Is your NICU a Pit or a Palace?

KRVRN, BSN, RN · Feb 21, 2005

Palace. 61-bed unit.

Feeder/growers are in a separate section as the sicker babies.

3:1 ratio with the feeder/growers, 4:1 if we're really slammed and short staffed.

2:1 ratio with the sicker babies, 1:1 if it's a really sick, busy baby.

It's a LAST LAST resort to give a nurse 2 vented pts, and if the have to, they are stable vents.

Admit nurses won't have a vented pt.

We have ALS nurses with special training whose sole purpose is to go to the high risk deliveries with a RT.

RT's set up and manage all respiratory equipment.

MA/CNA's constantly restock, enter orders and answer phones. We have at least one 24/7, and generally have 2 or 3.

We're very current with research and generally don't merely do things a certain way because we always have.

We have Neo and NNP coverage 24/7 and we aren't a teaching hospital.

In general our OB clientele tends to be moreso middle class than homeless or on drugs (interpret that how you will but it makes for easier nurse/parent/CPS interactions)

Our general attitude is one of helping our fellow coworkers, and generally won't let someone drown while we sit doing nothing.

We have a great manager who is always willing to listen and advocate for her staff.

NoCrumping · Feb 21, 2005

Palace, 55 bed unit. Split up into 2 rooms, one room, the "NICU", has 4 "bays".. all the vented , cpap babies are here, and any baby not vented with an IV. The "feeder grower" room is next door, called the "special care nursery". Some nurses prefer to stay in there, and if you've been there long enough, they will let you.

The pt load in the nicu is no more than 2 vented or IV babies to 1 nurse.In the special care nursery, you might get 4 ., but no IV's, all po meds, if any. We have a full R/T staff specific to the NICU. They retape, bag, fit and place on cpap, manage all vents, etc. We have a full lab support team, the nurses dont draw anything besides from an umbilical line, and we do bedside glucose. We have a blood gas mini lab right on the unit, so we usually run them over , and we get the results in about 10 min. We also have a full pharmacy team. The only thing we draw up in the unit, is , say, a one time lasix, first time amp and gent, and obviously code meds. Every single med order is faxed to pharm, and by, i think midnight, all the meds are there by the bedside for the next 24 hours. We have computerized lab results, computerized radiologic results. It is a teaching hospital, we have about 8 residents, 2 fellows, and 4 attendings available 24/7. We have charge nurses, they never have an assignment, they float around and help out....we have an admission nurse, she has NO assignment, she floats around to help out. We do, however, have a staffing problem, ( or is it a "the babies keep coming" problem?), so we have mandatory overtime, as we dont use travelers, and we dont use floats under any circumstances. They use a seniority system, and this has caused alot of people to leave. It is fine with me, however, because I need the $$$$$ lol.... They pay double time for any overtime, and if you are part time, you get double for any hours over those normally scheduled. Every shift, they send up a cookie/snack cart with these delicious cookies( people come to the hosp cafeteria from other places, its really that good), fresh fruit, drinks, cereal bars, etc. Your days are always the same, thats how they schedule. And, they have a "staffing specialist" to handle all those needs. We have at least 1 asst nurse manager on each shift, in addition to the charge nurse. Wer are a regional perinatal center, and the demographics really cover all spectrums. We have unit secretaries who send orders for labs, calls parents, etc. They have an excellent 13 week orientation. We have nurses who have been there for 25+ years, and they are all more than willing to precept new nurses. We are an all RN staff, no LPN or cna's, no MA's. Your not allowed to go to deliveries, or go on transport until you are there 2 years. They want you to learn just the kiddos first. We are never complacent in practice, and everything we do is of the most recent research, since we are one of the teaching hospitals of one of the best medical schools in the world. Nurses are respected here, need to be present on rounds, and are asked all the time by docs, attendings even, "what do you want me to do for this baby?" They know that we know those babies well. I came here as GN, and I had to leave due to my husbands work, and had to go to a TRUE PIT. Everything there was the COMPLETE opposite , except for it being a teaching hosp and a regional peri center. It was said that "every time you walk in here, you leave your license at the door, ya never know if you will leave your shift with it". I left, went back to the palace. And I here people complain about this and that, and then I tell them a story about an assignment I had at the PIT, ( post op, oscillator, 2 conv vents, and up for an admit) and they usually just act appaulled and laugh it off. But ya know what? if it were the only NICU I could work in (the PIT), I still would do it, because I truely never thought I could love a job any more than I do this one.:)

fergus51 · Feb 22, 2005

I would not say we're a palace or a pit. When it comes to equipment, I think it sucks at times. But, my coworkers are mostly great nurses and we are generally well staffed thanks to good management. They are willing to do whatever it takes to get more staff, including paying the big bucks to get travellers and registry in addition to offering bonuses to us regulars. Honestly, reading some of the posts on this forum have absolutely shocked me. The staffing ratios some of you work with are unacceptable for me.

