Charge and Resus --How does your facility do it?

NicuGal, MSN, RN · Jan 31, 2014

We don't usually go to deliveries since we always have an NNP, a fellow and 2 residents on during off shifts and a zillion people during the day, but if they need help it is the person who has the admit that goes. If they call for yet another person then it is the charge nurse. Our charge usually doesn't carry an assignment and our admit people usually only have 2 feeders when staffing let's us.

aerorunner80, ADN, BSN, MSN, APRN · Jan 31, 2014

When we are ideally staffed, we have 18 nurses on including one charge who never takes patients and 1 flex nurse who ideally wouldn't take patients but may have 1 very easy patient. Sometimes the charge goes to deliveries and sometimes the flex goes to deliveries. Sometimes if it has been busy and it is just a walkover, a nurse with an assignment can go if it is an easy assignment. I have also gone to deliveries when I am first admit which is really nice.

Our policy is that even though we have a lot of people on every day (Attendings, Fellows, Residents, NNP's, etc) an RN has to be present every time the team is called over. Typically it will be one RN, one NNP, and maybe one or two med students or Residents who go over. If we are called over 911, then we have an RT, Attending, Fellow, NNP, RN (sometimes 2)...basically anyone who is available to go, goes.

This system seems to work out very well for us.

Bortaz, MSN, RN · Jan 31, 2014

Those of you who go to c-sections: Are you required to scrub in and catch the baby at the table, or is the baby placed in a warmer for you? Yes, I hate scrubbing in.

NicuGal, MSN, RN · Jan 31, 2014

We don't scrub in...they never call early enough! We just gown up and the fellow catches.

rnkaytee · Feb 1, 2014

Bortaz - we don't scrub, the docs just set the baby on the sterile blankets.

Bortaz, MSN, RN · Feb 1, 2014

Maybe it's because we don't have residents/NNP/Etc, and it' usually the RN and an RT (With Neo ambling in after the baby is out), but we have to scrub in every time and take the baby off mom's legs.

prmenrs, RN · Feb 1, 2014

We had a charge who did not take an assignment (believe me, she was busy enough w/staffing and helping wherever needed), 3 "admits". 1st admit had the lightest assignment, and on down. You stayed 1st admit til you got a baby. You had to go to any hi-risk delivery, along w/an RT and the fellow. If the baby needed to come back to the unit, you admitted it. 2nd admit is not 1st admit.

Another hospital in the area has a dedicated transport team, but on occassion, we did transports. 1st admit hands off his/her pt to someone, goes on transport w/RT and fellow and other personnel as needed. (eg, twins).

On occassion, 3 admits was not enough. Healthiest babies went to the less acute nursery areas, thus creating another admit.

C-sections--Fellow or resident scrubbed in, RN and RT waited, checking things on the warmer obsessively and compulsively.

Our unit was a 40 bed Level 3 w/20 beds "ICU", and 20 beds "convalescing" babies. Assignments in ICU were 1:1 or 2:1; in the lower acuity 2 or 3:1.

In theory, all nurses were able to work all areas, including going to deliveries and transports; in practice, some folks were always in ICU, some were always in the other areas.

ckey01 · Feb 1, 2014

Our charge nurses do not take an assignment. They have a multitude of duties involved with staffing and admissions and help out around the unit.

We are a 107-bed Level III NICU so we get a lot of deliveries. Because of that we have a dedicated resus team that goes on all high-risk deliveries (accompanied by an RT, NNP, and sometimes a Fellow or Resident). They handle the entire admission process and the baby's first 4 hours in the NICU. They are then handed off to whichever RN is first-admit.

HopefulRN2010 · Feb 1, 2014

Thanks for all the suggestions so far! It sounds like most of you work in teaching or large NICUs! We are a small unit, only "supposed" to be a 15 bed unit. However, we have had up to 27. So we are MUCH smaller than the hospitals most of you work in! We also are not a teaching hospital, and since I work nights we do not have an NNP and the MDs on just on call. We go to all c-sections and any other "high risk" delivery. So for us going to deliveries is the biggest time consumer of our charge nurse. So if they want to separate charge/resus it just makes sense to me that they would at least give charge a baby. And then have a 1st admit like it sounds like most of you have. Thanks again everyone!

And Bortaz- We have to scrub in and catch for preemies; but for full term c-sections they place the baby in a sterile bassinet.

dseem13 · Feb 1, 2014

I work in a Level III 42 bed NICU (14 being intermediate beds). Most nurses are vent trained and trained for deliveries. The nurses that are on admits attend the deliveries with at the very least a NP and RT. If it's a known preterm delivery the MD with attend as well. We are not a teaching hospital so we do not have fellows or residents. You know first thing in the morning if you are first or second admit. I think you just have to be really flexible because you never know what's going to happen (ie those times we get 5 babies in a shift).

If it's a c-section the NNP scrubs in and will catch the baby. She will then bring it into our stabilization room (right off the c-section room) where we have all resuscitation equipment ready to go, and it's much warmer than the c-section room (ie 78-80 degrees).

If it's a micropremie you can ask the charge nurse to attend with you (or any delivery you may want an extra set of hands). Our charges do not take patients unless we are really short staffed. Admit assignments typically consist of at least 2 if not 3 other babies. The rest of the team will help with your admit and/or your other babies until your admit gets settled in.

During the day we have 2 MDs until 5pm, then we have 1 on site. We always have at least 1, but usually 2 NPs on site whether it's day or night, and we have 2 RTs at all times. Things seem to run really smoothly as long as L&D calls us before the baby is delivered... Last week we had 2 babies in 2 days (one at 30 weeks, one at 24 weeks) deliver in bed before the NICU team was ever called. That's always fun.

HyperSaurus, RN, BSN · Feb 1, 2014

We have a smaller level III with a max of 23 beds. Our charge takes a lighter assignment and goes to all c/sections or high risk deliveries. THe person who is most able to take the admit takes it (there is no specifically designated 1st admit) or we just call someone in. At c/sections, a NICU RN is always present, as well as either the peds MD on call, NNP on call, or neonatologist. I have yet to see RT attend a delivery or section, but I've only been here since November. The OB RN get's the baby (sterile gloves and sterile blanket). Transports are done by volunteers (for 2nd nurse) and call schedules (sometimes 2nd nurse as well as 1st nurse)