HELP. Travel RN, NICU RN, Nursery Job-is this charge?

[JacksGirl]

I need help deciding if this is or isn't safe.

I'm a seasoned travel RN , specialty NICU, nursing many, many years. A highly competitive busy urban region for NICU came up, I interviewed, was offered the job, but the pay was less than my agency had said and while they were working that out, the job morphed to the original higher pay but now in the nursery. It's been tight, I accepted. I'm flexible and I've been floated to nursery before, and figured it wouldn't be so bad and that it would segway to the NICU as they got to know me and needs there beefed back up.

The hospital usually hire for mother / baby but this is strait nursery because of course I don't do adults. I was to be cross trained to NICU and my impression from the NICU manager (different from the PP/ Nursery manager) to be 'shared' to some extent. My impression after one day when I asked for NICU orientation, was from the PP/ Nursery manager "her numbers were too low".

I have concerns. To address them I have to describe environment. I have done one orientation shift and am not certain, though I have never not completed a contract, concerns about whether I feel this is safe.

The floor has between 30-40 mother/ infant pairs-I don't know yet--there wasn't time in orientation for that kind of question. The nursery is at the end of a long hall of patient rooms, far away from the Post Partum Nurses desk. . The nursery is assigned one RN and one PCA on days, and one RN , two PCAs on nights (so I am told...I have my doubts...this may be because there is a clerk on days and evenings and not one on nights...I don't know yet. I have been hired for nights).

The nursery involves a very small area for a (tough urban clerk's) desk and three rolling chart racks. There is a door to the right of this clerk's space that leads to a small room. At night all mothers (although this is couplet care) send their babies to the nursery. This is the room they come to. It is also the room for boarder babies--two of them on the one day I worked this unit thus far. On my one orientation day (7AM-7pm) 30 babies were in this room, and I was asked to chart their HR and Resp , change them , and send them out to their mothers. The PCA took their temps and delivered them to the mothers. It was suggested I might fill out the systems check list (assessment) 'to help the floor nurses'. I didn't .

On the other side is a room with four radiant warmers (rec'd at 7 AM and each one filled and labor and delivery already calling. two babies were warming post bath, two were to be admitted and just arrived) , two chairs (one used by a provider) , a computor , a code cart, a supply cart and two isolettes. The isolettes are apparently for Bili Babies. On my one orientation day, there were four babies on the warmers, two post bath, two to be admitted--7 AM. 8 more babies would arrive during the day. THis is obviously the transitional nursery.

Remember, I was on orientation. But on that day it took till 10:10 AM to get the babies out of the one room...and there were 10 admissions total. The labor nurses call report demand to give it immediately send the baby down and have pushy, pushy urban attitudes. I can deal with that, but this is the environment.

The PCA feeds the babies, and the nursery RN is expected to fill in the chart from what the PCA writes on the (not for chart) log. That one RN was expected to do all of those admissions, receive every call from L and D, address every Pediatrician wanting help and report, address and get supplies for every MD wanting to do a circumcision, and the HR / RR of all those babies, and any bili baby that might come in, and the boarders is crazy. It's hectic, frantic, and ...dare I say, unsafe?

I am to understand that at night, there will be two PCAs and one RN (me) in these two rooms. THere is a code cart, I was not oriented to who checks it, but the PP charge didn't come to do it. I believe that the 'charge' nurse is on the floor, I'm certain she is not free charge.

I suspect since the babies 'All room in--all the mothers send them in'....that regardless of whether I take the stance that I do NOT chart on them because they are in couplet care and I can not be responsible for them (which is most assuredly the stance I will take), I am the RN in the 'room' without visual field of them while working in the other .

I think it looks like that since I am the sole RN in both a nursery and transitional nursery with two PCAs to work with, I am in a position of supervising them...or charge for the evening. I think any responsibility for the code cart cements that role.

I have never seen anything like this. I feel it is a two RN area, and I am uncomfortable.

The RNS state they used to have two RNs there, but for poor patient satisfaction surveys, now its routine to staff only one and put the other on the floor. They asked physician help in pushing for management response without effect. They feel it is unsafe. They are obvious harried. In regards to admissions...10 and 11 is busy not usual, but happens, 8 happens and is normol, 5 is common. I kept asking what was on the board at L and D and never was given a way to determine that. They calls just kept coming to accept babies.

[NeoNurseTX, RN]

1 RN to 30 babies??!? WOW. I used to float to newborn nursery and wasn't responsible for the moms. In the nursery we'd be assigned to 8 babies max. Two RNs would do admissions and 3-4 would have the babies to weigh, assess, and take out to mom (and check up on how much they ate, diapering, etc). If mom sent them back to the nursery, we'd feed them. And it was very busy!

[JacksGirl]

Thank you so much for your reply. I wasn't clear in my original post, though, I see now.

It IS couplet care, but the nurses never come in, a PCA is always there in that room or taking babies out. This is also where all the babies are fed, weighed, and kept when the mothers ask for the babies to be taken away for the night. No mothers on this unit choose to keep their babies all night long so it is pretty much full all night, probably with babies coming in and out. There are two PCAs there who I am told weigh and bathe the babies. The couplet nurses are out on the floor. The PCAs wheel the babies in and out.

There are several boarder babies there...bili light babies, babies without moms feeding them, on social hold...probably there are times when there are none. Right now there are two, and no bili babies. Any of those, I will have to chart on, and are not assigned to couplet care.

The PCAs are feeding and holding, weighing and bathing. These are babies under my care there. I will refuse to chart on any of the couplet care babies. They are assigned to floor nurses and need to be handled by the floor nurses. BUT, I'm the only RN in the area. The nurses desk is far far away. I am in the other room. I may look in once and again in a brief moment. But if I have 10 admissions when does one have time?

OK...then there is transitional room where the admissions are. 10 admissions the other day...Those are my responsibility...any and all admissions. MAYBE there is a night with none. I'm told 5 is 'common', 8 'usual' 10 'happens' (twice in the last eight days).

There is a code cart, and the acucheck to check in the transitional room, and noone else seems to do it. There is a PP charge out on the floor---There are two PCAs, and an RN in this nursery. I think this sounds like charge in the nursery, and that it's a two RN job to oversee two rooms. I have no visual contact with the second room when in the first. When its slow and there are no babies...no problem. But twice in the last week there were 10 admissions in one shift. Those days, the RN has everything she can do to just take care of those babies in that room.