What happens in your NICU when you are short staffed?

Specialties NICU

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Our unit has been chronically short staffed forever. However, lately the situation has gotten really,really bad. Last week the RN's had assignments ranging from 4 ICU babies each plus admissions to 8 special care babies without any NA/extern help. And I'm talking sick and tiny babies. And the charge nurses are often taking a full pt. load too. Fulltime nurses already have to work a mandatory OT shift. What does your unit do as an incentive to get nurses to come in when they know they will be slammed with a high pt. load/acuity? Do you have incentive or crisis pay? Do you use agency or travelers?

I think it'd be harder to have 8 babies in the newborn nursery than 8 in a Level II or step-down NICU. The 8 in the nursery would most likely be off monitors and PO ad lib, not to mention needing to go out to their mother's rooms, etc.

This is an EXCELLENT argument for rooming in. If you're caring for all those babes in the NN, then it becomes difficult to assess early feeding signals, I imagine. I know not every mom wants to room in, but I'm really into rooming-in as both a way to educate new mothers and to get the babies close to their moms where they belong. (Excluding crazy and dysfunctional situations, of course!)

For all you NICU RN's whose posts I'm reading, I am simply in AWE.

Alison

we pull extra nurses from other maternal child units (which happens quite frequently... they will get the feeder grower assignment, no ivs, pretty basic) that are available and then we start calling in for OT... if no one can do that then they use incentive pay... fat cash that hurts the dept budget... needless to say it doesnt happen much!

I'm getting SOOOOO tired of taking care of from 4 ICU to 8 special care babies! We all help each other but the travelers that are coming next month can't get here quick enough!

This is an EXCELLENT argument for rooming in. If you're caring for all those babes in the NN, then it becomes difficult to assess early feeding signals, I imagine. I know not every mom wants to room in, but I'm really into rooming-in as both a way to educate new mothers and to get the babies close to their moms where they belong. (Excluding crazy and dysfunctional situations, of course!)

For all you NICU RN's whose posts I'm reading, I am simply in AWE.

Alison

Slightly OT, (and not meant to discourage rooming in at all) but this reminds me of a time last year when we had a baby admitted to NICU from NN. The mother was so out of it from her pain mends (c/s) that she had DROPPED the baby on the floor. There was brain damage. That was horrible, can you imagine living with that guilt....

Specializes in NICU.

Even crazy and dysfunctional moms get to keep their babies, unless they have threatened to do them harm. Pending, of course, approval by Child Protectice Services. We do keep CPS Hold infants in the nursery, and most of those are because of a positive UDS. That's only because a mom decided to leave with her baby, when she heard it was going to foster care.

Those babies don't help much with staffing, either.

Sometimes, on bad nights, our head nurse will work a shift. Trouble is, the head nurses also get worn out.

My unit do have this problem too , the reason being staff taking medical leave ,family care leave etc are rather high . Infact our situation can be so bad that we can have 3 or 4 staff down with medical or emergency leave on one bad day ! We do 12 shift and each time we are short staffed , the rest of us will be over stretched ++.

We will try to borrow staff from the special care baby nursery if they can spare but if they can't spare , we'll try to call back staff that's on day off . Most of the time the staff are not willing to come back and last resort is to call for " bank nurse "

These "bank nurse " will be charged as daily rated and actually they are our own colleague , the charges is between $125 to $175/day depending on the timiing . Offering such rates is to lure them back to help out the ward but sometimes it's not easy to get " bank nurse " too.

The nursemanagers do help out too and function as one of the staff working on the floor if we are really short handed , but mind u not every NMs are helpful . The charged nurse work like anyone else without difference .

Our total census stop at 24 beds , if the total is more than this figure eg. 28 beds occupied ! Our HOD will inform the OB team not to accept any in-utero tansfer from any other hospital but if the mother walks in and deliver at 24wks ! we cannot deny admission .

Besides that we do have cases flying in from other countries too eg HongKong , Malaysia and Indonesia .

This can really make us very stressful but somehow we manage to overcome it again and again . I guess it's teamwork and endurance . Does anyone else have problem with staff taking medical leave or any othe leave all the time , pls share . :banghead:

We occasionally will have a nursing student as an extern. She will be assigned to help with feedings and baths, stocking the supply cabinet, answering the phone and setting up admit beds. However, there is no one there on a regular, scheduled basis because of their school schedule.

Hi everyone. I'm reading this thread with great interest. Im a nursing student (LPN at this time) and also a pt time LNA. I applied for a position as a NICU tech at a local hospital. I got called back and I am soooo excited! I hope that the hours are going to work for me, and of course that I get hired. I definitely need flexibility with scheduling due to school. Im not sure what days/nights rotating means.....its 24 hours a I guess.

I've read about one person who said her NICU uses techs. Anyone else?

Specializes in NICU, PICU, educator.

Days/nights rotating means that you will rotate usually 50% between days and nights, in our hospital it can mean either 2 weeks days, 2 weeks nights or one month days, one month nights.

We don't use techs in any of our ICU's anymore, but boy I wish we did sometimes! What a help they are with the feeders and chronics that just need a cuddle!

How I wish my department will have techs. They can be a great help for the chronics and also help in feeding , probably also help to soothe crying babies and play with some of them as well .

Sometimes I find myself very " mechanical " working in the NICU as there's already many equipment around us and the alarms are also constantly going on . I find that I do rush to complete my job and thus lost the human touch .

At times I do miss cuddling and feeding those bigger babies , I also miss those graduates from NICU . :bluecry1:

I can't hardly wait for my interview! I just hope they will be willing to be flexible with my student schedule :specs: I've never interviewed with a hospital before so I have no idea what to expect. After the regular interview she if the director of the unit has time, she hopes to have me also meet with her also....(I think that was what she called her...).

:)

When nurses are given a ton of feeder growers, on the logic that they're not as much work as the truly sick babies, it saddens me. Babies grow not only through feeding, but through cuddling and contact, no?

How seriously is kangaroo care taken in NICU's these days? I mean, beyond lip service ...

Alison

Specializes in NICU.

I find that kangaroo care is not emphasized as strongly once the baby is a feeder grower. Of course the parents are free to do it if they wish. I think that once they get bigger and are in a crib all wrapped up in clothes and blankets, they get grumpier being unwrapped and undressed than if you just cuddle them.

And I'm not sure if this is what you were asking but only the parents give kangaroo care. Nurses and staff just cuddle and rock the irritable ones when we have time. It's hard when we all have our hands full and there's a big baby screaming and you know it's probably because the baby wants to be held moreso than anything else.

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