NICU staffing

Gompers, BSN, RN · Sep 22, 2006

Please tell me what your pt ratio is in your hospital. I feel like our staffing is not right. I had to take care of 2 unstable premies on vents which made my day NON STOP from the get go .12 hrs of NON STOP work exusted me. I was just wondering what any one elses pt load is like. We also had another nurse taking care of 3 premies, 2 feeders and a vent. Can anyone enlighten me?? Thanks

We have several posts on this topic in the NICU forum already. Let me see if I can find some for you...

https://allnurses.com/forums/f33/nicu-safe-assignment-173833.html?highlight=ratio

https://allnurses.com/forums/f33/nurse-patient-ratios-42610.html?highlight=ratio

https://allnurses.com/forums/f33/how-busy-your-nicu-28901.html?highlight=ratio

https://allnurses.com/forums/f33/staffing-acuity-23576.html?highlight=ratio

mawjood · Sep 23, 2006

Hi,

Don,t make my cry, our staffing like you, some time 2 baby on vent,our 3 one on vent, one on infant flow CPAP and one feeder,some time I feel Iam dying..........

cathys01 · Sep 24, 2006

Today I had 26 week twins. One on an Oscillator and one on a Jet. Both with sterile lines (one had a PICC and one had a UVC), PALs, PIVs. Standard fare in our NICU (a little busy though!).

I've also had an assignment with a hydrops baby on an Oscillator along with a kid on a Servo vent and a feeder/grower. I've been on admission with a ventilator and one to two feeder/growers. I've been on first admit with 4 feeder/growers with all having PIVs. We just never know what we're gonna get!

This is the only NICU I've worked in, (and I've always heard our assignments are nuts sometimes) but I think it may be that we are a fairly small mixed Level II/Level III unit with about 25-30 babies usually, so our assignments tend to run a "little" tight.

I know it's crazy but I kind of like getting the experience of having "tight" assignments and being able to get it all done....it just means if I ever go anywhere else it'll feel like a vacation!

justjenny · Sep 26, 2006

While we have all had our shifts that were non-stop "super busy" BUT if you at all feel that you are not safe I would suggest talking with the charge nurse and/or your manager. In our unit, that would not be an unusual assignment, however, we all have limitations. At the very least, we have changed assignments for the next shift when one assignment is super busy (ie: day shift assignment is a set of very sick, unstable twins...maybe night shift will have one of the twins and another more "stable" baby)

Jenny

RainDreamer, BSN, RN · Sep 26, 2006

Hearing all this makes me grateful for the unit I work in! We definitely have our busy times, it's really busy in our unit right now .... we're a level III + ECMO and we're full a lot of the time. But we don't have real bad, unsafe assignments like some of these that I'm hearing about.

We do like Jenny mentioned ..... if one shift has a super busy day with their assigment, then they will change it around for the next shift. Or make a baby 1:1 for the next shift if it's a really busy baby.

We have "acuity sheets" that each baby has in their chart. We score them based on a number of things (type of vent, unstable or stable, number of lines, IVs, number of meds, labs/gases, drips, feeds, teaching for parents, etc, etc.) Whatever their score is will give an idea of what kind of assigment to put them in (3:1, 2:1, or 1:1).

I can't imagine being 1st admit with 4 babies, all with PIVs!! Oh my goodness. How can you have time to assess ALL 4 IVs, EVERY hour? While keeping up with feeds and assessments, not to mention getting an admit. Wow.

Gompers, BSN, RN · Sep 26, 2006

Me too!!!

Hearing all this makes me grateful for the unit I work in! We definitely have our busy times, it's really busy in our unit right now .... we're a level III + ECMO and we're full a lot of the time. But we don't have real bad, unsafe assignments like some of these that I'm hearing about.
We do like Jenny mentioned ..... if one shift has a super busy day with their assigment, then they will change it around for the next shift. Or make a baby 1:1 for the next shift if it's a really busy baby.
We have "acuity sheets" that each baby has in their chart. We score them based on a number of things (type of vent, unstable or stable, number of lines, IVs, number of meds, labs/gases, drips, feeds, teaching for parents, etc, etc.) Whatever their score is will give an idea of what kind of assigment to put them in (3:1, 2:1, or 1:1).
I can't imagine being 1st admit with 4 babies, all with PIVs!! Oh my goodness. How can you have time to assess ALL 4 IVs, EVERY hour? While keeping up with feeds and assessments, not to mention getting an admit. Wow.

We do it like you do - keep acuity levels on the babies so we can justify having more staff each shift, and we also reassess assignments each shift and make adjustments as necessary. Like if one of your patients gets NEC, blows a pneumo, gets septic, etc. during your shift, your other patient will be reassigned for the next shift and the sick one will be 1:1 - and actually, we almost always have either a nurse jump in and take over the other baby or the charge nurse will reassign it DURING that busy shift for you so you can concentrate on your sick little one. Same thing with admits - we don't keep our patients when we get admits, we give them all up and they get absorbed into other assignments so we can focus on the new baby. Our admit nurses usually have 2-3 stable babies that get divided up between nurses who also have lighter assignments that can tolerate another baby. We are so helpful with each other, too - if we see someone struggling, we're always there to offer help or take over a patient if necessary.

Yes, we all have random shifts where it hits the fan - quadrouplets are born, we get a bunch of transport calls, etc. - but for the most part, we have really safe assignments and I can't complain! :)

cathys01 · Sep 26, 2006

Let me also clarify that we do all help each other out if it's needed, and our charge nurses will usually jump in and help out with our other kids if needed. Anybody with a free hand helps with admits (one can measure while one gives vit K, someone sets up for IVs or labs, someone else can hang IVfluids). Of course with a level III admit, it takes alot more, but we're usually prepared for those and the admit assignment will be left intentionally light, or the charge nurse will assist the docs with placing lines so we can keep up with our other kids. We don't give up our babies when we get an admit, we just keep plugging along - but usually others will help out with feeds/vitals, etc. while we're busy with an admission. They also try very hard not give us a 4 baby admission assignment, but if our census is high and we can't get more nurses we gotta do what we gotta do and everybody looks out for everybody else. And if a nurse is drowning the assignments can get changed - the trick is to speak up when you need help and help will come!

I've been here two years and I've only seen 1:1 maybe twice (and once was for isolation not acuity).