This is a survey about staffing. The background: our unit does 65-75 deliveries per month and the LDR's, postpartum, and nursery are all in one area, and the staffing currently is done for all units together, not by each separate area. Although the nurse manager wants to have a Level II nursery and although there are flyers out at job fairs that say we have one, we were told yesterday in a staff meeting by her supervisor that "you do not have a level II nursery, you are not a Level II nursery, and you might not become one." So that being said, our dilemma is this: Do we staff with an NICU nurse or not?
Most of us feel that having an NICU nurse available is adequate unless we have a baby, and several of our regular staff are cross trained for that area. We do get deliveries that require that kind of care occasionally, but most times those babies are transported out, sometimes to come back to grow/gain, but on a percentage basis, I'd say our nursery is vacant at least 90% of the time. The nurses almost all agree that if low census leaves only 2 nurses on the unit, then we'd rather have 2 L & D nurses. The nurse manager wants to staff for the NICU patient that might walk in the door. Our question is what if 12 labor patients walk in the door, which is more likely.
I should add that we are not remotely located. Transport to tertiary care is easy, efficient and easily achieved.
Recently, the nurse manager made a decision to low census up to 9 nurses over a week's time, and call in the ON/CALL nicu nurse (at OT) to cover the NICU. There were no babies in the nursery, and no one in labor for those shifts. Yes, it was grieved; yes, the grievance was granted; yes, this is a perfect example why you should have a strong union.
So now, she's asking for our input, although it is rare when she actually does anything but round file it. In any case, we're looking to get input from other like units on how they deal with this issue.
On another issue,we're being told that at times we can have an extra RN or the ASP (unit secretary), sort of like being given the choice of buying a rowboat, or Ferrari, but not both. In any case, something goes lacking. I just shake my head and want to say that I surely hope and pray that the next time you fly on a commercial airliner the pilot doesn't have to leave the cockpit to serve your meal because the cost to have both the pilot and the flight attendant was too much to handle.
We're supposed to meet again in two weeks to share what we've found out and make suggestions. Thanks in advance.
Jun 15, '00
HI! We have 8 ldrp rooms, 4 triage rooms, 1 OR and recovery, and 12 private rooms for gyn or c/s pts. we do 80- 100 births a month. We also thought we were a level 2 but recently found out otherwise. Although we keep baby for o2, ivs, uac lines etc. we do not have ventilator. we also are union. Anyway our staffing guidlines are a MINIMUM of 5 nurses at all times unless no pts we can go to 4 nurse. We always have 1 who can do what we call scn (special care nursery) at least 2 for l&d and prefer 3. we have a call system for hours of 11am-7pm and 11p-7am. the other hours mgt. will have previous shift stay. Our unit is not all crosstrained either. right now we have l&d, mother/baby nurse and staff rn in the well nursery because pts don't keep babies in rooms 24 hours. Also we have scrub tech and secretary but no aides. sometimes we will only have scrub on call if one calls in. I can't imagine ever just having 2 nurses in the unit!!! I know we would grieve unsafe staffing on that one!!