Questions about staffing a small peds unit

suzanne4, RN · Jun 12, 2005

Minimum safe staffing guidelines would mandate at least two licensed personnel on at all times. What happens if you have an emergency? Where is your back-up? And what skills do they have?

Federal law also mandates that you get one 15 minute break for every 4 hours that you are working. This isn't a luxury but a Federal Law that must be followed. And if they aren't giving you breaks, as well as lunch, are you billing them overtime for it?

Unfortunately, it is going to take one crisis to occur and then I promise that you will always get what you want, but that will be after a patient essentially owns your facility because of a management issue. Just make sure that you document fully for each shift what your staffing consists of and what you attempted to do about it.

oldcurlyrn49 · Jun 12, 2005

I appreciate your response. My co-workers and I agree with everything

you wrote! There was a situation years ago, where a child died in Peds,

one nurse working on nights no one else. It took more than a few min.

to get a response from the code team. The nurse did everything within her power to save the child, but valuable time was lost gathering staff to help her.

As it turned out the child had an undetected congenital heart condition

and would have most likely died anyway. However the nurse that was working that night was and is an excellent peds nurse, the point being

it doesn't matter how great your nursing skills, are you need backup!

After that incident, the staffing module was changed to 2 RNs for every pt.

no matter what shift. However the manager we currently have states "this

is too costly", how can you put a cost on a child's life? This same manager

has not done bedside nursing in "years" and admits she "doesn't know much

about pediatrics". Our kids are coming in sicker and sicker, at times they need 1:1 nursing care.

We have the NICU for backup, but they admit "aren't comfortable", just

as I would not "be comfortable" taking care of one of the vent baby's.

NICU and PEDS are specialized areas,my co-workers and I don't want to

be teamed up with a CNA who "really, doesn't like kid's"!" "Can't do vitals on babies" We are told we need to "delegate better".

As for punching "no lunch" we have to ask permission from the manager!

renerian, BSN, RN · Jun 13, 2005

That ratio is horrible..........................not safe.........I would outta there quicker than you could blink your eyes.

renerian

mydesygn · Jun 19, 2005

I appreciate your response. My co-workers and I agree with everything
you wrote! There was a situation years ago, where a child died in Peds,
one nurse working on nights no one else. It took more than a few min.
to get a response from the code team. The nurse did everything within her power to save the child, but valuable time was lost gathering staff to help her.
As it turned out the child had an undetected congenital heart condition
and would have most likely died anyway. However the nurse that was working that night was and is an excellent peds nurse, the point being
it doesn't matter how great your nursing skills, are you need backup!
After that incident, the staffing module was changed to 2 RNs for every pt.
no matter what shift. However the manager we currently have states "this
is too costly", how can you put a cost on a child's life? This same manager
has not done bedside nursing in "years" and admits she "doesn't know much
about pediatrics". Our kids are coming in sicker and sicker, at times they need 1:1 nursing care.
We have the NICU for backup, but they admit "aren't comfortable", just
as I would not "be comfortable" taking care of one of the vent baby's.
NICU and PEDS are specialized areas,my co-workers and I don't want to
be teamed up with a CNA who "really, doesn't like kid's"!" "Can't do vitals on babies" We are told we need to "delegate better".
As for punching "no lunch" we have to ask permission from the manager!

The sad thing is that nothing will change until the physicians began to voice concerns to hospital administration . I once took a job as a prn nurse for a small, 6bed peds unit in an adult hospital. Typical patients were RSV, asthma , etc. A dedicated pediatric hospital was nearby so the really sick kids went there. Post - partum patients were also overflowed to this unit. The theory was that since the kids weren't sick then one nurse could capably take care of the patients. Often I would have to answer phones, restart IV's etc.. One night a physician even brought a baby up to do a septic workup. After that, I walked out of there so fast. Prior to this, the physicians had refused to admit patients being fully aware of the stafing and how unsafe that was. When the physicains complained, that is when it became a "problem". A CNA is worthless to you, you need two nurses on that, typical peds ratio are 4:1 on days and 5:1 on nights so actually you should have more than 2. They should consider prn pedi pool who can help cover shifts as well. I work in moderate sized pediatric hospital and we don't put DKA with drips on the floor -- they need such close monitoring.

margeux · Jun 26, 2005

:crying2:

