Nurse/Patient Ratios - page 2
Hi! I am new to this forum. I am working med/tele, recently graduated and I am starting to actively search for a position in NICU or possibly PICU. I was wondering how comfortable NICU nurses... Read More
Jun 1, '031:2 feeder-growers? Good Lord, I thought that was for LIII babies. We do up to SIX F-G's per RN beore we call Nsg Serices and threaten to slash their tires. I've found that 4 is just right- any less than that and I'm falling asleep. 6, to me, is too much if three or more have feeding issues. It's allowed by our grid, however so what can ya' do? :>)
Jun 1, '03We are a closed unit and no OB or level two in our hospital....so we've done however we can to get by sometimes. This means sometimes the charge nurse and transport nurse take assignments...this after we are tight already.
Our ratio's generally go 1:1 on new admits or sicker pts esp. the 23 weekers. We have had as many as 3 NCPAP babes paired, but that is not the rule ussually 2. If an intubated pt is paired it is generally with one off NCPAP...but sometimes it's two intubated babes or one on NCPAP. ICA care pts can be upto 4 to a nurse, but ussually 3.
We have a 24 bed NICU level III. Many of our RN's (all RN staff) have at least 15 years of experience and it's the most experience ones who get the heavey assignments when push comes to shove.
We have been full or near full for over a year....and are currently hirering!
Jun 1, '03At my new job that I just got the nurse manager tells to me 1:1 or 2 in the intensive care nursery and 1:2 or 3, possibly 4 in the step down. Of course we'll see how that goes when I get out of orientation.
Jun 1, '03Originally posted by Kristi2377
1:2 feeder-growers? Good Lord, I thought that was for LIII babies. We do up to SIX F-G's per RN beore we call Nsg Serices and threaten to slash their tires. I've found that 4 is just right- any less than that and I'm falling asleep. 6, to me, is too much if three or more have feeding issues. It's allowed by our grid, however so what can ya' do? :>)
Kristi, I don't know how you do 6 feeder growers, I would be running from baby to baby all night. Our babes take about a half hour to check, nipple and/or og feed, do teaching with parents, at the same time go to deliveries and do admits. We have an almost level II nursery, last night I started with three, did the PKU and finished up the d/c on one baby. My screaming baby was a bili baby ready to feed less than two hours after his last feeding. Started that feed, went to a delivery, turned out to be a 36 weeker, flaring, grunting...brought him back...looked ok at first then started to desat....under O2, needed an IV, labs, cxr....my other two...someone else had to finish one feed, get the other ready for mom to feed....glad she was there but she wore the kid out, he would hardly nipple the rest of the night (he's an ex 30 weeker).......That's a normal night for us, throw in 2 or 3 or more c/s and high risk deliveries, sometimes 3 or 4 admits. Thank heavens we have a ped hospitalist covering most of our admits...at least we don't usually have to deal with a sleeping doc at home.
I think I'm tired.......I would probably be bored if I didn't do the deliveries........we have a busy L&D, I think we are up to 400/month. We ship out vent babies, or surgeries.
I am amazed at how poor staffing is in many places. Somehow management always underestimates the amount of time it takes to give good, safe care. After all, they are only babies, and all we do is sit and rock them........doesn't often happen! Occasionally we have to take four or more babies, usually as core we only take 2-3, because we do the admits.
Jun 1, '03Oh, Mimi, don't even get me started!!! We don't do deliveries, thank goodness- we'd never have the staff for it. We're losing people left and right, but that's an entirely different thread. I'm in a large teaching hospital (we have two major medical schools nearby who utilize our facilities), so the deliveries are jam-packed with interns and residents. We like to crank call the units (we have two, linked together somewhat) and scare the crap out of the newbies by asking for the on-call resi's and screaming into the phone,
"Quick! Someone needs to get to L&D NOW! We've got a Code G coming up- triplets, 24 weekers, no PNC, two out, third on the way. Mom's a PS abuser and she just decked the attending Neo!"
You'd have to be there. Maybe that in itself is an entirely different thread. (Pardon me, the cackling...it can't be helped...) (P.S. Code G is OOH Delivery, FYI. Wow, that's a lot of initials in one sentence...)
