Help- Moving to private rooms! Need advice!

babyNP., APRN · Jun 21, 2012

We did this (had open bays moving to private rooms) when I was a brand-new nurse, let me see what I can remember...

We had lots of extra people helping out and luckily we only had like 25 patients (normal census is in the 40s). The night shift got everything ready (packed up everything) and then on day shift, we had the bedside nurses and then a "transporting team" of nurses and a "receiving team" of nurses (like 3-5 people per team, I think). Every baby had a number from which to go (I don't think it was based on too much acuity because I was #2 with my babies and I had stable kids and the first person had an unstable kid) and we had social work wait downstairs with parents and security also escorted the teams. I remember the most labile kid we had, we ended up paralyzing for transport because there was just no other way...

We generally have 2:1s in our unit, occasionally 1:1s and 3:1s. With 3 kids, we usually have a tech to help one of the stable PO feeders. We all have phones that we carry on our shift and after a red alarm of 10 seconds, it goes to our phone to alert us. It works well because there are generally lots of people in the hallways and we all look out for each other's kids; people don't "ignore" alarms if it's not their kid. We can also pull up the other kid's monitor on the monitor in the room that we're currently in, so that if it is an emergency, we can stop PO feeding the other kid and run into the other room.

We also purposely staffed very well for the first few weeks just to help staff ease into things.

edit: being here now for the past few years, I would say that it's harder to recognize when a co-worker's kid is crashing and needs help unless she/he asks for it. This is something we drill into our new grads to ask for help because at least in the bays, there were quite a few other nurses around in the immediate area who would pic up on it. We also have a second charge nurse who serves as a resource and helps with admissions, etc.

ToughingItOut · Jun 22, 2012

Ugh, I would honestly hate to go to private rooms for the above reasons. However, I'm sure that the parents will like it...

babyNP., APRN · Jun 22, 2012

I actually prefer it. When I do agency at other hospitals now, everything seems so cramped. Plus it's fantastic for chronic kids and labile kids like PPHNers

TiffyRN, BSN, PhD · Jun 22, 2012

I actually wrote a research paper about the superiority of single rooms for NICU after becoming curious about them when another hospital in town opened up such a unit. All the nurses in my unit were positive it was a horrible idea, doomed to fail, nightmare for the nurses, horrible parents that create roach havens and never leave, you get the idea.

The research I uncovered showed that once nurses actually worked in such a unit, they found they were the preferred way for NICU infants to be managed and the vast majority felt that even intubated vent patients were safely managed in this environment. Other research shows that infants managed in this environment and with good developmental care have a shorter length of stay (compared to same hospital infants also receiving good developmental care).

From a developmental viewpoint, what better way to provide a perfectly individualized developmental environment than with a private room?

To more directly answer the OP's question, I spoke with one of the nurses who works in that unit about moving day. This nurse stated that moving day for them found them with about 40 infants. They used about 60 nurses to quickly move all the infants. There were many extra neonatologists on hand as well as a double complement of RT's. They also called in all the available transport teams to help out. The move itself went flawlessly with that approach.

luvmyboys · Jun 22, 2012

I really appreciate everyone's input! The only hospital I am familiar with that has private rooms only has max 2 baby assignments. Since my current hospital does a lot of three baby assignments many nurses have concerns about lack of proximity to their patients. We dont have any techs such as "babyRN" mentioned to help - all of our nurses are fully assigned. Usually even our admit nurse has a light assignment and only one charge nurse. We usually have a relief nurse who covers for breaks but we have to leave the patient's bedside for other reasons as well (prepping feeds, getting meds from Pyxis, talking to a Dr. etc) and so far their is nothing in place to cover at those times - except another nurse who probably also has a three baby assignment.

I agree with TiffyRN that the private rooms are developmentally better for babies and families; Im not suprised that research shows this! Much quieter environment and more space. I like that fact that you can control your own lighting because I like to dim the lights when I PO feed but if someone is next to me with a sick kid and needs to have light for an assessment Im out of luck! We are so cramped right now that when we have all the parents in you cant even walk down the aisles! The fire department would have a field day if they saw our unit open to all the visitors!

Thanks again!

champagnesupeRNova · Jun 22, 2012

I actually wrote a research paper about the superiority of single rooms for NICU after becoming curious about them when another hospital in town opened up such a unit. All the nurses in my unit were positive it was a horrible idea, doomed to fail, nightmare for the nurses, horrible parents that create roach havens and never leave, you get the idea.
The research I uncovered showed that once nurses actually worked in such a unit, they found they were the preferred way for NICU infants to be managed and the vast majority felt that even intubated vent patients were safely managed in this environment. Other research shows that infants managed in this environment and with good developmental care have a shorter length of stay (compared to same hospital infants also receiving good developmental care).
From a developmental viewpoint, what better way to provide a perfectly individualized developmental environment than with a private room?
To more directly answer the OP's question, I spoke with one of the nurses who works in that unit about moving day. This nurse stated that moving day for them found them with about 40 infants. They used about 60 nurses to quickly move all the infants. There were many extra neonatologists on hand as well as a double complement of RT's. They also called in all the available transport teams to help out. The move itself went flawlessly with that approach.

