Hearing all this makes me grateful for the unit I work in! We definitely have our busy times, it's really busy in our unit right now .... we're a level III + ECMO and we're full a lot of the time. But we don't have real bad, unsafe assignments like some of these that I'm hearing about.
We do like Jenny mentioned ..... if one shift has a super busy day with their assigment, then they will change it around for the next shift. Or make a baby 1:1 for the next shift if it's a really busy baby.
We have "acuity sheets" that each baby has in their chart. We score them based on a number of things (type of vent, unstable or stable, number of lines, IVs, number of meds, labs/gases, drips, feeds, teaching for parents, etc, etc.) Whatever their score is will give an idea of what kind of assigment to put them in (3:1, 2:1, or 1:1).
I can't imagine being 1st admit with 4 babies, all with PIVs!! Oh my goodness. How can you have time to assess ALL 4 IVs, EVERY hour? While keeping up with feeds and assessments, not to mention getting an admit. Wow.