3 baby assignments

littleneoRN · Jul 18, 2009

We can have three baby assignments if they are truly Level II and ready for transfer out. But that doesn't happen very often because we try to mix kids by acuity. So it would be unusual to have three true level II kids in the same room. We have our own large Level II, so true Level II kids don't stick around our unit very long. We're much more likely to pair a Level II with a Level III.

MA Nurse · Jul 18, 2009

Only 1 out of the 3 babies I had recently was ready to go home...the other 2 were far from leaving...one still had a broviac with TPN and lipids. 2 out of the 3 were difficult to feed. They were not all truly level 2, that's for sure!

MA Nurse · Jul 18, 2009

Needless to say I complained and the assignment was supposed to be broken up.

iyqyqr · Jul 18, 2009

Consider yourself blessed if you only have a two patient assignment most of the time. I work in a 48 bed, Level III unit in the southwest US. We staff by a number matrix, rather than by acuity. We routinely have three babies; which can be 3 level 2's, 2 vents and a CPAP, a level 2 baby, a vent, and the admit, which is always fun. Our charge and transport nurse are not counted in staffing so at least one and sometimes 2 of them are available to assist, but they are helping all of us as needed with our rows of 3 patients. Day shift is staffed a little better and they will half the time have only 2 Level III babies, because "it is busier on days". We will soon move from an open bed unit to all private rooms and have been told that our assignments will stay the same. Needless to say, the staff has concerns.

MA Nurse · Jul 18, 2009

Wow, that sounds really bad....unsafe too.

Galore · Jul 18, 2009

I have occasionally had 3 baby assignments in Level III, but that's usually due to a baby in another nurses's assignment getting very sick so it's changed to a 1:1 midshift, or already having 2 babies and getting a new admission. Routinely having 3 (truly level III) babies seems unsafe and unfair to the babies and their parents.

UofAPNP2B, ASN, BSN · Jul 21, 2009

IYQYGR, I think we work at the same hospital in AZ. :) It's so frustrating because nobody in upper management seems to care that we all KNOW it's not safe. Where to go to get things changed??

NeoNurseTX, RN · Jul 21, 2009

Only 1 out of the 3 babies I had recently was ready to go home...the other 2 were far from leaving...one still had a broviac with TPN and lipids. 2 out of the 3 were difficult to feed. They were not all truly level 2, that's for sure!

If they're difficult to feed, then I guess they're nippling... so it sounds more like level II.

We get 3 baby assignments here and there but it's usually NC or CPAPpers. Last time I had one it was a mess...my CPAPper got intubated and a sepsis workup, one kid nippled and had an ostomy bag always coming off and had a broviac, and thank goodness the other kid was just on autopilot but I still had to nipple her.

NICURN29 · Jul 21, 2009

We can have up to four babies on the intermediate side of our level III NICU, and we can have up to three on our NICU side. It is rare to have an unstable kid in more than a two baby assignment, and our unstable Jets and Oscillators are 1-to-1 until the baby becomes VERY stable. I have had three kids with CPAP and lines before, but it's rare.

RainDreamer, BSN, RN · Jul 22, 2009

We never have three babies if we're in the unit ..... all those kids are real sick/unstable and are either 1:1 or 1:2.

In the step-down intermediate unit we always have three. Three of these kids is manageable though. They are on full feeds, no IVs, etc.

littleneoRN · Jul 22, 2009

So RainDreamer, if all the kids in your unit are "real sick/unstable," and the kids on the intermediate side are on full feeds and off IVs, where are the rest of the kids? Kids who still have IVs, O2, etc, but aren't unstable? I'm curious because in our Level II we are always 3 to 1, and this can range anything from stable full NG feeds (not much work) to labile hood box oxygen, HAL and Lipids, etc. Lots of our Level II kids are still on fluids, antibiotics, labile nasal cannulas, etc., and I'm wondering if these kids are 3 to 1 other places or 2 to 1. Just curious.