Best staffed specialty?????

[BeenThereDoneThat74]

i pose this question, because i am curious what everyone thinks. i've decided i'd like to work in the 'best staffed' specialty :chuckle . we all seem to think "the other units" get staffing priority. so i'm wondering if anyone will admit to working in a specialty that is (or better yet, has to be) the best staffed.

[RN4NICU, LPN, LVN]

NICU where I work is almost always well staffed. Vented pt's are 1:1, Charge nurse has no assignment, we also have a nurse for deliveries that has no assignment, and we try to have a break relief person with no assigment.

I think I want to come work with you!

It is not at all unusual for nurses in our NICU to have 4 pts (usually 1-2 of the 4 are still on oxygen and/or IVs), and having 2 vents is nothing out of the ordinary either. Almost nothing is 1:1 except maybe HFOV/HFJV and/or INO, and I do not doubt for one minute that they would pair those up too if we were in a staffing pinch (or maybe give one of the other nurses FIVE)

[BittyBabyGrower, MSN, RN]

Our ratio is anywhere from 1:1 to 1:4, depending on the acuity. We don't have many problems with staffing usually and it is very rare that we have more than 3 kids, no more than 2 vents/trachs. Our charge nurse doesn't have an assignment...she is the one that picks up the assignment of the transport nurse or the admit nurse. Our transporter usually only has 2 kids, 3 max. We'll do 4 feeders if we really need to :)

[Gompers, BSN, RN]

Another vote for NICU. I think part of the reason is that many NICUs have low staff turnover rates, so they're less affected by the nursing shortage. And even the busiest NICU assignments I've ever had are NOTHING compared with the kind of workload you'd get on a regular patient floor.

Now, if you really want to have "appropriate" staffing, go to California where they have safe staffing laws in place. In other states, I'd stick with the ICUs and stay away from the floors.

[TiffyRN, BSN, PhD]

I work NICU now after years on the floor with adults. Whereas I think our NICU has heavier assignments than other NICU's there is still no comparison. The workload is nothing compared to what I had to do as a floor nurse. I no longer drenched in sweat every night from 7p-10pm like I used to. There are still very busy shifts but nothing to compare. We also have a charge nurse without an assignment and also a delivery nurse without an assignment. That is usually how we mange to keep our assignments reasonable. If things are very very short then one or both of those will take an assignment and take turns going on deliveries.

I moved to NICU for several reasons. One of them was because I felt that the Mother/Baby/L&D/PostPart areas of the hospital got preferential staffing to med/surg. They make more money for the hospital, they are a big Public Relations area and also one of the most litigious areas of the hospital. Having worked in this area now for a couple of years, I'm not sure how right I was (since I almost never go out of the NICU) but I do know I don't have to work as physically hard as I used to.

I also know of several other nurses who came from med/surg areas to NICU and none of them would ever go back. As far as I know the only person who has ever left our unit to do anything other than NICU or PICU went to CRNA school.

[CritterLover, BSN, RN]

where i work, its definatly the er. not that we arn't short staffed at times, but our level of short staffing is never anywhere near that of the floor units. or the icu in this hospital. a friend of mine once pulled a shift in our icu. he left at 3am, and they were begging him to stay because otherwise the charge nurse was going to have five patients when he left....all of the other nurses already had 4! and we don't get pulled, because you never know what is going to happen in the er. i feel so bad for those floor nurses sometimes, getting their 7th or 8th patient when we are slowing down and don't have a whole lot more to do. we used to hold patients a while in those situations, but now with the nation-wide push to limit er stays to less than 180 minutes, (or is it 120?) we have to get them out as soon as we get a bed. from what i've read on these boards, our er is also pretty well staffed in general, even when we are running short. and we will close down rooms if need be. we average 4 patients per nurse, and our charge nurse doesn't have an assignment when possible, which is frequently the case. i know there are some ers that have 8-12 patients per nurse, and i try hard to remember that any time i feel like i am having a bad shift.

when i worked in an icu at a different facility, it was the norm that at least 1/3 of our staff would have a 3 patient assignment. i don't remember any 4 patient assignments, though there were times when i was in charge with 2 or 3 orientees who each had 2 patients apiece. (we had a 23 bed unit). and to only have 1 patient, well that only happened if you had an organ donor, and then someone had to pick up your extra patient (or 2 patients).

