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Discussion

High Census Question

Recently my unit has had a relatively high census for several weeks and it got me wondering, what happens in your unit when the beds start to fill ? Do you see overtime? More PRN staff? Do you ship babies elsewhere? Do your assignments get harder to handle? Does your unit work short (need more nurses than it has and not for want of trying to beg, borrow or steal?) Do you have staff float in from other NICUs or other units? Do you turn down transfers or divert admissions?

I am curious to know what it is like elsewhere. Can you tell me what is it like in your unit?

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"OVERTIME" covered our over census unit. Float in from other unit but preferably from maternal & child dept. only be considered if no more available staff in our unit to do extra duty or OT.

We can float staff between neonatal units. We also have a float team to draw from (being a Children's Hospital). We have been full to the brim and seeing lots of all of the above...overtime, casual staff, float team, and sometimes working a bit short. Our Level II can defer babies to Level III, and Level III can transfer a baby to Level II to make room for a Level III baby, but we don't defer outside of our facility.

We use PRN staff and overtime. We also pull from other departments (Mother/Baby and PICU/Peds) within the hospital. The pulled staff only work in our Progressive care area after they have been cross-oriented. We are the only NICU in our region and are also the only regional transport center within a 150 mile radius. We never transfer patients out or turn down transfers because of high census. They have no where else to go.

wow! OMG! toxic days are here!

high census definitely more overtime for everyone. if the unit is understaffed we pull-out nurses from the other units- nicu (another unit), peds, picu, etc. and they handle the stable babies.

if the beds are full to the brim (which happens) we place the stable ones in another unit (roomed-in with the mother).

we only turn down transfers/admissions if we do not have enough equipment to use (such as incubator) or as per doctor's advice. basically as long as we can admit, we will. after all that's more money for us.

We troll down the list of RNs and/or ancillary staff who aren't already scheduled and beg. If we have an appropriate assignment, we utilize RNs from peds or SI. If those things don't work, our hospital approves an additional cash incentive to encourage people to agree to come in.

I work postpartum and we get floated to NICU when needed to handle the feeders and growers. Most of us are happy to help out.

  • Expert

We have an OT book that people sign their name next to shifts they are available to work. Once that list is used, they start calling people. We also get floats from PICU or WBN sometimes. We try and shortlist any discharges, and arrange as many back-transports as we can. Our stepdown NICU starts taking over private rooms on peds and sticks 2-3 babies in each room. We start using overflow spots in our pods in the main unit, but these can't be used for babies on any kind of respiratory support.

Eventually we run out of spaces, portable monitors and IV pumps. Our unit is supposed to hold 58-65 babies, and we usually run at 68-75. A few weeks ago we hit 81. Then we discharged/back-transported 30 babies. Now we're creeping back up from 51.

We're so well staffed that unless our census has exploded, people are dying for the OT. So we end up being pretty well staffed.

How do you determine how many staff needed per shift? Is it based on an acuity score or hours per patient day (HPPD)? If you use HPPD, what is it? Thanks

  • Expert

We have a staffing grid based on HPPD I believe. It basically equals one RN per 2.2 patients or something like that. It doesn't really take acuity into it at all. Although with basically 28-34 RNs per shift we can adjust to census fluctuations pretty well. I can't remember the last time I had more than 3 pts, except in our TN (admission/stabilization unit on L&D)

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