NICU on another floor

NICU_Nurse, BSN, RN · Nov 20, 2003

Personally, I'm not comfortable with this, and they'd have to give me thorough evidence that ALL emergency situations (fires, loss of power that renders the elevator useless, coding babies, etc.) would be adequately thought-out before building it that way.

If NOTHING else, and it's MANDATORY that it be on a seperate floor, then I'd suggest that L+D be on the same floor, VERY CLOSE, to the NICU. You do NOT want to be forced to wait for an elevator with an ELBW preemie or another resuscitation situation. If it were up to me, L+D would be right next to the nursery, if not connected somehow (I've seen dept's with pass-thru windows, which is an ingenious idea IMO). Mother/Baby and Antepartum can be on a seperate floor- in general, it is assumed that these babies/moms are basically healthy and do not need next-door access to the NICU like L+D does.

While they're asking for your opinion, be sure to throw in stuff about infant security measures, room for family conferences, room for teaching, etc., and ask if they can put in a tube system (if they're not already planning this). Ask them how far away the NICU MD's call-room is from the nursery (I HATE when they put them on another floor- I have seen a baby code and not make it because our resident took their good old time waking up and WAITING FOR THE ELEVATOR because they didn't realize how serious the situation was (rather than taking the two flights of stairs down). Ask them what type of break area, bathroom, and locker area that they're planning. Ask them where the supplies are going to be in reference to your work area, and ask them about the desk space and how much is going to be available on a fully staffed night. Ask them to build a dedicated room attached to the NICU for parents staying in with an infant about to go home (for discharge teaching, etc. with those complicated babies). Where are the families going to wait when other family members are visiting? What type of space will be dedicated to the MD's (for dictating, etc.)?

Just off the top of my head. Now is your chance! I really wish the architects of the hospitals I've been in had taken the time to ask for the nurse's input on the design- we're the ones who have to work there, and it's SO much easier to just do it right in the first place then cut corners and then be screwed because it costs too much to fix it if it's wrong. :)

SmilingBluEyes · Nov 20, 2003

WEEEEEEEEEEEEEEEEL seeing as our closest NICU is 25 miles up the road, I can't see a problem with this. IF we can ship a baby up the road, I can't see why a baby can't go to another FLOOR in the same institution for such care. I don't see the big deal. IN the hospitals here, this is often the case where Labor/delivery, PP and NICU are ALL on different floors. It's how many places are designed.

SmilingBluEyes · Nov 20, 2003

Also I might ADD: most places with NICU have "boarder" rooms for families in-wait who have babies in the NICU. This IS appreciate by moms/dads more than you can know. (I was one of them ;-)

PegRNBSN · Nov 20, 2003

Part of the reason NICU is taking up so much space is that the babies are all getting private rooms with sleeping areas for families. The plan would be an elevator that would be used only for our floors, with a keyed system

Mimi2RN, ASN, RN · Nov 20, 2003

We have had very little input into the new unit that will be built for us. We are supposed to be right by the OR, and the same floor as L & D, very important. There will be a sleep room for family members. I must ask where our hospitalists will be.

There is flaw in the plan, however: right now we live in a cave, no windows to the outside world. One small window into the hallway, beside the door. No sunshine....and it's always been this way. Guess what....they are going to put us back into another cave! I suppose that the babies don't need daylight, and the nurses don't count. I work nights, anyway, but it would be wonderful to see the dawn of a new day, even if it's raining.

Do you have windows to the outside world in your units?

fergus51 · Nov 20, 2003

You didn't say what type of patients would be in your NICU. If you do generally level 2 type babies, then I wouldn't have a problem with it (like Deb, I have worked in places where the nearest NICU was in another city!). But, if you are doing the real level 3 stuff, I would want it on the same floor. Do you want to be in L&D with a 500 g 24 weeker, and have to wait for the NICU people?! As a former L&D nurse, and now an NICU nurse, I know I never would!!! I was never all that comfortable with sick babies.

If it has to be on a different floor, then a recusitation room (or 2) should be on the same floor and the recus team (doc, nurse, RT) should also be based there.

NicuGal, MSN, RN · Nov 22, 2003

When we remodeled the high risk floor they were 5 floors above us...try running those stairs for a delivery on the floor! I would have no problem with one floor up or down with an elevator.

We remodeled about 5 years ago..1/2 the unit has window to the outside, the others are in a the dungeon as we call it LOL. They also forgot to give us storage rooms and a locker...go figure LOL Our fellows and residents have sleep rooms in the unit.

Are you a level 3...I can't ever imagine having private rooms with sleep beds....sounds like you are going to have to set some fast and steady rules about those beds or some parents are going to be living there!

tennurse267 · Nov 22, 2003

I agree, I can't imagine the sleeping/private room for each infant thing. But when I worked NICU (and we were a level 3) we were 2 floors above our L&D with a keyed dedicated elevator and never had a problem. Incubators were kept in L&D, we had an emergency box with drugs, tubes, etc (large and heavy) and L&D notified us as soon as a potential problem arose so we were always on stand-by. While our neonatologist wasn't always at hand, we kept a resident in the unit at all times. No rest for the weary!!!

Texagain · Nov 22, 2003

Our APU, LD, OR, and Level 3 are all on the same floor, but our level 2 is one floor up as is the GN and PPU. We have 3 infant stabilization units in LD and each SU can handle 4 kids.

NCgirl · Nov 22, 2003

Hey guys- I'm in anesthesia school, not NICU or L&D, but I have seen this before. My old facility had a 45 bed NICU with some very sick babies, the only thing we sent out were babies who needed ECMO. The L&D was a floor above us, but literally right on top. Our NICU elevator (which was directly in the unit) opened up right outside the C-section rooms, and about 10 yards from the hallway with the L&D rooms. We never saw any problems that I know of, but was just a lowly nursing student doing some tech work in NICU. But just so you know, it is working at other hospitals who are taking care of really sick babies. Good luck with the planning, and I hope you enjoy the new facility!

Gompers, BSN, RN · Nov 22, 2003

I work in a 50-bed level III NICU and we have our OB and NICU departments on different floors. We don't have a special elevator or anything - we just take the regular ones. While it would be nice to have both units together, it's not always possible. Maybe because I'm used to it, it's not a big deal to me?

Each shift two nurses and respiratory therapists are assigned to be part of the high risk team. One RN and one RT hold pagers (the others are considered back-up in case of twins, breaks, etc.) and L&D pages us BEFORE a high risk delivery whenever possible (meconium, preemie, c-section) and we run downstairs, almost always getting there before the baby is born. Even if the baby is out and it's an emergency, we're there in minutes (besides, anyone helping with the delivery should be NRP certified to work on the baby in the meantime). We have everything we need in the LDR to recussitate and stabilize the baby, then we transfer to the NICU in an isolette ASAP. Usually once we establish an airway, a good HR, and good sats, they're easy to move. It's very very rare that the baby totally decompensates during the two minute trip between the units!!!