Care Teams vs Primary Nurse? What do you do?

[kellsM]

Hi this is the first time I have posted here but I need some help before we all leave my current NICU!!

I work in a small (18 bed) NICU that is mostly single rooms except for 2 3 bed rooms. Our staff is about 56 nurses and that is a mix of full and part time nurses. For as the past 20 plus years the staff has self scheduled in 6 week blocks with a few rules regarding nights and weekends and we also signed up to be part of a primary team. The problem is last year when my nurse manager complained that no one was signing up for teams so she wanted to make preassigned teams. We tried it out on one baby and it worked but when we had 6 teams it was terrible.

One time switch and the whole week was a bust because now there were 3 team 2 nurses and no team 1 nurse. After 6 months of this we transitioned to 4 teams with more nurses but now our self scheduling has been taken away and we have to schedule around the other 10 nurses on a team, needless to say people are not happy with their schedules so they are again making switches and if we are not able to switch within the team then we go to the whole unit ... the moral of the unit if terrible right now, no one feels like they have any consistency and we all just feel like a number and not a nurse. Our CCI numbers are no better with the current 4 team plan than they were with the 6 teams but someone at work just suggested that we go back to the 6 teams again!! My boss wants our ;cci number to be less than 0.6 and we have been in the 0.6-0.9 range...

Our unit is hard in that it is small, we do transport, CVVH, ECMO and surgeries...so there needs to be a nurse on every shift that can cover these istems also we have 2 nurses that are pulled every time plan to do charge, so they are out of the basic staff numbers. We traditionally staff with 7 or 8 nurses and then a nurse for transport. When we are busy we do not have a large per diem pool so we pull constantly form other days of the week.

My questions are:

1. Is your NICU looking at the CCI and if so what changes if any have you made to improve this number?

2. How are you assignments made? Primary, team or something different?

3. How do you make out your schedule?

4. Any thoughts on what might help us??

THANK you so much for taking the time to look at this and offering any help you can!!

[BittyBabyGrower, MSN, RN]

What is CCI?

I don't quite understand how you do your scheduling...you have teams that have to have the same schedule to take kids? We do primary nursing and we just self schedule (we have over 100 nurses for our over 50 bed unit). We usually staff 14-18 depending on our yearly acuity levels (determined by the previous year). What you guys are doing sounds too chaotic.

We do our schedule in 4 week blocks, we get 6 requests for days off, etc per 4 weeks. We have to work one full weekend and one Saturday or Sun. We have to work 2 Fridays and 1 Monday. It goes to the schedulers and they can move some of your days, but not your requests unless 50 people want it and then it goes by seniority. We don't schedule around anyone else. Primary nursing works better than team nursing.

[umcRN, BSN, RN]

Huh?

What is CCI?

We do self scheduling. We have a 56 bed private room unit. Assignments are made by the charge nurse based on patient acuity. If a nurse wants to sign up to be a "consistent" caregiver they may do so and they will have that baby for the remainder of the patients stay during all of their shifts. Not all babies have a consistent caregiver and some have more than one but no one is forced to care for the same patient all the time. For many of us that would become boring. Most chronic, long tern kiddos end up with consistents anyways so thats good for the patient/family

[kellsM]

Thank you for your replies...CCI is the continuity of care index..it looks at how many nurses have taken care of a pt in a specific amount of time...my nurse mananger is trying to lower our numbers. If 7 differnt nurses cared for one baby over a week..so 14 Possible shifts(we are allmost all 12 hrs) then the CCI is 0.5, more nurses in that time then the number goes up. We are currently trying to make our schedule out so that there are 2 nurses per team every shift. It has been so hard to go from self scheduling with few rules and minimal problems to such a specific schedule. It need ideas of what other units do to present to my boss to try to get her to understand that this current system is not working:(

[umcRN, BSN, RN]

I don't know. That just doesn't seem like a good practice to do with such a small unit. Pain for the nurses especially being unable to maybe have certain days off that you need. Yes I agree that continuity is good for the kiddos but not at the expense of the nurse. Typically in my unit a nurse will get their same assignment back if they work multiple days on a row and then whenever the kid has a consistent they get that nurse, but the nurses don't change their schedules based on who is going to be a nurse for which baby...definitely wouldn't work well in a 56 bed unit! But also doesn't seem right for an 18 bed unit either

Have you found other units that use this "CCI" method? Because I've never used it...what is her reason for wanting to implement it, I feel like there should be an easier way to give consistent care that doesn't mean the nurses all have to move their schedules aorund.

[nicurn5a]

My Unit does CCI but we call it FTE. A full time employee is a 0.9 whereas a part time employee is 0.6. It takes 3 part time employees to replace 2 full time employees. It has something to do with hours worked and paid. Any way, we just assign nurses according to the accuity in the unit and the nurses experience level. If that nurse works several days in a row, she/he usually gets the same team of patients back. There are exceptions especially when we get in new babies or more critical ones.