Designated NICU staff or all float staff ?

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Specializes in NICU.

My facility is currently allowing nurses regardless of degree or certification work NICU.  It is easier for scheduling and it allows everyone to be competent. (which I understand as well).  Our floor consist of L&D, Newborn nursery, Women's services (postpartum) and Pediatrics.  There are days that a 20 year RNC-NIC certified nurse works peds or newborn nursery and a new grad no experience works NICU.  Is this the norm in other facilities ?  To me, this seems like a legal liability.  If my baby had a poor outcome and I knew that a seasoned certified nurse was present but scheduled in a different area other than her expertise I would be questioning why that nurse wasn't scheduled to work her expertise, with whom my baby would given the best possible care. Can anyone else weigh in on this ?

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Specializes in CVPCU, CVICU and NICU.

My question is are the new grads trained and oriented to NICU, and is there adequate help and support for them when they are working NICU? If so then I can see how it would be beneficial for them to gain experience in NICU.

My unit is a level 3 NICU and we have designated NICU nurses who only work NICU. Occasionally we float to PICU or pediatrics if we are overstaffed and they need help. L&D, couplet care and the nursery are a completely separate unit from NICU.

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Specializes in NICU.

All new staff are given orientation of a few weeks in each nursery/NICU. There are no more than 2 nurses in each area during the day, one of which leaves and goes to deliveries. A respiratory therapist in house and a Neonatologist or NNP.   We have enough certified nurses to staff independently.   But it’s “not fair” to staff with only the most qualified nurses is what we are told.     I would think the public would want those most qualified working in the highly specialized area. And I find it insulting that all my years and dedication and two specialized certifications in this area are not respected or utilized in any way.     

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Specializes in NICU.

I have mixed feelings about this. On one hand, this is a low level NICU that deals with minor issues that can not be handled in the newborn nursery and could be cared by any of the staff. On the other hand, it is a case of "Jack of all trades and Master of none." What happens when a baby get subtly worse throughout the day? Would a nurse that works the NICU every few weeks/months be able to notice the subtle changes before it becomes critical? 

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Specializes in NICU.

This is a very soon to be Level 3 NICU. Yes I feel continuity of care is extremely important and has been proven to decrease morbidity in the NICU.  You are absolutely correct in the fact that you can be scheduled 3 days in a row, one day maybe in NICU the next in pediatrics or newborn nursery or postpartum.  No rotation. So it could very well be weeks before you would ever step foot into the NICU again.   
 

I appreciate your input.  I feel like I’m just being a cranky old nurse.  But I feel like this is almost teetering on a patient safety issue. 

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Specializes in NICU.
8 hours ago, WifeMotherNurse said:

This is a very soon to be Level 3 NICU

In this case, there has to be dedicated NICU staff. This is a definite patient safety issue. At a Level III, you will deal with infants with serious medical conditions that can not be cared safely by nurses that are float nurses. We get critical care float nurses and PICU nurses that are pulled to our unit for the day. We have strict guidelines on what types of patients they can take. The medium and high acuity patients are required to be assigned to a NICU nurse.

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Specializes in NICU.

I am confused- does everyone come to work, trading units each day? How many beds is the unit?

In most units, floating is a normal part of life of a nurse and in most cases, it's usually done on a rotation, "who did it last" with new grads getting 6 months to a year reprieve when they are more experienced. When I worked at Level 4 children's hospital, it was based on who did it last and I floated to PICU every 8-10 months or so for a shift. At smaller hospitals where I've worked, there was a float pool for the birth center, meaning a group of nurses came to work not knowing where they would work but floated to L&D, post partum, or NICU based on the unit needs.

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Specializes in NICU.