Gompers, BSN, RN · Feb 22, 2005

As far as the actual unit goes - it's pretty outdated and our equiptment is starting to fall apart - I'd say we're more on the "pit" side. It can be embarrassing sometimes, using isolettes and warmers that are 20 years old! But if it works...use it!

Now, as far as our staff and how we care for the babies, it's "palace" all the way! No doubt. We've got the best group of nurses in the world, IMHO. Our babies get top notch care, because even though some of our equiptment is old, the ideas are new and ever-changing with the times.

(And as far as staffing and assignments, that other thread we have going was talking about what we do when we're SHORT, not about what normal staffing is!!! Everyone has shifts from hell where you get five admits and two nurses go home sick, stuff like that. It happens, and on nights we're not going to call and wake people up at 2am and ask if they want to come to work! You make do until the next shift comes on.)

Noelle_RN · Feb 22, 2005

I am from New York and somehow ended up in New Jersey at a great hopital. We had Nitric and all but still we were treated with respect and trully worked as a team. I took time off to see if making money was for me as a pharmaceutical rep and soo nrealized NICU nursing was my calling. I recently went to a facility where it was a 57 bed unit and had three patients with an admit, it was so different from what I had been used to. Not that I wouldn't do it again, I just felt that I was in a whole different type of NICU. Even the NICU nurses treated me as if I came from a palace even though my knowledge and skills were up to par. So many people were leaving that they were mad and seemed to be mad at me for coming in place.I know this is my calling but I am a novice nurse compared to the amazing women I have met along the way, and looking for advice on job hunting and if you could let me know what hospital you were talking about in NY(I am trying to move back) I would greatly appreciate it, NoCrumping! Just trying to get some insight is all.

Any advice would be greatly appreciated!

NoCrumping · Feb 22, 2005

I am from New York and somehow ended up in New Jersey at a great hopital. We had Nitric and all but still we were treated with respect and trully worked as a team. I took time off to see if making money was for me as a pharmaceutical rep and soo nrealized NICU nursing was my calling. I recently went to a facility where it was a 57 bed unit and had three patients with an admit, it was so different from what I had been used to. Not that I wouldn't do it again, I just felt that I was in a whole different type of NICU. Even the NICU nurses treated me as if I came from a palace even though my knowledge and skills were up to par. So many people were leaving that they were mad and seemed to be mad at me for coming in place.I know this is my calling but I am a novice nurse compared to the amazing women I have met along the way, and looking for advice on job hunting and if you could let me know what hospital you were talking about in NY(I am trying to move back) I would greatly appreciate it, NoCrumping! Just trying to get some insight is all.
Any advice would be greatly appreciated!

HI Noelle, I have worked in 2 NICU's, and , actually, the "palace" I described in my post, was not in NY at all.... I did work in a true "pit" on LI. Do you need to stay in the city? Let me know, I can probly give you some names of hospitals, as I am sure many here can. I understand what your saying about it being a calling. I cant imagine myself doing anything eslde and loving it as much as I do, it's become part of what I am, I think, and I never thought that would happen... I always wondered what pharm sales would be like though, I was in between jobs for a few months, and thought about it as a temp thing.how was it? Do they kind of welcome nurses to the field? Let me know what kind of insight you are looking for, have you ever worked in a NICU in NY?

Noelle_RN · Feb 23, 2005

Hi! Sorry took so long to get back. THis job hunting takes up all my time! I feel like I am getting the run around with some of the agencies. I loved sales because of the freedom and the money. I worked for a top 5 Fortune 500 company.The bonuses were the best parrt! My biggest disappointment really comes with my new respect for medicine and healing on the holistic level and realizing what our world is doing to the earth and so forth,(not to sound like a tree hugger). But, I am starting to see that I have to practice what I preach and prevention really is the key as well as treating the patient as a whole! I haven't come across that in offices and hospitals, that is the biggest disappointment. I am trying to balance my holistic belief with modern medicine. AND, here I am wanting to work in a Level III NICU! I believe I can help and hope during the process my education continues and I find my path in holistic nursing, but I know that is years down the road. I worked in NJ hospitals. My experience in NY ranges through nursing school in Wagner College in Staten Island where I did clinicals throughout the boroughs. My friend loves NYU and I am looking in NYC today actually with a staffing company. I am moving from NJ to NY(originally from SI,NY) I want to travel, I just need to bridge the gap of my experience for a solid year because of the pharmaceutical sales. Then I am willing to travel anywhere. Right now I am just trying to get in somewhere that I can strengthen my skills and feel secure, at least for a year or two. I like NYC or Brooklyn because its central to friends, family, and I am newly single!

