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Acuity and Ratio

Posted

Specializes in NICU. Has 1 years experience.

How many pts are you assigned on a daily basis and their acuity level? What is the "standard"? I am wondering because in the NICU I work in, we have had an unusual amount of overflow babies where we have had to open a closed unit. Many nurses have had rather heavy assignments lately, and we have been short on nurses. We have had many instances where Level 2 and 3 babies are mixed together with assignments, and most of the time are left with no charge nurse and no clerk..... we are suppose to "share" with the other unit, but they don't really have time to be of use to us, so we are most of the time left with no supplies, left to scrounge for supplies, restock, put in our own orders, answer the door and phone. Mostly we have feeder grower assignments, but there are always others put into the mix such as babies on IV's, TPN, PICC lines etc.... People started complaining so the manager sent out an email to everyone saying that "4 babies is the standard" and it has been passed around that the director even made a comment that if we kept complaining that everyone was going to start getting 4 baby assignments all the time. Well it seems like that has happened, and it is even worse now because everyone is so tired, noone wants to come in and work any extra shifts to help out. Nurses are starting to turn on eachother because not everything is getting done on the previous shift and it just seems like it is turning into a nightmare. Its like if we bring up what I think are valid points, we get into trouble and they make it worse on us. Plus, there are "clicks" where a select group of nurses get better assignments or a regular basis, such as 2 babies and others will have 4. Can anyone shed some light on what the "NATIONAL STANDARD" is? I'm just wondering where she is getting this information. Thanks for any feed back!!

discobunni

Specializes in NICU. Has 1 years experience.

Newborns:

1:6-8* newborns requiring only routine care

1:3-4 normal mother-newborn couplet care

1:3-4 Newborns requiring continuing care

1:2-3 Newborns requiring intermediate care

1:1-2 newborns requiring intensive care

1:1 newborns requiring multisystem support

1:1 or greater -unstable newborns requiring complex critical care

Can anyone tell me how "continuing care" and "intermediate care" and "intensive care" are defined? What are the factors involved that place each pt in any particular category?

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

The last unit I worked in, we used a point-based acuity system. Vents and pressors were an instant 0.5 points, or 1 point if really critical. NCPAPs/NCs were made 0.33 points each unless requiring extra attention or teaching, (eg d/c teaching) (in which case they became a 0.33) Babies requiring no O2 or IV fluids/meds (basically gavage and po feeders) or phototherapy were given 0.25 points each. Each RN was to be given as close to 1 point's worth of patients. So you could have a vent and 2 NG feeders, or 2 vents, or 3 cpaps, etc.... 1:4 assignments were only given as 2 gavage feeders (not requiring any of the above therapies) and 2 decent PO feeders. In my 3 year career, I have rarely had more than 3 babies. Mostly 2-3 baby assignments. If you were a 0.25 pt baby, you were so close to going home that you needed extra teaching, and deserved 0.33 points.

We figured 3 admissions into assignments. So 3 nurses were given around 0.5-0.66 point assignments, with the extra admission figured in, so no one would have to pick up babies if they admitted....

Your manager shouldn't be threatening you with 4 baby assignments for speaking up. If you feel you cannot practice safely, speak up, and if ignored, file a complaint with the director of Women's & Children's services.

RainDreamer, BSN, RN

Specializes in NICU. Has 13 years experience.

We have "acuity sheets" that each baby has in their chart. We score them based on a number of things (type of vent, unstable or stable, number of lines, IVs, number of meds, labs/gases, drips, feeds, teaching for parents, fussy baby, wound/ostomy care, etc, etc.) Whatever their score is will give an idea of what kind of assigment to put them in (3:1, 2:1, or 1:1).

The acuity score needs to be re-evaluated each shift, as the score can change in a short period of time. Some nights with a 1:1 I've been bored to tears, yet some nights I'll be busier with a 1:1 than if I had 3 babies in the intermediate nursery.

I don't know if there is any certain standard as far as what defines "intermediate care", it probably varies by facility. We define our intermediate babies as those that have no running fluids and are not on NCPAP/vent (they can be on cannula). They're basically just feeder/growers.

The majority of our babies require "intensive care". The least intensive would be a running IV of TPN/IL and maybe some nasal cannula. The most intensive would be ECMO.

Generally speaking vents 1:1 (includes Cpap and Vapotherm as vents. Other ICN 1:2.

Intermediate 1:3

Charge Nurse and a High Risk delivery Nurse out of the count

And 1 or 2 break relief.

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

Generally speaking vents 1:1 (includes Cpap and Vapotherm as vents. Other ICN 1:2.

Intermediate 1:3

Charge Nurse and a High Risk delivery Nurse out of the count

And 1 or 2 break relief.

Holy Crap. I need to work where you do......

NeoNurseTX, RN

Specializes in NICU Level III.

Holy Crap. I need to work where you do......

No kidding!

Imafloat, BSN, RN

Has 13 years experience.

Generally speaking vents 1:1 (includes Cpap and Vapotherm as vents. Other ICN 1:2.

