How many patients a day

preemieRNkate, RN · Feb 9, 2008

We have anywhere from 1 to 4 babies, usually. Pretty much the same as what everyone else said, a sick baby on HFOV/HFJV with multiple drips, needs frequent vitals, multiple blood products, etc is a 1:1. Or, 2 stable vents, a vent and a feeder, a vent and a CPAP, CPAP and a feeder. 3-4 feeders, or 2 or 3 feeders and you're on admit. The transport nurse usually has an assignment that is easily absorbed into the room, whether it be an easy feeder, a stable CPAP with NG feeds, whatever. On 2 occasions, I have seen a 2:1. One baby was a reeeeally unstable FT baby that we thought had cardiac issues (turned out to be some rare metabolic disorder) and the other was was a baby that got NEC, perf'd, went to the OR, came back, and went into DIC. I was working 7p-7a taking care of him, and staffing allowed for there to be a second nurse assigned with us from 11a-11p. That was sooo nice (and incredibly rare)!

When staffing got bad over the summer and the census was way up, there were times when a nurse would have up to 5 babies. They were all feeders, but that is my worst nightmare! I feel like I'm being punished for something when I have a bunch of pokey feeders.

littleneoRN · Feb 9, 2008

Elizabells,

Do you know what your unit's motivation for having all the babies on the same three hour schedule. In our stepdown, we almost always have three babies, so having them on each hour (8,9,10) works perfect. If they're all on the same hour, I can't possibly give them each a thorough assessment, hygiene, and bottling effort if appropriate. This would be different with 1:1 assignments, which many of our ICU babies are. Just curious if you have any insight into their motivation? :)

elizabells, BSN, RN · Feb 9, 2008

I don't have the foggiest idea. I'm about 90 percent certain that if I asked anyone I'd get the blankest look. Maybe because, as someone said upthread, it makes the assignment harder to work out?

The mantra of my unit: "Because that's the way we do it here."

littleneoRN · Feb 9, 2008

The convenient thing for us is that we have rooms of 3 or 6 kids. So, we try our darnedest to have two kids on each hour in each room. So, depending on acuity, if you have two nurses, with three babies each, there should be one on each hour for each nurse. That's the biggest our assignments get. Occasionally due to whatever reason, you might have two babies on the same hour, but you still wouldn't end up with three feeders on the same hour. I can see how this wouldn't be so naturally easy on a unit that wasn't conveniently organized into multiples of three. Granted there are the q4h or ad lib kiddos who like to throw the whole thing off. But then I say, if you're eating ad lib, it's time to move out of the hotel. :)

elizabells, BSN, RN · Feb 9, 2008

But then I say, if you're eating ad lib, it's time to move out of the hotel. :)

Or the corollary: If you can scream that loud, it's time to go home.

BittyBabyGrower, MSN, RN · Feb 9, 2008

We too stagger our feeding times, we have the 8-11-2-5 and 9-12-3-6 schedule. Sometimes you end up with all your feeders on the same schedule, sometimes not.

With our census being over capacity right now, we are getting some tough assignments, with some of our sicker kids paired with 2 feeders or a vent, I had 6 feeders the other day...thankfully half were ng'ers, but then again, when I started way back when , this was the norm for us, so it wasn't hard for me, but the newer people are really struggling, so the ones of us that have been here longer will take the heavier feeders assignments, but then the newer people are getting the sicker kids and they are uncomfortable with that. It is a hairy situation all around. We are hoping to get some of the bigger kids off to the children's rehab this week so that will help out.

But usually our ratios are 1:1, 1:2, 1:3 or 1:4, mostly 1:2 or 1:3 unless the kid is really unstable.

littleneoRN · Feb 9, 2008

A lot of you talk about having census over your actual capacity? First, where do you put them? I mean, doesn't every kid need a set up with a monitor, wall oxygen, etc.? Second, do your hospitals not allow you to simply close the unit when you have no more beds? We don't even have to say closed...if there are no beds, it's a given to them that we are NOT taking any babies. Our contract even says we can close to new admissions if we don't have staff, but of course that is a little more sticky and not very well respected. But, we never have more babies than beds. In fact, our L & D will send high risk/premature moms to other facilities if our neonatal units are full. So just wondering how this works other places.

BittyBabyGrower, MSN, RN · Feb 10, 2008

We close to outside maternal and neonatal transports,but we can't refuse the ones that deliver at our hospital. Actually, all the nicu's in our area are over or at capacity, so we are all in the same boat. So, in your hosptial what do they do with the inhouse deliveries? If someones walks in and delivers a 24 weeker do you just go to DR and stablilize them and send them out? I would love to just tell LD and to close their doors, but that isn't happening.

We have monitors at all bedspaces and overflows, we will rent monitors and put the beds back to back as each wall unit has 4 outlets for O2, air and vacuum. We try to send the older kids to peds or long term faciltities, but most of them are too sick to go anywhere.

I wish there was an easy solution like yours, but I am willing to bet you are the exception to the rule!

elizabells, BSN, RN · Feb 10, 2008

We use portable monitors and suction with an O2 tank. Kids in overflow spots must be on room air.

Since we're the regional referral center for, like, everything, we CAN'T legally turn some kinds of kids away. There's nowhere else for them to go. And we're the major MFM center, so all the high-risk moms come to us. We also can't transfer less sick kids to other hospitals/LTC if their parents don't want us too - and many of them refuse.

littleneoRN · Feb 10, 2008

Sometimes I'm not sure how we do it, but we always manage to empty a bed just in time. We also are a major referral center for most of our state and parts of neighboring states. sometimes there's shuffle between stepdowns and the icu. Sometimes we send some of the bigger chronic kids to PICU, PICU stepdown, or med/surg. We usually have a few families who would love to transfer to a small level 2 closer to home, but the transport is often denied by insurance. If we're itching for beds, administration will pay for the ambulance ride out to the community level 2. We defer maternal and neonatal transports to other nearby Level IIIs unless they are something that needs to come to us. And our Labor and Delivery will close to high risk moms expecting to need level II or III care. Moms are supposed to call their OB before they show up at the hospital, and then the OBs send them to a different hospital. Of course we know that sometimes they don't make that phonecall, but most of the time this system works pretty well. Also, we try not to get to a one bed left situation. As we approach that, we start deferring later preterm moms who will probably do fine at a hospital with a level 2. That way there's always a few beds open for the surprise code in NBN, the 24 week twins who have nowhere else to go, or the undiagnosed left hypoplast. :)The bigger trouble for us is when the NNP shows up at our door with a baby and a dad, and we have physical beds but no staff to admit. That we don't seem to have worked out so well yet. Help!

elizabells, BSN, RN · Feb 10, 2008

I was also told by one of our fellows that our NICU provides 70% of the hospital's revenue. So the Powers That Be put enormous pressure on us to take all the babies we can. I remember one day when the VP of the hospital personally called the transport fellow on duty and bullied her into taking two cardiac transports. One of them went to the OR from an overflow spot, and while the kid was in surgery we had to figure out how to move the other babies around so she could come back to a real bed in the cardiac section of the unit.