Level I Nursery

I don't work in the inner city. I work in a small community hospital. We have no one physician-wise or OR staff in house unless we call them in. Most of our pt's get PN care and they are usually low risk. We have had people walk in and go from low risk to high risk in 10 seconds flat. (ie. bleeding, persistent decels, ROM at an early gestation w/ adv. dilitation). It is is hard at times to deal w/ these things. Our tertiary facility is 25 miles away and it usually takes about 60 min. for them to get to us. Our ob docs are pretty proficient in intubation and will call peds doc to come in for delivery (if there's time) when we're anticipating a bad baby or having a C/S. There are some hairy, scary moments, but they are rare because we do have a low-risk population. It doesn't sound practical in your environment.

I have also worked in a place in a small town where there were no doctors in house. This was typical. They could get there if they knew in advance for a delivery but like the person stated before if there was no ped...the anesthesia department and the ob doctor were required to do this.... Before you resign you should voice your concerns through your chain of command...if you get no where with your hospital you can always file a complaint with JCAHO.

I have complained to the manager and VP of nursing and I was told that a doctor is not required to be in-house for a Level I Nursery. But our population is high risk and we are called to the delivery room for almost every delivery. I am not sure what the JCAHO standards are in this situation but I am going to find out.

I have also worked in a place in a small town where there were no doctors in house. This was typical. They could get there if they knew in advance for a delivery but like the person stated before if there was no ped...the anesthesia department and the ob doctor were required to do this.... Before you resign you should voice your concerns through your chain of command...if you get no where with your hospital you can always file a complaint with JCAHO.

Now I am thinking...shouldn't the high risk patients be delivering someplace else??? It seems to me that the high risk patients should be going to places with at least a level 2???

Now I am thinking...shouldn't the high risk patients be delivering someplace else??? It seems to me that the high risk patients should be going to places with at least a level 2???

The 1st problem with that is that you cannot control who will walk in off the street in labor. The 2nd problem that I've run into is that some docs don't want to label a pt "high risk" if that requires them being sent to a different doc or hospital. I know, I know - can you imagine an OB doc letting his/her ego get in the way of what's best for the patient? Perish the thought! Of course, a strong nursing administrator could help take care of this problem, but we were not lucky enough to have one.

I do understand that in some communities a level one is all they can support. But my last job only had a level one nursery and I will never, NEVER work in one again. Way too scary.

I can understand how you feel, we also attend all high risk deliveries.....on call docs aren't always there when you need them.

Will this make much difference as to how many babies need special care, or will they be sent out?

For the last year or so, we have had hospitalist peds, it has made so much difference in the outcome for many of our newborns.

My hospital just closed our Level II NICU and converted us to a Level I Nursery. They also fired our Neonatalogist of 25 years and bought in a new on-call neonatlogist. We are in the inner city and a very high risk neigborhood where most of the mothers don't have pre-natal care. Do any of you with a Level I Nursery and no NICU have just on-call doctors and no one in house. We have already had two incidents in the pass six days since they took over. One baby was mec-stained and no neonatalogist to intubate and visualize the cords. Prayerfully the baby didn't have any resp. distress but I feel that is a very dangerous situation. The nursery nurses are still required to attend all high-risk deliveries in L&D and any outside deliveies that come in the ER without a neonatalogist, pediatrican, resident, intern or NP. We have no doctors in house except the OB-GYN. I am getting ready to resign because I don't feel that this is a safe situation.

Aloha,

I am a L&D RN in Waimea, Hawaii and we have a level I nursery. If the OB-GYN knows it is a high risk patient they are sent and delivered at the tertiary care center on another island.

If the patient comes in labor and high risk such as your case(which they sometimes do as we all know very well) they are delivered with RT and Peds present. Both of them, in addition to the OB-GYN or CNM, can intubate. We have an AWESOME group of Docs that are very dedicated to their craft and

to their patients we have no problem having them in attendance. By the time the transport team from Oahu where the tertiary care center is, the babe is usually stabilized---usually! The transport team is awesome as well and the PEDs and OB are in constant communication by phone in anticipation of any problems during or after the delivery.

Our RN team averages 20+ years experience with an NICU RN of greater than 20 years on staff. All RNs are NRP certified as you are. I am only the second RN with experience under 5 years.

Sounds like you all have restructuring you all are adjusting to. I feel for you. Hang in there---find strength in your staff. Do you have Respiratory Therapy on staff readily available and experienced to intubate? What about your OB?

Tammy