hands on care schedules in your unit

SteveNNP, MSN, NP · Aug 17, 2008

My last unit had 8-11-2-5 and 9-12-3-6 kids. Assignments were made so RNs had a mix of patients. We had some 8-12-4 and 9-1-5 older babies too. It definitely spread the workload out over the shift better.

Here, everyone is on 8-11-2-5 schedules, and it can be a hassle when you have 3 babies screaming for food/diaper changes at the same time.

littleneoRN · Aug 17, 2008

We stagger our 3 hour feeding kids so that they are mixed 8-11-2, 9-12-3, or 10-1-4. That way if you have kids who are bottling you actually have time to work with them and if they're breastfeeding, you can spend time with mom and baby. We try our very best to make it so the three kids who are assigned to the same nurse are one on each of the hours, so you have cares and time to chart before the next hour. Most of our NPO or continuous feed kids are 8-12. Why in the world would anyone want all the kids eating at the same time? After all, if you're a feeder, isn't that what you're here to work on? Do you find any benefits to doing it this way?

BoopRN · Aug 17, 2008

On our unit if the kiddo has feedings ordered (PO, NG or OG) then they are either 8,11,2,5 or 9,12,3,6. If they are not on feedings then they are scheduled for hands on at 8,12,4.

ilstu99 · Aug 17, 2008

PO/NG Q3 feeders are done 9-12-3-6 or 8-11-2-5. Assessments are done with the 1st and 3rd feedings. I wouldn't like not assessing my baby until 1000, even though the 10-1-4 schedule would be cool. Do you have different shift-change times, then, or is everyone feeding an 0700 baby during report?

Our NPO, micro babies are hands-on Q6 only. We have very few ad lib babies, and those are usually on their way out the door. Most often, they have parents at the bedside that do everything but the assessments. :)

Our CN's are great about making sure that a nurse doesn't get stuck with 3 babies all on the same schedule. They're very aware of acuity and schedules, and make assignments accordingly.

texas2007, BSN, RN · Aug 17, 2008

Wow our "schedule" sounds lax compared to some of yall....

Basically our rounds are based on vitals. The critical kids have vitals q4 but sometimes more often if they are on BP drips or whatnot. Mostly all of Level III are q4 vitals and most of Level II is q6 vitals. When you do these vitals is up to you...Most people usually start with their sickest that first hour and go from there. We also reposition everybody q3-4 hrs. We do seem to have a lot of headbleeds but maybe that is because we always have a bunch of micros at any given time. I also find myself having to go into the isolette more often than that also because the baby is no longer on his right side like he should be and keeps desatting, or the temp probe gel melted off in the humidity etc.

As for feedings, it's up to the nurses discretion as to when they are. It's rare to have a 7-10-1-4 feeder in level III just because its kinda crappy to finish report and then jump right in with a screaming kid...I did have one of these the other day but I delayed his feeds 15 min each time so he was on the 8 o'clock schedule by the time I left. So most level III kids are 8-11-2-5 or 9-12-3-6. Feeding times aren't really accounted for in staffing since most of the kids are either gavage all or nipple X1. Level II nurses usually have a 7-10-1-4 just because you kinda have to with 4 kids, with a tech if you're lucky.

iyqyqr · Aug 17, 2008

We stagger our 3 hour feeding kids so that they are mixed 8-11-2, 9-12-3, or 10-1-4. That way if you have kids who are bottling you actually have time to work with them and if they're breastfeeding, you can spend time with mom and baby. We try our very best to make it so the three kids who are assigned to the same nurse are one on each of the hours, so you have cares and time to chart before the next hour. Most of our NPO or continuous feed kids are 8-12. Why in the world would anyone want all the kids eating at the same time? After all, if you're a feeder, isn't that what you're here to work on? Do you find any benefits to doing it this way?

