Guidelines/ Requirement for one to one Nursing Care in a NICU

[ona fofah]

Hi All,

I want to know what guidelines NICU's use for their one to one nursing care.

Could someone please share their policy or guidelines with me.

Thanks you so much.

Ona Fofah

University Hospital,

Newark, NJ

[ittybabyRN, RN]

I don't think we have any policy, just depends on how acute/busy the pt is. Any hfov/cooling/ecmo/cvvh, pd kid will be 1:1. Kids on pressors may be paired depending on how stable they are on their pressor. We pair vents if they're stable as well and kids going to/having surgery are also paired if the procedure is expected to be minor

[NeoNurseTX, RN]

ECMO, HFOV, cooling blankets are generally NOT one to one unless they are maxed out on pressors and circling the drain. Heck, we admit when we have kids on those. No big deal.

PD is supposed to be 1:1 but isn't always...most of the time, yes though.

[BittyBabyGrower, MSN, RN]

I don't think there are specific guidelines written anywhere. Each unit is different. We try to make our bad PPHN kids 1:1, little bad micronates 1:1, usually if we have an isolated kid who is the only one with whatever he is 1:1. Admissions are 1:1 until settled. OR kids are until stable. Usually, unfortunately, our staffing is such that we take an easy feeder with those kids.

Our cooling kids are until stable.

[SteveNNP, MSN, NP]

Our HFOV/Jets/ECMO/cooling/postop cardiac/sick vent kids are all 1:1s until stable.

[rockabye]

Our ECMO and dialysis (if not on the machine) patients are always 1:1. Other than that, it is based on staffing and how sick the baby is expected to be (i.e. emergency surgery, unstable baby, baby not expected to live through the shift, low census and on admit, etc.)

[NICU_babyRN, BSN, RN]

1st Admit RN has one easy pt and is expected to help others until she/he gets an admission.

Transport RN is singled with one easy patient that can be easily absorbed (or taken care of by 1st admit nurse) in case we go out on transport.

charge RN on days = no patients. Nights: sometimes one patient.

The rest of our babies are usually 2:1 unless they are critically ill. If a baby has PPHN is on Jet or Oscillator and multiple drips, 1:1. Once in a while we have 2RN:1baby if doing REALLY badly not expected to make it through or having emergency, bedside surgery. It's all dependent on infants then staffing. We bring in extra RNs whenever needed and have on-call RN every shift. He/She gets activated or de-activated depending on what's expected to happen. If we know we are going to get triplets for example, we'll staff accordingly prior to the delivery taking place whenever possible. otherwise we are REALLY freakin' good at helping each other out until extra help comes our way.

[littleneoRN]

ECMO, HFOV, cooling blankets are generally NOT one to one unless they are maxed out on pressors and circling the drain. Heck, we admit when we have kids on those. No big deal.

PD is supposed to be 1:1 but isn't always...most of the time, yes though.

I'm sorry. I don't mean to be critical, but if my child was on ECMO and his/her nurse was also admitting another patient, I would be fit to be tied.

[littleneoRN]

1:1s for us are all ECMO, HFOV, jets, post-ops for at least one shift, admits for at least one shift, PD, hemofiltration, and most chronic trach-vents. In addition, most vents are 1:1 but may be paired if staffing dictates and they are stable.

[NICU_babyRN, BSN, RN]

I'm sorry. I don't mean to be critical, but if my child was on ECMO and his/her nurse was also admitting another patient, I would be fit to be tied.

Hmm...Agree! Our ECMO nurses are singled and have nearby a RT, another RN, residents, NPs... ECMO=beyond singled and I too would be fit to be tied up TIGHT if my child's nurse had another assignment on top of ecmo.

[NeoNurseTX, RN]

I'm sorry. I don't mean to be critical, but if my child was on ECMO and his/her nurse was also admitting another patient, I would be fit to be tied.

I agree. We have RNs that run the pump so they do all the labs, MD calling, troubleshooting, blood giving. The baby nurse only does vital signs and diaper changes, sending labs. Never seen an ECMO kid without a central line and we have a line team that gives all central meds so the baby nurse doesn't even have to give meds.

However we'll have a really unstable HFOV paired with an "easy" kid all the danged time. I think I've had a 1:1 HFOV kid maybe once.

[umcRN, BSN, RN]

I agree. We have RNs that run the pump so they do all the labs, MD calling, troubleshooting, blood giving. The baby nurse only does vital signs and diaper changes, sending labs. Never seen an ECMO kid without a central line and we have a line team that gives all central meds so the baby nurse doesn't even have to give meds.

However we'll have a really unstable HFOV paired with an "easy" kid all the danged time. I think I've had a 1:1 HFOV kid maybe once.

A line team for all central meds?? How does that work? Is that for every baby???