 week old baby from home with fever AND unexplained RASH!!! That's safe for a NICU with immunosupressed preemies in it?!
- Feb 9, '05 by BittyBabyGrowerWe only take back our own kids if they have been home less than 48 hours.
When shortstaffed, first we look for people to stay, we call people, then hope for a float. If that fails, then we load up the assignments...4 feeders, 2 vents and a feeder, etc. The charge person will also take a full assignment. We aren't allowed to mandate anymore, so all we can hope for is for help. I have to say that we are really good about staffing ourselves.
- Feb 10, '05 by sparkyRNThanks for your input.
I'll pass these suggestions along to my NM. However, It is an up hill battle to get admin to cut loose of any money. A couple of years ago we faced this same situation and they offered crisis pay (doubletime) to fulltime RNs if it was over their 40hrs for the week. We haven't had such an offer this time around. There is no policy in place that automatically kicks in when the staffing numbers are at a certain level below what is considered adequate for the pt. acuity. As a PT it's hard for me to get motivated to come in and do 12 hours for straight time when I know I'm going to work my tail off. Do any of your hospitals allow you to come in and work partial shifts in such a situation and still pay OT or DT?
- Feb 10, '05 by GompersWe of course first try to call people in to work, and when it's really busy (>80% capacity) we get "bonus pay" which is $50 per 4 hours extra that you work, in addition to your regular and overtime pay. We rarely get floats from NBN, PICU, or Peds, but sometimes we get lucky. When all else fails, we get agency NICU nurses to help out and they're usually very good. We don't have mandatory overtime.
Our charge nurse very very rarely has an assignment, the most I've ever seen is picking up 1 or possibly 2 feeder growers on those crazy nights where we get a ridiculous amount of admissions, but this only happens once in a blue moon. Our assigned admit nurses have easier assignments, like a couple of feeder growers, and if they get an admission they give those easy kids up to other nurses who are able to absorb them into their own assignments. It's nice because then we can totally focus on our new admits for that first shift.
The busiest we'll get...6 feeder growers, 2 stable vents plus a feeder grower, 3 non-vented but busy babies (CPAP, chronics, multiple IVs, etc.). On nights, we're such a good team that those crazy shifts are tolerable because we're always helping each other out. We get through the shift, and while it is busy, I can't say I've ever had an assignment where I felt the babies were completely unsafe...maybe just a little ignored (no cuddling, all NG feeds instead of taking time to PO, etc.) if anything. We don't have externs or nursing assistants, but our NICU respiratory therapists all take a special class (run by one of our nurses) to learn how to care for feeder growers and they really pitch in when we're busy. They can do everything except draw up and give meds (though if an RN checks all the PO meds and adds them to a bottle, the RT can then feed it to the baby of course). It's very helpful because they are great with the parents, and they're able to do baths, weights, vitals, PO and NG feedings, etc. We just need a nurse to do a set of hands-on vitals for each baby in the unit Q shift.
- Feb 10, '05 by kitty29Our unit is closed (no floating or floats), we do have a supplimental staff pool to draw from and we also call staff for OT or extra shifts. Sometimes we allow each other to work a shift for another one off as long as it doesn't drop below a base number we have all agreed on (right now it's 15).
We staff a free transport nurse and free charge nurse...but sometimes the charge nurse does take assignments (which is a bear). We try not to assign the transport nurse now so they can go on transport quicker...but if the charge nurse already has an assignment, the transport nurse has to take the new pt.
Since we have a very experience skilled staff we do carry heavey loads if we need to also...but we can do this now that we are closed...and don't have to look over our shoulders as we had to with floats.
We get time and a half for any hours over 40 per week.