The insight I am looking for is - Are all NICUs' the same and is it realistic to look for a place that is trully dedicated to developmental growth, has a realistic nurse:patient ratio, and cares about the parents? I am not sure if it is tiem that has changed my outlook on how things work or if I just had a bad experience. I guess my biggest question is hard to write, I have to think how to write this one diplomatically. I appreciate your help and advice! Look forward to hearing from you!

NoCrumping · Feb 23, 2005

Hi! Sorry took so long to get back. THis job hunting takes up all my time! I feel like I am getting the run around with some of the agencies. I loved sales because of the freedom and the money. I worked for a top 5 Fortune 500 company.The bonuses were the best parrt! My biggest disappointment really comes with my new respect for medicine and healing on the holistic level and realizing what our world is doing to the earth and so forth,(not to sound like a tree hugger). But, I am starting to see that I have to practice what I preach and prevention really is the key as well as treating the patient as a whole! I haven't come across that in offices and hospitals, that is the biggest disappointment. I am trying to balance my holistic belief with modern medicine. AND, here I am wanting to work in a Level III NICU! I believe I can help and hope during the process my education continues and I find my path in holistic nursing, but I know that is years down the road. I worked in NJ hospitals. My experience in NY ranges through nursing school in Wagner College in Staten Island where I did clinicals throughout the boroughs. My friend loves NYU and I am looking in NYC today actually with a staffing company. I am moving from NJ to NY(originally from SI,NY) I want to travel, I just need to bridge the gap of my experience for a solid year because of the pharmaceutical sales. Then I am willing to travel anywhere. Right now I am just trying to get in somewhere that I can strengthen my skills and feel secure, at least for a year or two. I like NYC or Brooklyn because its central to friends, family, and I am newly single!
The insight I am looking for is - Are all NICUs' the same and is it realistic to look for a place that is trully dedicated to developmental growth, has a realistic nurse:patient ratio, and cares about the parents? I am not sure if it is tiem that has changed my outlook on how things work or if I just had a bad experience. I guess my biggest question is hard to write, I have to think how to write this one diplomatically. I appreciate your help and advice! Look forward to hearing from you!

HI Noelle.

First, NO, NICU's are NOT all the same..... hence this thread... "pit" or palace" lol . Some are more on the up and up with developmental care, parental involvement, etc. And pt ratios can vary widely too. Sounds like you did have a bad experience.. I did too, so I left. What you need to do is find hospitals with NICU's and when there interviewing, ask all these questions directly...... you will most likely get an honest answer from the manager. One said to me, when I asked her about pt ratios: "Well, we try our best, but most of the time, you should expect to care for 3-4 stable vents in an assignment"

so I knew there, I would have a heavy pt load every day, so I declined. My suggestion though, but this is just me, is to try to get into a teaching hospital. They, for the most part, will be up to speed on those issues you mentioned, plus I like having a docs on the unit 24/7, since I work nights sometimes. There are lots to choose from in NYC bklyn. NYU, Columbia/Presb, Montefiore, etc. Explore all these, dont jump at the first offer. I used to think all NICU's were the same..... I took a job in a pit, coming from a palace, and I was in another world, thinking how the nurses even functioned in that environment.Also, even though you have some experience, look for a GOOD orientation program. By this I mean.....at least 8 weeks of preceptorship with didactic components.The hospital I work in now gives new hires 13 weeks, with 3 wks didactic..... thats extreme and hard to find mostly, though. There are many things to find out about a prospective nicu... all which vary in importance from nurse to nurse... I like to know about RT support, pt ratios, dev care. It is possible to find a NICU with all these things. Thats initeresting what you said regarding holistic care an NICU's being opposing forces.... but who knows what is down the road, its a good area to pursue, good luck to you!! How is the staffing agency working out? I have never worked with one before, let me know....I may be relocating back to NY again.....and might go that route... Good luck today with the job hunt... :rolleyes:

Noelle_RN · Feb 24, 2005

Thank you for that great advice! I have come to learn the hard way that I shouldn't jump on the first offer ad to ask upfront and honest questions. THe agency thing is weird, yesterday they liked me so much they offered me a job as a nurse recruiter. I am waiting for an interview next week with a peds clinic in NYC. Clinics seem to be in need of nurses and the pay is competetive with hospitals. I found only one recruiter that I liked, but there are one or two agencies that i believe are decent. If you decide to relocate let me know I'll e-mail you some of the agencies and contacts. I have been weeding through them already! I think I am old fashion because I prefer to research the hospital and focus on them to get the job, through HR. I am waiting on an interview with NYU. That would be my dream come true. My friend makes it sound like a castle in the sky, its so great! I talked with a travel recruiter from California. I am thinking about going out there next winter. 25,000 for 12 weeks and 2:1 patient/nurse ratio by law. Housing and all, it sounds nice for a change. I am so sick of this weather. She is really nice too.

