NICU/SCN Staffing Questions

[RN*mommy]

Hello,

Where to begin...

I currently work for a small-ish urban hospital in the Special Care Nursery. Our hospital probably does approximately 80-90 births a month. Our SCN has a total capacity of 6 beds. In my three years at this job we can go from having a full nursery to having a zero census in a short amount of time. Anytime our census drops to three or less babies there is often only one nurse staffing the nursery...of course this depends on acuity of the babies. Our core staffing is generally 3 labor and delivery nurses, two postpartum nurses and two SCN nurses. Our SCN nurses are "cross-trained" to work on the postpartum unit, where they care for mom's, babies and GYN surgicals. This, in the past, has really not been a huge problem...however times have changed. Our nursery has been very busy for at least the last six months, and both nurses scheduled for the nursery have been primarily working in the nursery. At the same time our postpartum nurses have been seeing more "high risk" moms with issues such as hypertension, diabetes, postpartum hemorrhages, even seizures. As we approach our historically less busy time, many of my fellow SCN nurses and myself are nervous realizing we are going to be going back to deal with adults again soon.

I guess my question in all this is how does your hospital handle things when census drops? Are you expected to staff the postpartum unit and care for adults as well as babies? If you do float out to the floor do you just get a healthy baby assignment?

I'm in the process of receiving responses to a survey I sent out to my co-workers regarding us possibly rallying for baby only assignments anytime we are expected to staff the postpartum unit. I would also like to include responses gathered here as to how other hospitals handle this situation. Any responses would be greatly appreciated. It would also be helpful to have a little background about where you work. Total number of NICU/SCN beds, average monthly deliveries, typical staffing for your unit, etc. The hard part is I would really like to present this information at a meeting we are having on Tuesday, 9/27. I know this isn't a lot of time, however I can always add information I receive after the meeting. I have already attempted to contact most hospitals in our area.

Thank you for any help you can offer!!

P.S. Please forgive any typing errors. I had to use my phone to type this message, and it really likes to change words I'm attempting to type into new and often more interesting words...

[RN*mommy]

I should also add that we have added a lot of new staff to our nursery, and many of these new hires have come from level 3 NICU's. There is definitely a general dissatisfaction amongst them when they are required to float out to postpartum, mostly, I believe, because in their old jobs they didn't have to work with postpartum women and feel out of their comfort zone. Thankfully some have stayed on, but many have quit and found other jobs where they aren't required to float. I do believe that management is telling these hires that they will float out to work with our adult patients, but I feel many of them find they don't like that type of nursing and chose to go someehere they will always care for the newborn population. Staff retention has definitely been an issue.

[babyNP., APRN]

That's a big problem with the floating. It's a good thing that management is telling the new nurses that they will be floating so that they have a realistic idea...I would never work at facility that required me to take care of adults...

[littleneoRN]

It seems unlikely that when floating to post-partum you would have a baby-only assignment. Most places do couplet care, so if you've got the baby, you've got the mom. I thought separate baby and mom nurses (after delivery of course) had gone by the wayside. For continuity sake, as a patient, I would prefer couplet care.

[phoenix99]

Hi, Our unit is very similar with regards to the census issue. Just recently we were closed for 10 days!!!

Our nursery nurses that float only take baby assignments. Myself being labor and delivery trained prior to SCN/NICU do couplet care, take antepartums( with currently credentialed labor and delivery nurses being responsible for the strips), help in triage etc.

I feel blessed that I can help out so much. I get hours that other nurses don't want, so I am always working.

I hope this helps. In other words, I guess it depends on your skill set and how much you want to work when the census is low.

[NickB]

I work in a very similar situation as well. The difference being that I was hired as a post partum nurse. After my orientation, I chose to orient to the SCN. We have 2-3 warmers in the nursery so there is generally only one of us in there with 1-3 pt's. Also, our nursery is only open if we have a newborn needing special care. In otherwords, I am on call for the nursery 3 days a week. On these three days, I am scheduled to work in post partum but if nursery is open, I go in the nursery and another nurse gets called in to cover my floor pt's. There are only 3 nurses that work during the day who are qualified to work nursery so I get a lot of overtime shifts as well. I don't mind the adults because I originally was hired to work with both and I don't want to lose those skills. I think I will be pursuing a position in a NICU (level 2-3) in the next year or so and wouldn't want to float on to the floor in that situation.

[DBellevi]

I am seeing this after your meeting date but the hospital where I work once had a 6 bed SCN with 2 nurses scheduled per shift and did about 90 births/month. SCN nurses were required to attend all high risk deliveries and c-sections. If there was even 1 SCN patient then both nurses had to be in house. One nurse would take the pt assignment and the other was assigned to deliveries and would attend every delivery and stay to do all initial baby care. She would also help with the well baby assessments on the floor. If there were no SCN patients one nurse would be mandatory called off (downstaffed on call) and the other would do the role of deliveries, NBN/well baby assessments. They offered SCN nurses to be cross trained to PP if they wanted to so they could work there instead of being downstaffed and most of them chose to do it rather than being called off.

[phoenix99]

Thanks for your post.

It's good to know how other people deal with smaller units.

I like the olden days when "called off" was not even invented yet.