I'm curious what everyone's nurse
t ratios are lately on your respective NICU's.
Are you 2:1? 3:1? (for Level III babies)
4:1? 5:1? 6:1? (for Level II babies)
Do you have mixed assignments, i.e., 2 vents (L.III) and 1 feeder-grower (L.II)? If you're 2:1, do you do 2 vents, or 1 vent and 1 HFNC, etc.? What about oscillators? N.O.? Post-Op?
What are your unit "boundaries"? At what point does the assignment become too heavy and require redistribution amongst staff? When do you balk? I realize it's difficult due to acuity to speculate, but examples are welcomed.
The reason I ask is that we're overwhelmed, but have been told again and again that this is "the way it was always done" and "it's not going to change" or else we're fed B.S. about "when we get enough staff for 2:1..." but "we don't know when that will be". Coming from another state with better ratios and staffing, I feel like I'm the only one who KNOWS this isn't true. Many of the staff I currently work with have been at this facility for many, many years and seem to think that what we do is the norm.
Nov 27, '06
We had a problem with n/p ratios last year before our new NM cracked down. We currently strictly follow DHEC guidelines, and the charge RN figures out the # of RN's based on those guidelines.
1:1 ~ Sick vent (hfov/simv) that requires a high level of care, including multiple drips, meds, marked instability, usually iNO.
2:1 ~ Vents, UA/UVC's, multiple gtts, dopa/dobut, CPAPs that require a higher level of care, roughly as stated above.
3:1 ~ stable CPAP's, NC o2, can have central lines, drips, meds. key word: STABLE.
4:1 ~ stable feeder-growers, no o2 needs, no parenteral meds.
Add in an extra 1.25 nurses for charge and a lighter transport assignment.
We went from having, like you said 2 vents plus another baby, to much better assignments of vent+feeder+admit, 2 vents, 3 feeders, 1 vent 2 feeders, 3rd+admit, etc. If there are 4 4:1 babies, they are grouped together and we help that rn out with feeds. (no admit with that one) Charge has no assignment, and the RN assigned to transport has a lighter assignment.
We have a 10-bed "intensive" area in the back of our unit, but we just opened it, and don;t have anyone back there as of yet. We're still a mixed unit.
Hope this helps
Last edit by SteveNNP on Nov 27, '06
Nov 28, '06
Everytime I read these types of threads I think about how LUCKY I am to work where I do!
So no, I don't think you're being unreasonable. I think I would feel the same way if I were to go to a place like that after working in a place that staffs pretty well. And being in AZ, we have a HUGE HUGE nursing shortage. But somehow we always have safe assignments.
Quote from NICU_Nurse
1- 1st admission with an oscillator
If it's a stable oscillator, then yes. Being on an oscillator doesn't necessarily make them high acuity. On our acuity sheets, I think being on oscillator or jet gives them 40 points, which is the most points you can get for each category. But some of those kids on oscillators just have bad BPD, but they'll be on full feeds, with no lines, and no meds ..... so their acuity is actually pretty low, and if that's the case they might have that nurse take first admit.
2- 1st admision with 2 vents (could be stable, could be unstable)
Doubtful that would happen on our unit. That would NEVER happen if there was an unstable vent in the assignment. And even with 2 stable vents, it's doubtful you'd be 1st admit. Usually if you're 1st admit you'll have 2 "easy" babies ..... either they'll be on room air or nasal cannula (maybe CPAP). And once you know you're getting an admit, then they'll move one of those kids to someone else's assignment. So usually we never have 2 other kids + an admit. And if it's a critical admit, then both of your other kids will be moved to other people's assignments.
3- On Delivery Call with 3-4 babies (mixed assignment, say, 1 vent, 2 HFNC's, 1 feeder-grower)
NEVER. We have a high risk nurse that goes on all deliveries, and she never has an assignment unless we're critically short-staffed. I've only been working in this unit for 8 months and I've only seen the high risk nurse take an assignment (1-2 easy babies) once or twice.
4- 2 Level III's (HFNC), 2 Level II's (HFNC), 1 12 hour old HFNC 26 wkr on Dopa and rec'g blood
5 babies?!?! Did I read that right? NO WAY! And if someone actually agrees to take that assignment they are absolutely INSANE! Yeah I understand that's 5 kids on nasal prongs, but sheeesh .... 3 of them are still considered Level III status for a REASON, because they need to be closely monitored. How can you closely monitor them while you have 4 other babies?! That is NUTS!
5- Same scenario as above, but no Dopa and no blood- does this make a difference?
Doesn't make a difference at all. We can have up to 4 babies in the Level II, step-down unit, but I wouldn't even agree to taking 5 of those. And I've never seen it done in our unit. 4 is the max, and that's in the step-down unit. FIVE babies is too much for an ICU.
6- 3 vents on one assignment (does it make a difference? Are 2 vents plus one other baby more reasonable?)
We'd rarely ever see this. In our Level III we usually always have 2. Sometimes we'll have 3 but they're usually all on room air or nasal cannula. I've had a 3 baby assignment before with 1 on room air, 1 on nasal cannula, and 1 on CPAP ..... and that was when we were over our census and short-staffed. I never see 3 vents in one assignment, or even 2 vents with 1 more on room air.
I know this is highly variable. I appreciate you all answering!
Also, would anyone be willing to share their acuity calculators or ratio policies? I'd like to see how others are figuring this out.
I don't have a copy of our acuity sheets. But they tweeked it a lot to make sure the scores we were getting were actually correlating with how busy the kids actually were. It's pretty accurate. We score them based on a number of things ...... type of vent (SIMV, HFOV, HFJV, NC, CPAP, etc), stable or unstable, number of lines (PIVs, UVC, UAC, PAL, Broviac, PICC, etc), number of meds (PO or IV) and how many in a certain time period, labs/gasses and how many in a certain time period, drips and how many, feedings (NG or PO) and how long it takes to nipple feed, etc. They also get more points if they are a fussy/unconsolable baby, if they're a new admission, if they're post-op, ECMO, if they're <1500 grams, if they're <1000 grams, etc. There are others that I can't remember, but that's the gist of it.
Last edit by RainDreamer on Nov 28, '06