Well, I am off to research mmore jobs. Thank you so much for everything. Let me know if I could be of help.

Tomskatt · Feb 27, 2005

:smiley_aa

Palace, 55 bed unit. Split up into 2 rooms, one room, the "NICU", has 4 "bays".. all the vented , cpap babies are here, and any baby not vented with an IV. The "feeder grower" room is next door, called the "special care nursery". Some nurses prefer to stay in there, and if you've been there long enough, they will let you.
The pt load in the nicu is no more than 2 vented or IV babies to 1 nurse.In the special care nursery, you might get 4 ., but no IV's, all po meds, if any. We have a full R/T staff specific to the NICU. They retape, bag, fit and place on cpap, manage all vents, etc. We have a full lab support team, the nurses dont draw anything besides from an umbilical line, and we do bedside glucose. We have a blood gas mini lab right on the unit, so we usually run them over , and we get the results in about 10 min. We also have a full pharmacy team. The only thing we draw up in the unit, is , say, a one time lasix, first time amp and gent, and obviously code meds. Every single med order is faxed to pharm, and by, i think midnight, all the meds are there by the bedside for the next 24 hours. We have computerized lab results, computerized radiologic results. It is a teaching hospital, we have about 8 residents, 2 fellows, and 4 attendings available 24/7. We have charge nurses, they never have an assignment, they float around and help out....we have an admission nurse, she has NO assignment, she floats around to help out. We do, however, have a staffing problem, ( or is it a "the babies keep coming" problem?), so we have mandatory overtime, as we dont use travelers, and we dont use floats under any circumstances. They use a seniority system, and this has caused alot of people to leave. It is fine with me, however, because I need the $$$$$ lol.... They pay double time for any overtime, and if you are part time, you get double for any hours over those normally scheduled. Every shift, they send up a cookie/snack cart with these delicious cookies( people come to the hosp cafeteria from other places, its really that good), fresh fruit, drinks, cereal bars, etc. Your days are always the same, thats how they schedule. And, they have a "staffing specialist" to handle all those needs. We have at least 1 asst nurse manager on each shift, in addition to the charge nurse. Wer are a regional perinatal center, and the demographics really cover all spectrums. We have unit secretaries who send orders for labs, calls parents, etc. They have an excellent 13 week orientation. We have nurses who have been there for 25+ years, and they are all more than willing to precept new nurses. We are an all RN staff, no LPN or cna's, no MA's. Your not allowed to go to deliveries, or go on transport until you are there 2 years. They want you to learn just the kiddos first. We are never complacent in practice, and everything we do is of the most recent research, since we are one of the teaching hospitals of one of the best medical schools in the world. Nurses are respected here, need to be present on rounds, and are asked all the time by docs, attendings even, "what do you want me to do for this baby?" They know that we know those babies well. I came here as GN, and I had to leave due to my husbands work, and had to go to a TRUE PIT. Everything there was the COMPLETE opposite , except for it being a teaching hosp and a regional peri center. It was said that "every time you walk in here, you leave your license at the door, ya never know if you will leave your shift with it". I left, went back to the palace. And I here people complain about this and that, and then I tell them a story about an assignment I had at the PIT, ( post op, oscillator, 2 conv vents, and up for an admit) and they usually just act appaulled and laugh it off. But ya know what? if it were the only NICU I could work in (the PIT), I still would do it, because I truely never thought I could love a job any more than I do this one.:)

Okay, I need to know where in NY this kind of palace exists!!! I have been an RN in NICU here for 10 years and haven't been so lucky.... yet! But choices are limited on Long Island.

NoCrumping · Feb 27, 2005

:smiley_aa
Okay, I need to know where in NY this kind of palace exists!!! I have been an RN in NICU here for 10 years and haven't been so lucky.... yet! But choices are limited on Long Island.

They certainly are..... are you in nassau county? ( its not in NY, I am not there currently) I left this place to go to a NICU on LI (Pit), then went back to the palace, wanting to kiss the ground.