Definition of Level II Nursery?

llg, PhD, RN · Mar 30, 2004

Level III nurseries are the Neonatal ICU's with the most critical patients, ventilators, etc. (At least one state, Virginia has a couple of Level IV Nurseries that include all the subspecialities.)

Level I nurseries are essentially "normal newborn" patients with a few minor, common complications thrown in.

Level II nurseries are in the middle. They care for patients that have a few complications, but that are not life-threatening at the moment. Level II nurseries often include patients that used to be in the NICU, but who are now stable and in the (often prolonged) "growing phase" necessary before they are ready for discharge. Some of those patients can have some very complicated histories and complex needs.

The exact mix of diagnostic groups is a great discussion topic for your interview as nursery populations do tend to vary from hospital to hospital depending on the availability of a NICU nearby. Some include sicker babies than others. Some include a lot of NICU step-down patients while others don't, etc.

llg

Gompers, BSN, RN · Mar 30, 2004

Okay, this is pretty much the jist of it...

Level I nurseries are basically for normal newborns. The majority of these babies spend most of their time in their moms' rooms and are fine once they start eating and get that blood sugar up!

Level III units are your typical NICUs: micropreemies (babies under 28 weeks and 1000 grams), babies with major surgical or cardiac problems, severe sepsis or pneumonia, etc. Sick kids needing critical care. The sicker ones are usually 1:1 and then maybe 1:2 when they get better. Sometimes these units keep babies until they are ready to go home, so then they might be grouped 3-4 babies per nurse.

So a Level II is somewhere in the middle. They usually keep preemies over a certain gestational age, do some nasal cannula oxygen and lots of NG feedings, keep an eye on kids with suspected infections and give them IV antibiotics. Sometimes can keep ventilated or sick babies, but usually they transfer them out to a nearby Level III unit. You'll see a lot of boarder babies who are too premature to go home with mom but not small enough or sick enough to require an intensive care unit. I think normal assignments in a Level II are something like 4-8 babies per nurse, but I may be wrong.

:)

dawngloves, BSN, RN · Mar 30, 2004

I think most do CPAP too.

denicu · Apr 1, 2004

I am currenly a RN on a peds hem/onc floor and I need a change! After applying to L&D and having that fall through, I've found a position in a Level II Nursery at a nearby hospital. What are the different levels of NICU's and what do they mean? What kind of patients would I expect to take care of in each? Thank you for your help!

A

A week ago i had a similiar discussion with a fellow NICU rn re: different levels if NICU. For years i worked in a unit that i believed and was advertised as a level 111 nursery. We were one of the largest nicu in the area that admitted many micro premies, used nitric, had kids on hfjv etc, however any kids that needed surgery was transferred to ChOP. I was told by this RN(we were both working as agencies RN) that my unit was not a level 3 unit because we did not do surgergies and several nurses in this unit agreed with her. According to the discription of level 3 units-thats the kind of nursery i worked in. I am going to print the response and show it to these nurses.

dawngloves, BSN, RN · Apr 1, 2004

Believe it or not I think there is a level IV NICU. Those, I believe do, surgery and ECMO.

llg, PhD, RN · Apr 1, 2004

The level I, II, and III designations have been standard for about 30-40 years. However, the lines blur as individual nurseries develop the ability to keep a few more babies that have a few more needs.

So ... experts started using expressions such as "level II and a half" to refer to those nurseries that started having some overlap with the level just above them.

The state of Virginia (and maybe some others) finally made a Level IV category to distinguish between the highest level nurseries that do things like ECMO, dialysis, nitric oxide, organ transplants, complicated surgeries, etc. and those that just do uncomplicated premies on ventilators.

llg (who has been around for a long time)

nurseiam · Apr 6, 2004

[ I think normal assignments in a Level II are something like 4-8 babies per nurse, but I may be wrong.

:)

I say find another job if they are giving out 8 pt assignment. NANN has guidelines for neonates and I think it is 4 level II babies. When we give some nurses four it is like their worlds have been shattered! Three is a nice number!

Mimi2RN, ASN, RN · Apr 7, 2004

[ I think normal assignments in a Level II are something like 4-8 babies per nurse, but I may be wrong.
:)
I say find another job if they are giving out 8 pt assignment. NANN has guidelines for neonates and I think it is 4 level II babies. When we give some nurses four it is like their worlds have been shattered! Three is a nice number!

I agree, depending on the babies, three is good. We have all kinds of babies, 28 weeker on cpap, 35 wks on vent, 6 or so growing premies, term sugar babies, r/o sepsis, TTN (or frequently, fat baby syndrome). I may start out with two, but who knows what we will bring in the door. We do attend high risk deliveries, and if I bring one back, it's usually mine.

I don't know why people think four is such a wonderful number, you don't have time to pee between feedings....you don't have time to drink, either.

Gompers, BSN, RN · Apr 7, 2004

Well that's why I said that I could be wrong.

In our Level III unit, we have a step-down area that has basically a Level II population, and there we usually have 3-4 babies each. But I have coworkers who work agency and sometimes go to other hospitals that only have Level II nurseries, and they have had up to 8 babies at times! I don't think that's even worth the $50/hr that agency pays!!! I don't think it's common for them to start out that way, but by the end of their shift if it's a busy night for admissions that's what it ends up being like.

wjf00 · Apr 7, 2004

Well that's why I said that I could be wrong.
In our Level III unit, we have a step-down area that has basically a Level II population, and there we usually have 3-4 babies each. But I have coworkers who work agency and sometimes go to other hospitals that only have Level II nurseries, and they have had up to 8 babies at times! I don't think that's even worth the $50/hr that agency pays!!! I don't think it's common for them to start out that way, but by the end of their shift if it's a busy night for admissions that's what it ends up being like.

8 babies?That many babies in one assignment is not acceptable not matter what you are being paid. You have an absoloute responsibility to protect your patients and refuse that assignment.

Gompers, BSN, RN · Apr 8, 2004

8 babies?That many babies in one assignment is not acceptable not matter what you are being paid. You have an absoloute responsibility to protect your patients and refuse that assignment.

Well I would have a problem with that assignment, too, but as I said some of my coworkers have experienced this at other hospitals. In Illinois we don't have as many laws about staffing as California.

On our unit, if it got to that point we'd call in people to help if it was day shift, or if it was at night we'd have the house nursing supervisor grab us a body from either an agency or another unit (peds/ob). It's rare for us to have unsafe staffing - the only time I remember was when we got 7 admissions in 6 hours and even then we were able to get extra help pretty quickly.