We are currently at odds with management as to how best"staff" our 14 bed
pediatric unit.Our patient's ages range anywhere from neonate to 18yrs.Our acuity varies from day to day. On any given day we may be caring for a sickle cell pt. with an "acute chest" who needs a blood transfusion, a severe asthmatic on cont. nebs, surgicals,and a DKA on an insulin drip.Our policy in the past has been to staff with a minimum of 2 RNs at all times.We should also mention we do not have a PCA that regularly works on our unit. That means the 2 RN's are responsible for baths, linen changes, answering all the call lights,passing meds, etc.We also transport our pts to the door at discharge.
Some days we are also entering our own orders on the computer, answering the phone, and letting in visitors, because we do not have a secretary all the time.We rarely get breaks, or a lunch,our manager has told us the hospital does not "have " to provide us with these luxuries!(?)
Most days it is do-able, however there have been times both RNs have been
busy in the treatment room starting an IV, call lights are going off with no one to answer them immediately. We have been fortunate so far that nothing terrible has happened.Management has recently been trying to staff with 1 RN and a PCA, while the other RN stays at home "on call". Not only has staff been losing hours,morale is at an all time low, with many of us looking for other jobs.There are many days one RN has to leave after 8hrs.(we work 12's) on call, replaced by a PCA who may or may not be familiar with our unit, with the expectation we could be "called back" at any time before the shift ends. Some of us are crossed trained to the NICU(our sister unit) but their staff have been losing hours also. All of us work peds because we love it! However we also have car pymts., mortages to pay. The ironey is our unit is
part of a brand new beautiful buliding that adjoins the main hospital, it was built specfically for Women& Children", in the community. We continually meet with management to discuss our different views on staffing. It would be interesting to know if other small pediatric units experience some of the same problems.

my hospital had the same problem so what they did was train a few nurses to be intervention nurses. taking care of areas where they were needed as pertaining to kids or babies, they go to er if lots of kids or need iv 's started or for anything relating to kids down there or to nicu just to help feed the slurps and burps or give the staff a break, also to mombaby to help out with feeding baths or giving moms breast feeding instructions when they don't have time to do those things and to L and D to help with normal birthed babies. maybe you could utlilize some of your nurses like that. also we do conscious sedation for procedures , mri, ct scans or ivp/vcug, when ever the kids need sedation, that also gives everybody some hours. maybe some of that will help. our ratio is 1:3-4 and we do primary nursing. and also have all the dx. you mentioned. we almost had a disaster such as yours when administration decided to staff with a rn and a pca. there was a code and it almost wasn't a good turn out. so they quit that practice.

maybe this helps let me know

margeux

ajohnson8407 · Jul 14, 2010

Im an RN currently in a similar situation as you. I work on an 8 bed pedi unit that staffs only one nurse until she reaches 5 pts. no aide, no sec, you are alone. and did I metion we are now a locked unit and have another phone to answer (the door) that I have to actually walk to let ppl into there is no buzzer. It's like having another patient.

does anyone know if there are laws against this or have any ideas of how staffing could work in this situation from a mgmt point of view. I am having a staffing meeting with my CNO and I want documentation to take with me to the meeting.

concernedrn! · Jan 3, 2011

Im an RN currently in a similar situation as you. I work on an 8 bed pedi unit that staffs only one nurse until she reaches 5 pts. no aide, no sec, you are alone. and did I metion we are now a locked unit and have another phone to answer (the door) that I have to actually walk to let ppl into there is no buzzer. It's like having another patient.
does anyone know if there are laws against this or have any ideas of how staffing could work in this situation from a mgmt point of view. I am having a staffing meeting with my CNO and I want documentation to take with me to the meeting.

I'd LOVE to know what happened with your situation and your CNO meeting! We are having the same problem in our small peds unit in CA. We are all alone, no aide, secretary, nobody. We are trying to get help from our union but nothing has come of it yet.

HRM672 · Jan 16, 2011

When I first read your post and it said 2 RN's I assumed there was an LPN also! This sounds completely unsafe to me. When kids go bad they do it fast. I work on a 27 bed unit, so we don't have the same staffing issues, but we do have a rule (which rarely comes into play, but has before on Christmas, etc) that there are a minimum of 3 nurses. Period. Even if we are down to 3 kids. It seems like at the VERY LEAST there should always be 3 people, even if the 3rd is a PCA who can help with call lights, phones, etc. I don't understand how they would expect 2 nurses to be starting an IV, an no one else available to monitor call lights, etc in case of an emergency. There are alot of activities which require 2 nurses and would leave no one available. Double checking high alert medications, helping with kids who are fighters, starting IV's, starting/dose changes on PCA's or drips, managing kids who are deteriorating, doing sterile procedures or dressing changes....the list is endless.