How many patients a day

elizabells, BSN, RN · Feb 8, 2008

1-4, depending.

ECMO, REALLY unstable vented kids, and cardiac post-ops are 1:1, barring extenuating staffing circumstances.

Feeders/rule-out sepsis kids in our stepdown unit are often 1:4

In between you could have a mix of anything. A relatively stable vent and a feeder. Three CPAP/feeders. Whatever.

EricJRN, MSN, RN · Feb 8, 2008

Mine works basically the same way, but we don't perform ECMO or cardiac surgery, so 1:1's are very rare for us.

BittyBabyRN · Feb 8, 2008

I will agree with EricEnfermero! We do have some 1:1s but usually if the kid is extremely unstable or not expected to make it through the shift. We also will occasionally get up to 7 kids, but will get a Patient Care Assistant or well-baby float nurse to help us out. That is usually only when we r very understaffed and have no other options! BUT it does happen!

elizabells, BSN, RN · Feb 8, 2008

SEVEN???

Holy moly! I guess it's different for us because our NAs aren't techically supposed to touch the babies, but WOW.

I mean... I GUESS if they were all gavage/continuous/NPO (I'm a slooooow bottle feeder, just not my skill set) and didn't all have to have cares done q3 (we don't rotate our kids; they're all 8,11,2 and 5) you could do it with help, like if parents were there or something. But that sounds insane to me.

Sweeper933 · Feb 8, 2008

I mean... I GUESS if they were all gavage/continuous/NPO (I'm a slooooow bottle feeder, just not my skill set) and didn't all have to have cares done q3 (we don't rotate our kids; they're all 8,11,2 and 5) you could do it with help, like if parents were there or something. But that sounds insane to me.

I don't know you do that - have all your babies due at the same times! We get our babies in different schedules - q3 starting at either 8,9, or 10. (same thing with q4 schedules).

To answer the above question - we usually staff 1:2-3, depending on the acuity. When we have an unstable kid we will staff 1:1. Any kid in isolation also gets staffed 1:1 as well.

elizabells, BSN, RN · Feb 8, 2008

I don't know you do that - have all your babies due at the same times! We get our babies in different schedules - q3 starting at either 8,9, or 10. (same thing with q4 schedules).
To answer the above question - we usually staff 1:2-3, depending on the acuity. When we have an unstable kid we will staff 1:1. Any kid in isolation also gets staffed 1:1 as well.

Yeah, it... well, let's just say it SUCKS. It's partly because, as I said, I'm really bad at bottle-feeding - give me an unstable ECMO cannulation any day, but three feeders and I'm ready to tear out my hair. Being in our step-down unit feels like I'm on punishment for something. Thank goodness there are enough nurses who like it up there that I don't have to go very often.

Your isolation kids are 1:1?? That would be awesome. I've had three kids, all on isolation, on more than one occasion. Our MRSA outbreak seems to be over for now, thank the lord, but for a time 1/3 of our 60 beds were on contact precautions. Not all of them had it, but everyone in that wing went on isolation to protect them. It was really fun gowning/gloving just to smack the butt of a little peanut who forgot to breathe. [/sarcasm]

Before anyone gets all het up, no, I don't *literally* smack them. Defensive posting, table for one!

Sweeper933 · Feb 8, 2008

Your isolation kids are 1:1?? That would be awesome. I've had three kids, all on isolation, on more than one occasion. Our MRSA outbreak seems to be over for now, thank the lord, but for a time 1/3 of our 60 beds were on contact precautions. Not all of them had it, but everyone in that wing went on isolation to protect them. It was really fun gowning/gloving just to smack the butt of a little peanut who forgot to breathe. [/sarcasm]

We rarely have a case of MRSA on my unit (47+ bed level III). Lately we've had a few kids come in from the "outside" w/ RSV that we have put into isolation on a 1:1 assignment. Since our isolation rooms are separated from the rest of the unit, it would be impossible to be taking care of another baby as well. I must say, only having one baby who PO feeds every 4 hours can make for a VERY long shift!

Imafloat, BSN, RN · Feb 8, 2008

Our assignments range from 1 to 4 babies per nurse. 1:1 are usually extremely unstable kids on multiple drips. We have had high census lately so my assignment has been 3 babies, usually a vent, HFNC, and a feeder or 2 vents and a feeder. You can get a 4 feeder assignment too, but we give those to the pool people so if they don't stay the whole 12 hours their kids are easy to divy up at 1500.

Personally, an entire feeder assignemnt makes me crazy. Usually the feeders are ready to go home, they are a little older, and don't need as much sleep as the sicker kids. They cry the minute you put them down. Our assistants can get vitals and feed the babies as long as the first assessment has been done by a nurse and a nurse listens to the patient before the feed starts.

Our feeders aren't on the same schedule. They are either every 3 or every 4 hours, depending on what was ordered. If I have 2 feeders due at 0800, whichever one is sleeping soundly gets moved to 0830.

NebraskaRN · Feb 8, 2008

We can be responsible for 1-4 babies. 1:1 babies are very sick and are fighting for survival if they are not expected to survive they are 1:1 and depending on the care that needs to be done they may be 2:1 (2 nurses to one baby) although 1:1 and 2:1 depends on staffing sometimes the ratio changes each shift.

In a day to day ICU assignment we have 2 babies each or a baby and an admit bed.

In intermediate we can have 3-4 babies per nurse (feeder/growers).

We also try to have our babies at different times (8,9,10) we make assignments so one nurse does not have all their babies due at the same time if we can help it, sometimes that is just how it works out.

Our PCA's can do patient care if the nurse assess first PO feeding babies. We have started to also have :yeah: resource nurse who assignment is to ask anyone charge nurse included (ICU and Intermediate) if they need anything, staffing permitted.

Our isolation/contact precaution babies are cluster in the same room and one nurse has all the babies. ICU 1-2 babies, Intermediate 1-4.

BoonersmomRN · Feb 8, 2008

I'm new but from what I have garnered - extremely unstable vents/oscillators are 1:1. Stable vents are 1:2. CPAP is usually 1:2 but may have a feeder/grower as well. Feeder/Growers are 1:3-4.

Last night I had 3 feeder/growers. We don't have any techs. ALl 3 of mine were on 8-11-2-5. All 3 were extremely slow eaters needing lots of stimulation and we have a rule that you have to attempt PO feed for 30 mins before gavaging. I spent the entire night trying to coax them to eat or setting up/taking them off gavage. Thankfully one of mine was a a sleepy little thing and was able to be pushed to more of a 9-12-3-6 schedule. I wanted to yank my hair out...it's sooooo frustrating when you have this rule and your baby is not ready for PO feeds for every feed and 30 mins later you're happy that they have taken 5cc po out of the 28 they need.

nurserynurse55 · Feb 9, 2008

We are 1 - 4 per nurse. Step-down babies have their own unit (except for isolation step-down). The problem is that we often have 2 baby assignments where both of them are HFOV/JET. We have kind of a tuff unit.:paw: