NICU ratios

[mlang, BSN, MSN]

I am an RN on a level 3 NICU in California. Our standard ratios for lower acuity NICU patients are 3:1 and 2:1 for higher acuity. We have had 4:1 when we are short staffed. I am relatively new at this hospital, but I have never experienced these ratios before. They say that the lower acuity patients qualify as a step down. I've never heard of that before and my previous CA NICU got hit pretty hard by the state for trying this. Any advice?

[vanilla bean]

Those are the ratios used in our NICU too (not California). 1:1 are few and far between; reserved for very unstable patients and fresh post-ops. I just had 4 patients the other night (3 CPAPs and a FG) due to short-staffing and multiple admissions on our shift. So, no advice for you. What were the ratios at your previous job?

[mlang, BSN, MSN]

I have worked at a level 2 and a level 4. 1:1 for titration drips and oscillators and 2:1 for all other patients on the NICU, even if they are a grower/feeder. If they are not well enough to go to the nursery they are a NICU patient

[vanilla bean]

Where is this Shangri-La of which you speak? I wish to go work there.

[TheCommuter, BSN, RN]

Moved to the NICU Nursing forum.

[essT]

Level III NICU, 45 beds:

1:1 patients are extremely rare (maybe a handful per year)

1:2 or 1:3 for our NICU patients

Step-down patients anywhere from 1:3 to 1:5 depending on staffing, most often 1:4.

[BrandNewBabyNurse]

I work in a level IV unit that has about 95 beds. For nurse to baby ratios, we do 2:1 for ECMO, 1:1 for titrating multiple drips or for just really sick kids and/or serious post-ops. Most of our babies are 1:2, and that covers most vents, all CPAP, and HFNC. We have a step down unit that is typically 1:3 but can be 1:4 if it gets crazy and usually if that happens you'll have discharged one by the end of the day.

[NicuGal, MSN, RN]

Our ratios run pretty much with the others, our gainer grower group can be 4:1 if need be.

[sergel02, BSN]

In California too, and the hospitals in this area are maxed at 3 babies to 1 nurse. Most are 2:1, some 1:1 and occasional 2:1 for them ECMO babies.

[tinybbynurse]

I was told on my unit we will typically have 2 pts. In very sick babies, we have 1:1, and the most we would have is 3 babies. 2 babies would be average most of the time, though.

[karnicurnc, MSN, APRN, CNS]

I work in a 60 bed Level III unit. Admissions, CPAP, vents and stable HFJV/HFOV are 2 patients per RN. Other intensive care status patients are 1 of 3 patients cared for by 1 RN. Intermediate care (stepdown/PCU) patients are 1 of 4 infants in an assignment. This allows the bare minimum care to be given with no time for extra stuff. Pretty ridiculous. These decisions are dictated by state regulations and we have been fighting for better ratios for years, using NANN guidelines, to no avail. Family satisfaction scores (which sadly have become the benchmark by which quality care is given even though the two are often mutually exclusive) would improve if parents perceived that nurses had time to give that extra care.

[tinybbynurse]

update: so in our so called "Step down unit" area, where we send mostly the feeders and growers, we will typically have 3 babies. With all the other babies you will typically have 2 babies, and 1:1 if they're more critical.