Dear 'Little', I find no benefit to having all infants due at the same time!! We have 2-3 RT's in our unit each shift and since we cluster our cares with theirs and they assisit us with weighing vented infants, we tie them up at those hours, also. Since all nurses are doing cares at the same time, it is hard to get assistance for IV's, admissions if you need it during feeding times. In addition, those times may not work for all families and our goal should be flexibility and permitting parents to choose the best time/times to bottle or breast feed their infants. My unit is a 40 bed open bay, so our noise level definitely is way over recommended decibels around feeding times. I also believe that excellent customer service depends on being 'fully present' for a family and that isn't possible when I have my back to them as I am feeding another infant on my row as they feed theirs. Staggered feeding times also eliminate hours of downtime when nurses may hang at the computer or gossip/socialize. Some of that is good, but too much can impact a unit's culture and negativity. We would not do 7-10 times, because of our shift changes and currently families can't be in the unit during that hour. Staggered times have been presented twice to our Unit Based Council and twice not been approved, because they felt it would make assignments more difficult. But then, we are not assigned on acuity, but rather by a number matrix, and that issue has needed to be addressed for many years. Thanks for your comments!!

BittyBabyGrower, MSN, RN · Aug 17, 2008

Our three hour feeders are 8-11-2-5 or 9-12-3-6 . Four hour feeders are 1-9-5. Vented kiddos are hands on every 6-8 hours, occas 12 if they are on an osc and stable.

If it happens that we have 3 kids on the same schedule, we just start early and hope for the best. :banghead:

Cares are done anywhere from 5p-7a, whenever we get them done or the parents come in. We only weigh most of our kids 3x per week and that coincides with isolette changes and vent tubing changes. :yeah:

munkypants · Aug 17, 2008

we work on an individualised basis. cares and feeds are done with each baby in accordance with when their parents/carers are in (within reason). To be honest we dont really have 'scheduled' times for babies, its up to the nurse in charge of that baby in co-operation with family.

Preemienurse23 · Aug 17, 2008

We stagger our kids also, but we do ours on the hour and half hour. So I may have an 830-900-930. Which can make things crazy depending on the kids. We usually try to avoid 7:00 kids too, the shift leaving does the 7:00's.

Imafloat, BSN, RN · Aug 18, 2008

Our NPO and continuous feeds are due at 8-12-4. If a kid is on high flow, cpap, vent, or oscillator, we do vitals q2, off the monitor and we are supposed to listen, but I usually don't. If you are that sick you need your sleep and I'm not going to disturb you. If a kid is on Dopamine their vitals are every hour.

Most of our feeders are Q3. We never schedule it so a feed is due between 7-8. They are either 8-11-2-5, 830-1130-230-530, 9,12,3,6 or 930,1230,330,630. I like when my feeders are a half hour from each other, I do my feeds (we usually get 3 feeders) for an hour and a half, catch up with my charting for a half hour, take a break, read charts, take off orders etc, then start my next round.

This being said, if staffing allows, we usually get a vented kid and a feeder.

elizabells, BSN, RN · Aug 18, 2008

I haaaaaate having all the kids on the same times. Honestly, in two years I've had MAYBE three kids on q4s. That's why I'll do just about anything to avoid going to our stepdown area. I can't stand teaching a pokey preemie to eat anyway, and having to do three of them, all of whose parents are there wanting my attention NOW? Um, no thanks.

NPO kids intubated or with art lines are vitals q1h, but our computer charting lets you just click them in. Temps and diapers q3, and they're expected to be done at 8-11-2-5 along with the rest. Micros are on the same schedule as everyone else, q3h cares with q1h vitals. Some nurses (myself included) skip one set or so per shift, depending on the baby, but you may get an eyeroll from the oncoming nurse. Like you're lazy, not like you spent two hours and a dose of morphine trying to calm the kid down from the last time you bugged him, and have no intention of waking him up half an hour later just to get a damn temp. Sometimes I'll just do those kids whenever they decide it's time to be suctioned. They're awake at that point.