Any PICU RNs from CHOP or Boston Children's here? - page 2

by Sloan RN

2,575 Visits | 12 Comments

Hi everyone, I'm hoping that some of you work in the PICU at CHOP and Boston Children's, or knows someone who does. I'm looking for information on their staffing model to compare it to lower-ranked PICUs in the nation.... Read More


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    @jan, goodness that sounds like a mess!
    Our peds transport nurses don't typically hang out in the unit, I don't know what they do when not on transport. NICU transport stays in the unit and helps out if needed or will take a patient to MRI/Fluro etc
    As far as docs go each unit has their own dedicated attendings however there are a few cardiac attendings who will occasionally cover picu shifts. picu/cicu has an attending on the unit 24/7...for the cicu this was recently implemented in the last year or so because of dangerously high acuity for a few months. I believe they hired 3 new attendings during this time to get us to this point. We have peds ICU fellows and nicu fellows. The peds ones rotate between picu and cicu for a few months at a time, nicu ones stay in the nicu except for 2 months (in three years) that they do in the cicu to learn about cardiac babies. The only doc issues we have is that the picu team goes to all acute care codes so if a cardiac kiddo codes on the floor the picu team goes but like I said our docs are all pretty on the ball with the cardiac differences and you can bet if a cardiac kid is coding on the floor our charge nurse already knows about it and is sending our docs over. As far as nursing goes we all work in one specific unit unless we are floated which is rare, and in my hospital icu only floats to icu, acute care only to acute care. We also have an icu "float pool" to help fill the holes, these nurses are trained in all three units. All our units have unit secretaries, sometimes two, staffed 24/7, all the units are "locked" units meaning that visitors have to be buzzed in and our secretaries are usually pretty good about enforcing our 2 visitors at the bedside rule. All our icu rooms are private (including nicu) so that eliminates the isolation problem. We also do not decrease the level of care on a 2:1 assignment (or 3:1 in the nicu) so we still do hourly vitals, I&O, q4 hr assessments etc but our techs can also prime and hang feeds among the other things i mentioned which helps too. For breaks/lunch everyone is assigned a back up and it is written on the morning assignment sheet. Usually we only have to cover one other person but occasionally we end up in a 3-way but since we know ahead of time we can usually get a plan in place well before lunch. Respiratory therapists will only cover one unit for their shift (and we typically have anywhere from 2-4 RTs in each unit depending on census) but they are all trained in all the ICU's and will rotate between them. The role of the resource nurse in the cicu is continually being developed but they serve as a point person specifically for our newer nurses, to make sure they're on track, caught up, don't have questions about anything etc. we have found that this resource nurse is helping to get newer people working with the sicker kids sooner but not feel like they are completely on their own with them.

    Hope you guys are able to make some changes, that does sound like it's getting unsafe!
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    Sorry for the delay in responding, I fried my laptop and had to buy a new one! Each ICU does not have a dedicated transport team. CHB has their own transport team that does air/ground transports from outside hospitals, and they also use MedFlight which is our area critical care specialist team that also does ground/flight. CHB's own transport team will float to various ICUs to support staffing until they get called, and I believe the NICU does some of their own transports.

    Each ICU has a charge nurse and utilizes patient care associates (the name keeps changing, they might be clinical associates now but basically a fancy term for a tech). The techs assist with bed baths, some stocking, blood sugars, emptying catheters, vital signs, appropriate delegated tasks from nursing.

    CHB definitely staffs well. Every hospital has their challenges but I'd say the overall opinion at this hospital is that safety is paramount.
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    Quote from Sloan RN
    Hi everyone,

    I'm hoping that some of you work in the PICU at CHOP and Boston Children's, or knows someone who does. I'm looking for information on their staffing model to compare it to lower-ranked PICUs in the nation. Specifically, I'm looking for:

    1. Unit setup (how many beds, are they in physically separate pods, are cardiac and medical patients divided into separate units, etc)
    2. Patient:nurse ratios
    3. How many techs?
    4. How many receptionists?
    5. Ancillary nursing help (meaning nurses with no assignments…charge nurses, help all, etc)

    If anyone knows this information, feel free to reply to this thread or send me a private message. Thanks so much!
    Hello, and thank you for all that you do. I do not hope that you mind Children's Hospital Boston from a doula point of view, so please, take it from what it's worth because I don't want to step on anyone's toes.

    I'm giving my experience via my cousin who had a CDH baby and she wanted me to fly into BOS to help her deal with the unknown. I found CHB to be a wonderful hospital.

    1. Although I can't answer some of your questions, the CDH babies were all kept in one pod. There was one room for babies who were stable, and others for babes who weren't as stable.
    2. At the time I was there, the most were 1:2.
    3. Don't remeber the techs, but they might have been there and I didn't recognize there.
    4. Can't remember exactly.
    5. Yes, there was ancillary help.

    Sorry I couldn't help a bit more. But this hospital touched my cousin and myself in the way they cared for their son. They explained EVERYTHING they were going to do, and the only time that they asked my cousin and her hubby to leave the room was for suctioning. Although a baby in the pod died suddenly, the staff was uplifting to them. I even remember one nurse a a traveler.

    The experience at BCH was so great. And my cousin's boy arrived home in 6 weeks. I hope that does help.


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