There are 23 employees.   When the schedule is made 2 months in advanced you are randomly assigned to work either NICU, delivery nurse who attends all births and recovers infants, or newborn nursery nurse. There are about 10 people who are also assigned possible peds in that as well.   Nothing is based on acuity level. Just randomly “fairly” assigned.   We currently have about 6 NICU beds. Our unit is under construction to be a level three and will be 13 beds.       Out of this group we also have a float rotation where you can be pulled anywhere in hospital if there are needs... this happens about once every couple of months for me as well.     Nothing is based on need or acuity.  Your assigned about 2 months ahead which area you will work in on a particular day.   And it can be weeks before you end back up in NICU.   Example.....Sometimes you have newborn nursery 2 or 3 days in a row. Maybe deliveries a couple of days in a row then back to newborn the a NICU day then a newborn day than a peds day 

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Specializes in NICU/Mother-Baby/Peds/Mgmt.
On 4/30/2021 at 10:48 AM, WifeMotherNurse said:

This is a very soon to be Level 3 NICU. Yes I feel continuity of care is extremely important and has been proven to decrease morbidity in the NICU.  You are absolutely correct in the fact that you can be scheduled 3 days in a row, one day maybe in NICU the next in pediatrics or newborn nursery or postpartum.  No rotation. So it could very well be weeks before you would ever step foot into the NICU again.   
 

I appreciate your input.  I feel like I’m just being a cranky old nurse.  But I feel like this is almost teetering on a patient safety issue. 

Oh yeah, this is teetering, and more on the dangerous side than safe side.  NICU is an ICU and quite frankly so is L&D.  Your hospital is giving a few weeks orientation in a NICU and then someone who's never done it before could go weeks before working in it again?  There's no way I'd work for a place like that.  I can see if an experienced NICU/L&D nurse wanted to cross training and do other areas because they aren't going to forget things, but a new to the area nurse?  Dangerous.  Dangerous for the patients and dangerous for the nurse. Who's idiotic idea was this anyway?

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Specializes in NICU.

Our Manger who over sees Nursery NICU And Peds.  Along with the Clinical Assist who does the scheduling.    “It makes scheduling easier when staff can shift around and fill in where needed”.  And it allows all staff( the entire women’s and children’s units) experience so they can stay competent to “fill in “ and work where needed.

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Specializes in NICU.
13 hours ago, WifeMotherNurse said:

 “It makes scheduling easier when staff can shift around and fill in where needed”.  And it allows all staff( the entire women’s and children’s units) experience so they can stay competent to “fill in “ and work where needed.

That is the scary part. They actually think that you can remain competent working every few weeks or months in the NICU. You can't even begin to be competent with that schedule. It takes our new grads 12-18 months full time to become competent in a Level IV NICU with highly experienced nurses around them as a resource.

What is the background of your Manager? Does she actually know what is required to run a Level 3 NICU. This is beyond mind blowing. It is not a matter if babies will die due to this system, it is how many will need to die before they change their system.

 

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Specializes in NICU.

The devil's advocate in me thinks this sounds like a small community Level 2 nursery. What is your average daily census? Most Level 2 NICUs are not able to stay open unless they can float to other units as needed due to low census issues. At several of the Level 2 places where I work, the nurses are trained to 2 areas out of L&D, post-partum, and nursery. It's hard to staff with just dedicated NICU nurses when you only have 1-2 babies or 0 babies at a time. Is this a critical access hospital? There is also the issue that it's great you have 20+ year veteran nurses, but with such a small number of staff, if a few of them go out on LOA or retire, then the hospital will be up a creek if they didn't train any of the younger generation.

Running a Level 3 would be different but as you get a higher census, this will become more apparent to have a dedicated NICU staff. I doubt you will go straight to 22-24 weekers though- what is gestational age limit now and then plans for what? Most "new" Level 3 units will go down to 28-30 weekers first. What gestational age do you currently take and do you do CPAP and short term ventilators?

At the end of the day, you can bring your concerns to your manager. If you have a union, I would recommend bringing it up to them. But if it feels really unsafe then it sounds like your options are to look for another facility. 

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