Staffing and acuity

Specialties NICU

Published

Hi, I work in what is referred to as "the newborn nursery". Because we do couplet care, the nursery babies are those to acute to stay with mom but too stable for NICU.

The problem is that the nursery was origanally staffed for well babies. One RN for up to 5 babes. That would be me and 5 newborns. However, one is withdrawing from heroine, is receiving morphine Q3. Two are on amp and gent. One is under triple photo therapy, on a monitor for As ans Bs. a 34 weeker, on AZT and penG. Another is a preemie on gavage feeding. All need Vitals and feeds Q3.

And I an swat for couplet care, too. I draw all the blood,start all IVs on babies, delee, monitor ect.

I can see where one RN and 5 well babies would work, but is this load too much. Shouldn't acuity be considered?

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Specializes in NICU.

Should be at least two in your nursery. How do you manage to do everything for all those babies? This is not normal newborn nursery. Do you have to turn in any kind of shift report to your manager? Otherwise talk to the house supervisor, maybe risk management needs to know as that kind of staffing is trouble waiting to happen. We would have at least two, maybe three as we also attend high risk deliveries and c/s (a level II nursery).

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Wow! I couldn't imagine being that busy. God Bless You!

Shygirl

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Specializes in NICU.

Most definitely too much of a load. How on earth do they expect one person to adequately care for these babies? Agree with mimi2rn that there should be at least 2 RN's . If the person who makes these ridiculous staffing decisions actually had to do the job, I'm sure the staffing would change.:confused:

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Well, if "Wonderland" is in California, your facility is in violation of Title 22 which mandates staffing minimums in certain units. Nursery and NICU are 2 of the units with minimum staffing ratios currently in effect. If you are outside CA, maybe you can use the info as ammo to get your staffing changed. All of the babies you describe would be at least 1:3 anywhere I have ever worked. It's just not possible to assess, medicate and feed more than 3 babies that are q 3 hr, much less fit in starting IVs etc. By the way, when do you fit in a lunch break???

Neonatal Intensive Care: 1:2

Unit which provides care to neonates and infants who require 12 hours or more of nursing care by an RN per 24-hour period, including continuous cardiopulmonary monitoring and other specialized technology for their multisystem problems. (California Children's Services)

Intermediate Care Nursery: 1:4

Nursery that has the capability of providing neonatal care services for sick neonates and infants who do not require intensive care but require care at a higher lever that provided in a general nursery; providing 8-12 hours of care/day. (California Children's Services)

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Specializes in NICU, PICU,IVT,PedM/S.

This is like our special care nursery (we alson have a level 2 and level 3). The ratio there is 1:3 max. It varies if the SCN nurse that attends deliveries has patients or not!

You must be tired at the end of a shift!

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Thanks for all the info. I was told last month that I work in a "well baby nursery" (because we only provide intermitten IV therapy) and that the ratio here in Az is 1-8.

The good news is that I found at that the new manager (just Fri) changed the ratio to 1-4 because of acuity. Nursery staff banded together last week and started calling the floor leads and insisting that they cover us for breaks. I guess that covering the nursery gave the supervisors a better picture of what I do each night. Now, five babies calls for an RN and a PCT. The PCT does vitals, oral feedings, weights, cordcare, and diaper changes.That leaves me more time for assessments, treatments, meds and gavage feeding. It worked well this weekend.

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use your AWHONN Guidelines for staffing to support the correct staffing ratio for acuity. Even if the state requires less, the national standard is what the lawyers will use.

good luck

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Specializes in NICU, PICU, PACU.

Wow! I work level III and the most we have is a 4:1 and that is only gainers and growers. We rae usually 3:1. It sounds like you all need to sit down with legal and set guidelines up for this!

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Oooh no they are wrong for doing that to you. Definately should have been an extra hand.

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