6 F-G's IS a lot; note the "slashing tires" comment that was attached to that sentence! LOL! Our Nsg Services people are...well, I feel bad for them. It's a crappy job. Nobody likes working, right? I mean, we'd all love to stay home and attend to our personal interests, and when we're short, it's nearly impossible to get people (let's not mention the fact that if they paid more, I, for one, would gladly leave the dirty dishes to attend in someone else's place, but I digress...). Still, they're animals. Really, really rude. AND they insist that, "It's NIGHTTIME! The grid goes DOWN by at least one nurse at NIGHTTIME, so whaddyaMEAN you need more help?" Add this to the fact that WITHOUT FAIL, every time the DON comes for rounds at night, he manages to come in when we've JUST SAT DOWN for the first time all night to do our long-neglected charting (Assessments? We don't need no stinkin' assessments...) and he then runs back to the office with glee, saying, "See? I told you they don't do crapola in the nurseries. They're all sitting on their fat bums gossipping, and I could swear one of them was giving herself a facial in the back corner..."
We can't win. But I say that with a smile. Sort of. A half-smile, kind of, like the kind where you stub your toe and it hurts really bad and you smile when someone innocently asks you if you're okay, and you're not, but you can't get over the nerve of them implying that it might NOT have hurt, so you lie, and smile sarcastically while you're biting your tongue. That kind of smile. But I mean it. It's from the heart. ;>P
Jun 9, '03I am currently on a travel assignment where it is ALWAYS 3 babies to 1 nurse. Most of these babies could easily be a 1:1 assignment at my home hospital, and certainly no more than 2:1. They get away with it by only having q4, q6, or q8 hour vital signs!! I think it is very unsafe, and I assess/do vital signs much more frequently if I have time. The thing is, last night my assignment was so heavy that I did not have time to do any more assessements/vitals than what was ordered. They are staffing regularly with 6 nurses for 21 babies.
Thank God I am not regular staff here and can leave when my contract is over. I just hope nothing bad happens during my time here. I don't know why the regular staff tolerates it.
Off to work now
Jul 3, '03I cant believe the staffing problems Im reading. Im at a level III, 30 bed NICU. All RN's. 1:3 feeder growers. 1:2 vents or CPAP. 1:1 HFV and NO. Usually send heart babies out. We attend alot of deliveries. At least 500 a year. We attend all C/S and all high risk deliveries. If we admit a baby, reguardless of gestation, we usually give up one of our assigned babies to another nurse. We strongly encourage Primary and Associate nursing. We place our own PIV's. Only a few of the RN's place PICC's. Only the NRP's and Neo's place UAC's and UVC's. 2 RT's per shift. We consider them our best friends. Sometimes things get very hetic in our unit. Especially when the census is up. We are very crowded. Plans are being made to expand. But as the saying goes, "The check is in the mail". We complain alot. But I guess we really dont have it that bad! I make about $60,000. Not great. However, comparative for this area. Full time day shift. 12 hour shifts. 2 days on, 2 days off. Then every other weekend. Night shift has a shift diff. No manditory overtime or nights. Competitive benefits. We have our own registry staff to pull help when needed. Sometimes we are still left in a bind and short staffed. However, its sure better than getting a staff nurse from med/surge, or worse, no help at all. Im not saying we are never placed in bad situations. Ive been in numerous. Sometimes it just cant be helped or anticipated. But, that just goes with nursing.
Jul 15, '03I am quite upset about the dangerous staffing levels at my travel assignment, and I really feel sorry for the regular staff here. They are all required to work every other weekend, plus do 16 hours of call a month. They get very little in shift differential, and SC is one of the lowest paying states for nurses. Of course, I guess they have free will, and could leave if they wanted. Most of the staff nurses here have never worked anywhere else, lots of new grads, and they don't know what other NICUs are like.
I am counting down the days till I am out of here! 18 more shifts.Last edit by NurseAmy on Jul 15, '03
Jul 17, '03Our unit officially takes 13 babes and can have as many as 9 vents going. We try and give 1:1 for these. Often we go over this figure, and we have to pull in pediatric nurses to help out. Feeders and growers in a busy unit is no fun. We found a big room near to the unit and have made it into a low dependency unit. Guess what, we are being given extra staff to run it. It will also be good for staff suffering from burnout. My turn will be in 3 months! Ah feeding and cuddling babies, can't wait.