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!!
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.
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.
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!
I had him again after about 2 weeks. Hes now been on it for close to 3 weeks, and we went down to a PEEP of 7. His nose is red, but amazingly no breakdown. Though he screams bloody murder every time I touched it. I'm sure his nose is sore.
I'm honestly surprised they didn't just reintubate. I'm hoping we can get him off tomorrow.
Oh yeah...24 weekers on CPAP or NIMV, those kids are sometimes worse than an intubated kid!
I know CPAP is great for these little lungs but I feel so mean strapping it to their tiny faces, plus they always seem to be so much more irritable. Give me a vent any day (but don't tell the NNP who's trying to get all our tiny ones onto CPAP!).
We've just finished a randomised trial actually, either vent or intubate, give curosurf and put onto CPAP. Will be the long term outlook that gives us our answers though.
From the data I've heard lately, most trials in progress and newly completed are all saying that the INSURE method is becoming the gold standard for all preemies.
Intubate
Surfactant
Extubate
....to nasal CPAP, Vapotherm, HFNC, etc... no ventilation unless required.
I can honestly say that this approach makes the most sense to me. I can't wait to go somewhere that actually does this, like my old unit did. Here we do the NCPAP method. CPAP. Nothing else. No one gets surfactant except as a rescue. (seen it 2x in a year) And your CO2 better be >70 to get a vent.
SteveNNP, MSN, NP
1 Article; 2,512 Posts
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.