Intermediate 1:3

Charge Nurse and a High Risk delivery Nurse out of the count

And 1 or 2 break relief.

Wow! Do you get bored?

RainDreamer, BSN, RN

Specializes in NICU. Has 13 years experience.

Holy Crap. I need to work where you do......

You would be bored to tears though!

Our little micropreemies are 1:1 for the first week, no matter what. So even if it's a 24 weeker on CPAP or HFNC, they're still 1:1. So that's 2 rounds for the entire night (because they're Q6). It makes for a LONG night. Don't get me wrong, those little ones can keep you busy, but if they're stable, it can be quite a long shift ........ it's nice at times though, for a break.

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

In my present unit, I usually end up with a fresh postop Norwood-Sano or Arterial Switch who's a 1:1 for the course of my 3-4 shifts in a row. It's nice to be able to focus on only one patient, even if it means titrating pressors, pushing cellsaver and FFP all night, and drawing up my 8th syringe of NS bolus.

When I do get more than one pt, it's usually only two. I really can't complain. I do find myself getting a little testy if I end up with three cranky ex-cardiac feeders these days.

Guess I'm getting spoiled.

texas2007, BSN, RN

Specializes in NICU. Has 2 years experience.

In my present unit, I usually end up with a fresh postop Norwood-Sano or Arterial Switch who's a 1:1 for the course of my 3-4 shifts in a row. It's nice to be able to focus on only one patient, even if it means titrating pressors, pushing cellsaver and FFP all night, and drawing up my 8th syringe of NS bolus.

When I do get more than one pt, it's usually only two. I really can't complain. I do find myself getting a little testy if I end up with three cranky ex-cardiac feeders these days.

Guess I'm getting spoiled.

Phew im SO GLAD our post op hearts recover in picu! We just don't have the resources on our floor...I figured that out after a few pre-op cardiac codes.

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

That's why I'm here. I love the high-acuity and complexity of it. We're the only hospital in the area that keeps its cardiacs postop. We're pretty top notch when it comes to cardiacs.... we could do so much better with the rest of our pt population.

Our little micropreemies are 1:1 for the first week, no matter what. So even if it's a 24 weeker on CPAP or HFNC, they're still 1:1.

24 weeker on CPAP??! :chuckle

RainDreamer, BSN, RN

Specializes in NICU. Has 13 years experience.

24 weeker on CPAP??! :chuckle

Oh yeah, quite often. Either CPAP or high flow nasal cannula ..... although more often than not it's CPAP.

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

24 weekers on NCPAP here, too...

You don't get a vent until you fail IMV CPAP with a CO2 >70.

How many pts are you assigned on a daily basis and their acuity level? What is the "standard"? I am wondering because in the NICU I work in, we have had an unusual amount of overflow babies where we have had to open a closed unit. Many nurses have had rather heavy assignments lately, and we have been short on nurses. We have had many instances where Level 2 and 3 babies are mixed together with assignments, and most of the time are left with no charge nurse and no clerk..... we are suppose to "share" with the other unit, but they don't really have time to be of use to us, so we are most of the time left with no supplies, left to scrounge for supplies, restock, put in our own orders, answer the door and phone. Mostly we have feeder grower assignments, but there are always others put into the mix such as babies on IV's, TPN, PICC lines etc.... People started complaining so the manager sent out an email to everyone saying that "4 babies is the standard" and it has been passed around that the director even made a comment that if we kept complaining that everyone was going to start getting 4 baby assignments all the time. Well it seems like that has happened, and it is even worse now because everyone is so tired, noone wants to come in and work any extra shifts to help out. Nurses are starting to turn on eachother because not everything is getting done on the previous shift and it just seems like it is turning into a nightmare. Its like if we bring up what I think are valid points, we get into trouble and they make it worse on us. Plus, there are "clicks" where a select group of nurses get better assignments or a regular basis, such as 2 babies and others will have 4. Can anyone shed some light on what the "NATIONAL STANDARD" is? I'm just wondering where she is getting this information. Thanks for any feed back!!

Wow, that sounds scary, discobunni. I just started working in a NICU as a unit secretary and it is a lot busier than my other unit secretary positions...between admissions directly from the DR or via the NBN when situation warrants, transports in and out, discharges with making sure that follow up docs get all the pertinent information, phones, stocking, running to blood bank or lab (done at night by the unit secretary), it can get very busy. Now, I personally love it and I really go to work with a smile on my face, but that is also because the nurses enjoy working there.

We have 4 different acuity levels. With 1:1 for the most critical to 1:4 for the feeders and growers. Usually all babies coming on to the unit from the DL are 1:2 to start.

Your unit sounds like it is one step from some serious problems.

Kris

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

Doesn't Acog put out standards? I know I've seen them somewhere, but darned if I can remember.

Our acuity/assignments flucuate, depends of staffing also. The most kids we get are 4 gainers/growers....I hate to sit and feed those kids LOL. Our vents are usually paired with another stable vent or one to two feeders.

Oh yeah...24 weekers on CPAP or NIMV, those kids are sometimes worse than an intubated kid!

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