Level IV NICU Model of Care

**NICU Guy, BSN, RN** · Sep 14, 2015

How is your unit set up? 28 individual rooms and 15 five bed pods/sections

How many beds? 101

How many nurses do you have? 300

How are patients assigned? based on the complexity of patient and experience of nurse

What specialty teams do you have? (PICC, ECMO, Transport, PPHN, Wound, etc) PICC, ECMO, Infant Stabilization Team (exclusively attend deliveries), transport team (NICU/PICU)

How are patients assigned to bed spaces? Separate pod/section for very sick patients, otherwise assigned to available beds.

Do you separate by diagnosis? no

How do you provide continuity of care? nurses are assigned same patients on consecutive work days

12 hour shift? 8 hour shifts? 12 hr shifts with small percentage working 8 hrs

How many charge nurses and what are their roles? 2 -3 per shift.

What is your nurse to patient ratio? 1:1, 2:1, 3:1 depending on acuity

How well is staff supported each shift? (resource nurses? extra staff available to help? 1 float person to help when needed by staff

Do any of your nurses attend deliveries? separate 3 person team to attend all deliveries

Elvish, BSN, DNP, RN, NP · Sep 15, 2015

How is your unit set up? Open-bay area for sickest kids, individual rooms for more stable ones or feeder-growers.

How many beds? We have bedspace for 53 but certified for 48. 28 of those are individual rooms

How many nurses do you have? Obviously depends on pt census but on average we staff with 13-14 bedside nurses plus a charge and another who goes to deliveries alongside a RT and NNP/MD.

How are patients assigned? Generally by acuity. Obviously sickest are 1:1. Sometimes the feeder-growers can be 3:1, if we are really short 4:1

What specialty teams do you have? (PICC, ECMO, Transport, PPHN, Wound, etc) Transport, delivery team

How are patients assigned to bed spaces? Generally by what is available. If extenuating circumstances (short life expectancy or uber-sick we may shuffle bedspaces to accomodate the need for more space)

Do you separate by diagnosis? No

How do you provide continuity of care? 1) Primaries; and 2) if a pt doesn't have a primary, then charge tries to reassign same pt/same nurse on consecutive days.

12 hour shift? 12s exclusively

How many charge nurses and what are their roles? 1 per shift, and we have a core group of charge nurses. Roles include making pt assignments, reshuffling staff if we have a large patient flux (either d/cs or admits), general putting out of fires, helping with task-y things like line/tubing/TPN changes, and coordinating with newborn nursery and L&D to anticipate possible admits/transfers.

What is your nurse to patient ratio? see above

How well is staff supported each shift? (resource nurses? extra staff available to help?) Generally pretty well. The charge nurse does not have a pt assignment and if all goes according to plan neither does the nurse on the delivery team. We also have a person who helps coordinate discharge - doing parent education, arranging for whatever follow-up services and DME baby will need after d/c.

Do any of your nurses attend deliveries? Yes. There is one dedicated nurse that goes to deliveries. Occasionally this nurse will have an assignment but the charge nurses try to make it very light and easy to cover when a high-risk delivery happens.

What do you feel works best in your unit? We have really good leadership - management generally sticks up for us and is almost always willing to come in and staff when needed. The MDs/NPs have also started making both morning and evening rounds which has helped A LOT in catching issues before they become massive problems...also has helped foster the relationship between the bedside RN and the medical provider staff.

What works the leastâ€¦ what would you change? Hmmmmm. I hope this doesn't mean I'm categorically criticizing family-centered care because I'm not. But the move to private rooms has sometimes been a bit problematic - parents storing their food etc. in the baby's milk fridge, being inappropriate in the room because it's a private room and they think nobody will catch them, etc. This is not the majority of parents by a long shot but the few bad apples make it hard. Management usually back up staff on things like these but if I could change anything at all I would change the few families who seemingly take it upon themselves to make things as difficult as possible!