This is really interesting...I did my senior preceptorship in a NICU without private rooms and I'll be starting my first job in a NICU with all private rooms. Honestly, I could only see the negatives of private rooms. It just seems so much more safe to be able to see all of the babies and just run over and answer an alarm. But slowly starting to change my mind.

umcRN, BSN, RN · Jun 22, 2012

I've never worked in a "pod" style NICU, only private rooms. I personally love the private rooms. We have "code blue" and "staff assist" buttons in all the rooms for emergencies. When pushed the appropriate people will be notified via a text to the phones that we all carry (and you do get who you need pretty quickly) we also have the numbers to our appropriate doc/nnp/RT to call if something doesn't seem right. You can't be afraid to yell if you need help but people don't generally ignore alarms on patients that aren't theirs. Also our alarms go to our phone and if they "overtime" without being silenced they will also go to a back-up RN's phone (every nurse is assigned a back-up at the start of the shift, assignments are put into the computer/phone system). We can have two other babies pulled up on other monitors so if you have three patients it's possible to see them all on one monitor.

Definitely great for the unstable term kiddos - pphn, CDH and the rooms are designed with plenty of room for oscillators, ecmo, cooling equipment, CVVH, whatever you happen to need without needing to be cramped around multiple patients and equipment. Also the other patients in the area don't have to be disturbed by the activity going on around a sick patient and families do not have to leave if another patient is crashing. We can also do emergent surgeries at the bedside without having to relocate the patient to the OR. There is plenty of room for the OR team to come to the unit with their own surgeons, nurses and supply cart.

We actually to have two four bed pods on our unit as well. The size of each pod is still quite large so that each patient is in its own separate area. This seems to be a good place for preemies that act up because there usually is at least two nurses in the pod. Placement of patients doesn't always happen that way obviously but it can be ideal.

Since the unit is so large it is considered to be "de-centralized". We have no central nursing station but have instead alcoves between patient rooms with computers for charting, there are also computers inside each patient room for charting. There are also multiple pyxis machines & nourishment stations throughout the unit each serving the patients in it's area to decrease the amount of walking back and forth to a central location. The only real central places people have to go to is the deep freeze (there is a freezer at each nourishment station to store a small supply of milk near the patient, and each patient has their own refrigerator & milk warmer in their room) and the supply rooms.

In regards to visitors despite the private rooms we still have a policy of only two visitors at the bedside at a time. No parties and large groups of people allowed! This is still an ICU after all.

I was not an employee yet when the move happened so I can't give too much insight onto actual move day.

MnemonicMonkey · Jun 23, 2012

My wife is a NICU nurse that went through this a few years ago, and I do recall her dreading having separate patients everywhere for all the reasons listed above, but now likes it despite "days where we have our running shoes on." The rooms are quieter, family drama contained (there are even warning lights on the ceiling if the noise level in the room gets too loud), and there is much more room for equipment (the old space was maxed out). They have two rooms specifically set up for twins and one for triplets, and all the private rooms can actually support two patients if needed (which has happened on occasion- usually twins where one is stable). There are two secretaries' desks and pods between each pair of rooms.

The key to the system is the Vocera communicators. It's a handsfree device that does voice calls, texts, but most importantly, receives alarms. So you get immediate notification if the kid way down the hall that the charge nurse just HAD to give you is misbehaving. I would think that if you're moving to a new facility there's some type of provision like this, be it Vocera, Cisco, etc...

She also said that she was actually the first assignment to be transferred, so they transferred her three patients up (there was plenty of extra help) and she stayed up on the floor as other assignments were brought up.

umcRN, BSN, RN · Jun 23, 2012

Having a couple rooms that can hold two babies is a good idea...one that my NICU didn't really think of until we admitted the conjoined twins :eek: Luckily we have a "procedure" room on unit (that is never used for procedures btw, all procedures are done in the pts rooms) but it has two monitors so while it's smaller than the other rooms we were able to get the twins set up appropriately in there.

CoraBeth RNC-NIC · Jul 2, 2012

Will you have central monitoring in your new unit? I came from a private room unit and we could "pull up" my other baby on the monitor of the room I was in. That way I could see if my other baby was having a brady while I was with my other baby. If I had three babies I always pulled up the one that was prone to having bradys while I was in another room.