NICU safe assignment

NICU-RN · Aug 16, 2006

In my unit the ratio is 4:1 in the feeder\growers. 2:1 for vents. 1:1 for HFOV if it is very critical. I was told that there is a chance to get 5:1 if an emergent situation arises but they really try not to do that. If you do not feel comfortable, make sure you vocalize that professionally to your charge nurse. Sometimes they can help find techs or other nurses to help with your feedings, which will tremendously help you out. Again, never be afraid to say that an assignment seems a bit overwhelming. 90% of it is time management. Always start things early!!!!

Hope this helps, God Bless.

NICU-RN · Aug 16, 2006

Congrats! Im glad you picked the place you wanted to be. I didn't do that and spent 2 years in a place that I didn't thrive. Im now in a NICU and loving it. God Bless.

Gompers, BSN, RN · Aug 16, 2006

Hi,
I am a new graduate and just interviewed for a NICU position. Their staffing ratios are 4:1 for Level II and 2:1 for Level III.
Is this usual/safe? My experience is that if the say 4:1, in reality, it may turn out to be 5:1.

That sounds pretty normal. Many units give you 4 feeder/grower (level II) type babies together. It's hard at first, but once you get more comfortable it's easier. That kind of assignment is usually busier than 2:1 in the level III area! Hopefully they also have 1:1 assignments in level III when a baby is really critical.

But overall, this unit sounds normal.

shah · Aug 16, 2006

Thank you.

I haven't joined yet, but just wanted feedback before I committed myself.

Congrats! Im glad you picked the place you wanted to be. I didn't do that and spent 2 years in a place that I didn't thrive. Im now in a NICU and loving it. God Bless.

shah · Aug 16, 2006

Thanks,

They did not break it up like that, but I hope it is so.

In my unit the ratio is 4:1 in the feeder\growers. 2:1 for vents. 1:1 for HFOV if it is very critical. I was told that there is a chance to get 5:1 if an emergent situation arises but they really try not to do that. If you do not feel comfortable, make sure you vocalize that professionally to your charge nurse. Sometimes they can help find techs or other nurses to help with your feedings, which will tremendously help you out. Again, never be afraid to say that an assignment seems a bit overwhelming. 90% of it is time management. Always start things early!!!!
Hope this helps, God Bless.

wjf00 · Aug 16, 2006

Minimum ratios are a good start, but assignments should always be based on acuity. Never forget to advocate for your patient. If the assigment is unsafe refuse it, whether it meets the 'ratio' or not.

RainDreamer, BSN, RN · Aug 22, 2006

Our ratios are:

2:1 in the ICU. Sometimes we might have 3 if we're short-staffed. But those 3 are not as critical, they're close to being intermediate status. If the baby is really critical then it'll be a 1:1.

3:1 in the Intermediate (Level II) Nursery. Sometimes we might have 4 if we're short-staffed.

They usually assign based on acuity. Usually if you have one sick baby (on the vent, lots of meds, lots of labs/gasses, etc), then your other kid is a stable feeder/grower usually.

Your unit sounds good. I would NEVER accept an assignment of 4:1 in the ICU. In the intermediate nursery 4:1 isn't bad at all. It's really busy, but I like having 3 or 4 feeder/growers .... sure makes the night fly by!

nurse_snoopy · Aug 31, 2006

Wow! Your ratios are a lot nicer than ours. Of course, we're almost always short staffed, but an easy assignment is a 2:1.

On our unit (Level 3 without surgery), we typicaly get

2(2:1) --> that's 2 vents, not always stable

(2:1) + 1 --> 3 babies, 1 on vent, not necesarily stable

HFOV is not always considered a 1:1 either. Our Assistant Head Nurse has decided that they can be paired with 1 or 2 other babies, depending on stability. If the baby is not a yoyo with his oxygen, he is considered stable, regardless of the million drips he might have or the gazillion bloods ordered.

4:1 or 5:1 is only for our step down, where the babies are just feed & grow.

Needless to say, a lot of us don't take a break or lunch :nono: ...

prmenrs, RN · Aug 31, 2006

My problem w/the feeder/grower area is that you need to take care of the parents, too. Help w/breastfeeding is a HUGE time drain, irritable babies require consoling, discharge teaching--all that stuff takes time. If you have 4 or 5 kids, you can barely do assessments, feed and chart. You need to keep an eye out for a baby going bad, too. In other words, actually THINK about what you're doing.

I always think management dismisses the convalescing area way too easily. "Well, they're JUST feeder/growers!!" :trout: :angryfire They're still here for a REASON???!

TiffyRN, BSN, PhD · Aug 31, 2006

I like to remind my charge nurses/manager that the day care run by our hospital is required by state to provide one day care worker for no more than 4 infants. NICU's (other than CA) do not have State mandated ratios however; I don't think they like hearing how well infants in our day care have more attention (be it not as skilled) than our sick NICU infants.

I seriously doubt it has anything to do with me or my comments but compared to 3-4 years ago we rarely get 5 baby assignments anymore. And that's for all feeder/grower, more intense infants are in 2-3:1 assignments.