[pebbles1977]

So far in L&D I see the staffing to be pretty adequate. At least in our facility, they try to go by the national standards. Of course, call outs, etc can affect that. But the nurses do help out each other almost always and the standard of care is high.

Ask me in a year, I may have a diff perspective, as I'm only 2 mos old in this job. But it sure is diff that the gyn/gyn onc floor I was on before! (the one the med surg RNs said was "specialized" and treated diff than them; not so, just great teamwork and a great work ethic there).

[Jolie, BSN]

I've worked in a number of NICUs where the staffing ratios varied widely. One unit in particular was always short staffed. I consistently worked 12 hour shifts without meal or potty breaks. Not that the rest of the hospital was any better. But I think NICU is inherently more do-able than most units because all of your patients are always with-in eye-shot. No running the length of a hall to get from one room to another. Also, the care, while mentally demanding, is not physically difficult. All of nursing is emotionally and mentally draining. Fortunately, NICU nurses are spared (for the most part) the physical toll other nurses experience.

In my experience, L&D seems to have the best staffing.

[live4today, RN]

I don't recall ever working on a unit where staffing wasn't pulled from time to time.

[BeenThereDoneThat74, MSN, RN]

where i work, its definatly the er. not that we arn't short staffed at times, but our level of short staffing is never anywhere near that of the floor units. and we don't get pulled, because you never know what is going to happen in the er... we used to hold patients a while in those situations, but now with the nation-wide push to limit er stays to less than 180 minutes, (or is it 120?) we have to get them out as soon as we get a bed. from what i've read on these boards, our er is also pretty well staffed in general, even when we are running short. and we will close down rooms if need be. we average 4 patients per nurse, and our charge nurse doesn't have an assignment when possible, which is frequently the case. i know there are some ers that have 8-12 patients per nurse, and i try hard to remember that any time i feel like i am having a bad shift.

this surprises me, that you are so well staffed. i would think in the ed (as in l&d), because the census is completely unpredictable, that this would pose staffing issues. do you guys take call (like if it gets really busy, someone has to come in)? i've always wondered how they figure out staffing in the er. you must look at trends to figure out when the busiest days or hours are. hubby says they do that in ems.

a friend of mine works in the peds ed, she is night charge. she says she's not supposed to take pts. if she doesn't, it's typically 2 nurses, one of which has to be ready to triage at all times (and this is a trauma center) so she ends up taking pts., to prevent her nurses from drowning :uhoh21:

your comment about the 120 or 180 minutes explains a lot (from a floor perspective)!!! needless to say, it doesn't matter if there are enough nurses on the floor to take care of the patients safely. but i suppose that's an ongoing battle.

[BeenThereDoneThat74, MSN, RN]

another vote for nicu. i think part of the reason is that many nicus have low staff turnover rates, so they're less affected by the nursing shortage. and even the busiest nicu assignments i've ever had are nothing compared with the kind of workload you'd get on a regular patient floor.

now, if you really want to have "appropriate" staffing, go to california where they have safe staffing laws in place. in other states, i'd stick with the icus and stay away from the floors.

i know most will agree that it's not about the #'s but the acuity. but i think there's something to say about a 1:1 or 2:1 ratio, in a controlled environment. no matter how sick your 1:1 is, that's all you have!! i've taken care of 1:1s or 2:1's, and it's just easier. and you have monitors and medical staff supporting you, and most likely, other nurses with only 1 or 2 pts as well. instead of 10 pts with one other nurse who has 10 as well. you don't have to worry about what your 8 other pts are doing, behind a closed door, un-monitored, all the way down the hall.

[Limmywinks]

Do I work at the only crappy NICU in California? We have 4 babies all the time. For vents we get only 2 but I have had a vent with 2 other patients before. We do get a resource nurse but she has to do transport so she isn't always there. And the charge nurse is probably too busy figuring out ways to manipulate the state law. 4 babies is not an easy assignment. Babies are needy patients, NICUs don't have aides and because its an ICU you still have to asses q3 which is nearly impossible because it takes each baby 30 minutes just to feed. It could be worse though. In Nevada and Arizona they get 4-5.

[grimmy, RN]

in my unit, it's 1:1, sometimes 2:1 - of course, that's in the or. i never have more than one pt at a time.