Published
I am currenly a RN on a peds hem/onc floor and I need a change! After applying to L&D and having that fall through, I've found a position in a Level II Nursery at a nearby hospital. What are the different levels of NICU's and what do they mean? What kind of patients would I expect to take care of in each? Thank you for your help!
LEVEL IV: Admission Criteria Neonatal Intensive Care
Stage 1:
The following clinical elements/interventions must be documented in the medical record:
LEVEL IV Stage 2:
The following clinical elements/interventions must be documented in the medical record:
Discharge Criteria Stage 1, Stage 2
Level III
Admission Criteria Neonatal Intermediate Level of Care
Stage 3:
Level III
Stage 4:
Level III
Discharge Criteria Stage 3, Stage 4
Level II
Admission Criteria Neonatal Continuing Care Level
Stage 5
Level II
Stage 6
Level II
Stage 7 : Discharge to home anticipated
Level II
Stage 8 Revenue Code 172:
Level II
Discharge Criteria Stage 5, Stage 6, Stage 7, Stage 8:
References:
Level III
Admission Criteria Neonatal Intermediate Level of Care
Stage 3:
I have to disagree with this...we are a designated level III and we take everything but ECMO, we do all surgeries except cardiac, and use nitric. I think each state may also differ in what the units take. I know that many level II here do not have a neonate doc in house or a fellow for the night.
I have to disagree with this...we are a designated level III and we take everything but ECMO, we do all surgeries except cardiac, and use nitric. I think each state may also differ in what the units take. I know that many level II here do not have a neonate doc in house or a fellow for the night.
Level III
Admission Criteria Neonatal Intermediate Level of Care
Stage 3:
There is no real certification for a level IV that I am aware of so some Level 3 certified NICUs are actually providing level IV care(Revenue Code 174). Level IV is basically intensive care. Level three (Revenue Code 173) is intermediate care that involves 6-12 hours of nursing per day.
When I first began researching the differances I assumed that Level 3 care (Intermediate and non-intensive care) was intensive care. In fact it is not. Your facility most likely provides Level four care. One way to verify that is to ask your billing department if they send out claims with revenue code 174 on them for the cases you are describing.
I work in a Level 2 now (after retiring from a Level 3 stage i-don't-know). I typically get 2 or 3 pts. Three is the MAX! It's only 10 beds, and 2 beds are "transition" beds. Newborns come in, get admission assessments (weighed, measured, physical assessment), get bathed, eyes and thighs, etc....
We do get sick babies, and need to be able to stabilize, including intubation, ventilation and umbi lines, until the Neo and/or transport team gets there. One nurse on each shift is "ALS", has rec'd extra training to be able to do that stuff. They go to deliveries where problems are suspected, along w/an RT.
After the baby has gone to the Level 3, and is convalescing, they can come back to us for care til they're ready to go home.
I gotta say, @ my stage of life and nursing career, I absolutely LOVE Level 2.
I always wondered if there was a level IV nursery--if so, I think that is what mine would be called. We have the smallest mircopreemies and everything up to big, sick newborns. Five types of ventilators (HFOV, jet, ECMO, CPAP, high flow nasal cannula and conventional vents), we do all kinds of surgeries including cardiac--but not transplants, we care for all the genetic anomalies for most of the state, and every baby the other hospitals can't or won't care for.
We do keep the babies until they go home (sometimes for over a year) and mix sick and 'stable' feeders together. By state law, we can only have one to one or two to one assignments.
I've never worked in a level II nursery, so I don't know how that would be different.
nurseiam
150 Posts
I think laws are great but in our work it doesn't really mean much! What means more is when it comes to a lawsuit and it is discovered that this HIPPA baby had this tragic event because the nurse was taking care of 5 or more patients and thae NANN guidelines state that it is unsafe.
I know plenty of of nurses in my unit that could care for that many babies but that does not make it safe and it would not be worth your license!!