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

prmenrs, RN · Dec 7, 2010

I once read an essay in a Neo journal (and, no, I'm sorry, I don't have the complete citation) entitled, "Being on ECMO means never having to say you're unstable!". Or words to that effect.

That holds true for a lot of other situations: HFOV, p-op hearts, etc. @ least IMO.

HappyBunnyNurse · Dec 7, 2010

ECMO is the only thing that has to be 1:1 at my unit. Well that actually means 2:1. Pump nurse + baby nurse. They take it to the extreme though........ we had a baby beside the ECMO baby code (from room air to code and to DEAD in under an hour) one morning. The ECMO nurses sat and watched. This really goes aganist the culture of our unit but they would have got in trouble if even one had stepped away to try an IV or something. I mean there was plenty of help but...... dang! Everything else is kind of up in the air and IMO should have written guidelines that can be overruled by the charge nurse depending on the situation. For example nitric babies should be one on one. However, recently I had a five baby assignment (1. Room air OG feeder with PICC --- 2. Room air with fresh myleo repair PO feeder, PIV + angry and hungry because I couldn't get him full in the time I had and was therefore falling off the t-pad --- 3. Low flow nasal cannula on IV meds for SVTs and seperate line for nutrition + is a hard stick and poor PO feeder--- 4. CPAP OG feeder with frequent severe apnea spells and PICC---- 5. Room air frequent apnea spells + very poor PO feeder) and I was first admit. I didn't know I was an admit until my admit arrived at 8:30. My neighbor had a 1:1 very stable nitric because it had been decided ALL nitric must be 1:1. She texted and complained of boredom while I worried I was going to miss something and hurt one of my patients. She was also VERY condescending because I couldn't keep up lol. After that night the powers that be backed up and gave the nurse managers and charge nurses more leeway in case of bad staffing. I think they figured out they would have bad staffing ALL the time if they didn't. Lol. I was definitely checking my options with other facilities after that night. My point is (besides venting) is that nurses really know more about safe assignments than the doctors (and some NNPs who have forgotten what its like at the bedside.)

prmenrs, RN · Dec 9, 2010

Are there no acuity tools? That would really help to indicate where staff need to be. And, IMHO, NO one should ever, ever have 5 babies unless they're working in a straight Level 1 NBN. Not a Level 2, and DEFINITELY not a Level 3/4 unit.

Dangerous assignments should be written up, either as a "Quality Variance" or as an Assignment Despite Objection. Sorry, I think that's just insanity.

NeoNurseTX, RN · Dec 9, 2010

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

Yup. We have two RNs that come around and hang all IVF on nights that run centrally if it's with TPN. If the baby is on clears only, the day line team (one nurse and the bedside nurse assists) changes it out. The other line team RN does meds only for the whole unit. Granted we usually run around 70 babies in our level III unit so they are pretty busy. We've had a HUGE decrease in CRBSIs since starting the line team.

umcRN, BSN, RN · Dec 9, 2010

Yup. We have two RNs that come around and hang all IVF on nights that run centrally if it's with TPN. If the baby is on clears only, the day line team (one nurse and the bedside nurse assists) changes it out. The other line team RN does meds only for the whole unit. Granted we usually run around 70 babies in our level III unit so they are pretty busy. We've had a HUGE decrease in CRBSIs since starting the line team.

Wow, that's crazy! They must be running fast. On my unit we do all our own line changes and of course all our own meds, and probably 80% of the babies have central lines.

NeoNurseTX, RN · Dec 11, 2010

Wow, that's crazy! They must be running fast. On my unit we do all our own line changes and of course all our own meds, and probably 80% of the babies have central lines.

Bedside nurses do PIV everything and we can assist with the sterile line changes if needed. I used to work in a combo level II/III unit and we'd have 4-5 kids and did them all on our own "sterile"...which isn't really with only one person.

We used to do the meds even if they were central but started having our line team do them when CRBSIs went up a little. Now they're back down.

littleneoRN · Jun 25, 2011

Bedside nurses do PIV everything and we can assist with the sterile line changes if needed. I used to work in a combo level II/III unit and we'd have 4-5 kids and did them all on our own "sterile"...which isn't really with only one person.
We used to do the meds even if they were central but started having our line team do them when CRBSIs went up a little. Now they're back down.

Ok, I know this is an old thread, but...do you have to call this team when you want to give prn meds? What if need that pain med or sedation NOW...meaning 5 minutes ago? Is this a dedicated team, or is it something any RN can be assigned to for that shift? I get the point, but it seems very impractical in a large, high acuity unit. We've got roughly 100 beds, and they're not all together in one unit. I'm thinking of the other day when I had 2 lines and 7 IV meds including vanco and a transfusion to fit in a couple hours, and I had them just in a perfect schedule back to back to back to get them all in when we needed them. I wouldn't have been able to wait for any team. And I would have been waiting because there was a code and a couple new admissions whose meds would have taken precedence over mine. We also have taken measures to decrease central line infections in the last few years, with great success, but I'm glad we haven't done this.