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. The calls just kept coming to accept babies and I was never really oriented, but instead helped the RN and still left an hour late with her.

[Mimi2RN, ASN, RN]

That is not a safe situation. Couplet care means the babies should stay with mom. Day and night! Unfortunately you are responsible for too many babies, and if one kid has a problem, you will be the one left holding that baby. I would not stay there.