NICU's w private rooms?

[aviator411, RN]

Have any of you seen or heard of NICU's with individual private patient rooms? Construction begins soon here on a replacement peds hospital and NICU staff have been advised the new NICU will have private rooms exclusively. They have NOT been advised how such a unit will be staffed. Given current management practices, there is NO chance that staffing will be increased to accomodate coverage for individual rooms. Current assignments vary from 2 - 4 pts per RN.

[Jme2007]

There is a level III-c NICU in my neck of the woods and they have private rooms. Approx. 6 out of the 43 beds are private rooms. They are the last to be filled when the unit is getting full. They are primarily made for isolation purposes but that doesnt mean that isolation babies are in there. When I was there a few months ago as a student, the staffing ratio was either 1:1 or 1:2 depending on how sick the baby was. The rest of the unit had "pods" that housed about 8 babies in each pod.

[palesarah]

My hospital is building a new women & infants building, inculding a new NICU based on the the private room model. I'm not sure of the details, but I think it's going to be a combo of private & semit-private rooms arranged in several pods. They are planning to overstaff initially while staff adjust to the changes but we will got back to our current assigment levels which are currently 2-3 babies (occasionally 4).

I did work in one hospital that had a beutiful NICU designed similarly. I didn't work in the NICU there, but floated a couple times from newborn and interviewed for a NICU poisition, so I got the grand tour a couple times. This hospital successfully transistioned from an older single-room NICU to the private-room model, but did loose some staff in the process. Nurses who missed the opportunity to gossip, apparently- the remaining staff told me they felt it was a VERY positive change. In the new NICU, the nurses are basically buddied up on the assignement sheet so every nurse has another set of ears listening to her alarms. They had central monitoring, and alarms also went to each nurse's assigned cell phone. The system seemed to work well. This was a "less acute" level 3 NICU

I'm sorry I don't have more info, but maybe that will help a bit? Hopefully some others will chime in with better info for you.

[missapoo]

Just over a year ago, my level II unit underwent a transition from a cramped one-room unit to a brand new unit with 4 private/isolation rooms and 4 pod stations, along with a room equipped to hold about 4-6 growers at a time...we are a small hospital with approximately 8-14 NICU/intermediate beds. The staffing matrix is generally 2-3 babies per RN but occasionally we have 1:1 patients and when the census is high we are usually short handed and everyone has to take a heavier pt load. We team up and help each other even when pt assignments are made...this is usually very relaxed and casual and usually works out pretty well. Everyone pretty much gets to choose what they want to do. The problems we have encountered are pretty simple staffing issues since our NICU and Newborn nursery used to be in the same unit and now they are split up between 2 floors, this makes us shorthanded when the census is up because we have to staff both units with pretty much the same # of nurses we had before the transition. Nursery/NICU nurses are required to go to all deliveries and when the nurse pt ratio in newborn is 1 nurse to up to 5 babies it is difficult when deliveries are happening at the same time and you are the only one. Our director is supposed to be working on this....to be able to staff an extra nurse to go to all deliveries and help transition newborns. NICU has to step in and help out when the nursery is full, which is only a problem when our unit is also full (spells trouble from my perspective). Anyway, after a year of this we are closer to working all of the kinks out of the system and hopefully things are flowing much more smoothly than at first. Our director is also supposedly working on getting the L&D gals trained to do initial newborn care and transitioning in the same room as moms unless baby has problems....so far it hasn't even come close to happening and we are still responsible for all newborn care. The issue is that many of the L&D nurses are resistant to change and thus our dillemma! Hope this helps:)

[dawngloves, BSN, RN]

This makes me nervous. How are you supposed to hear a vent alarm if a baby self extubates or a hose pops off if you are two doors away? Wait until the baby starts to brady (die!) and your cell phone rings? And what if you are in the middle of a difficult IV insertion and your cell rings "Asystole" and you run down the hall to find out it was artifact? Now your IV is lost. Could have been averted if you could just look up and saw it was artifact or if you yelled to a co worker to look and they saw the artifact.

I think private rooms are a great idea for feeder/growers, but it would make me nervous to work in a critcal care enviroment where my sick patients were hidden in other rooms.

[aviator411, RN]

This makes me nervous. How are you supposed to hear a vent alarm if a baby self extubates or a hose pops off if you are two doors away? Wait until the baby starts to brady (die!) and your cell phone rings? And what if you are in the middle of a difficult IV insertion and your cell rings "Asystole" and you run down the hall to find out it was artifact? Now your IV is lost. Could have been averted if you could just look up and saw it was artifact or if you yelled to a co worker to look and they saw the artifact.

I think private rooms are a great idea for feeder/growers, but it would make me nervous to work in a critcal care enviroment where my sick patients were hidden in other rooms.

That is exactly the concern of the staff here but management seems to have no concern and no answers. It is a level III, ecmo.... etc.. Can you imagine runnning room to room on patients like this? Most of the senior staff are planning to bail out rather than put their licenses in jeopardy. It has all the appearances of a disaster in the making.

Thanks to all for your commentary. Please keep it coming.

[mac23]

When I was traveling I worked at a hosp that had all private rooms. I thought it worked ok. It kind of felt like working in the PICU. There was a free floating charge nurse that could help listen out for your patients and it was really unusual for everyone to be in a room at the same time. Also had the tech's that could listen out (I know a lot of NICU's don't have techs). If you had to be in a room to start an IV or something you just let your co workers know and everyone was really good about helping/listening out. I never felt my license was on the line. I liked it for really sick PPHN babies where noise control was an issue and those babies were 1:1 anyway. There was one giant room for ecmo or babies that needed surgery on the unit. They also had central monitoring.

At first I didn't like it but as I got used to it it was fine and I didn't see any increase in adverse events as compared to an open unit.

[prmenrs, RN]

I can't tell you how many really sick babies, totally snowed, but every time the gossipers laughed, took a dive in the sat dep't. We had a room that was licensed @ an OR room (and used for PDAs and other stuff), and we would put those sensitive kids in there. It was a BIG help.

Obviously, not all babies need a private room. But they all probably do better in a more quiet environment. And, it's also better for pt. privacy.

I haven't worked in this environment, but I'd sure like to "try it on" for size!

[justjenny]

This makes me nervous. How are you supposed to hear a vent alarm if a baby self extubates or a hose pops off if you are two doors away? .

It depends on how the rooms are designed.

Our NI has 3 "pods" of private rooms and it works just fine.

(1)Our monitors will show if another bed is alarming and you can view the alarming babies monitor as if you are in the room

(2) the rooms are centered around a "central" nursing station...all glass windows to see in from the desk, and to see in from the rooms next door (there are blinds to close for privacy if needed)

(3)There are 6 rooms in each pod with 3 RNs....if you are starting an IV, etc. you are essentially counting on your "podmates" to cover your other baby until you are finished...it works out fine in the end with everyone helping each other.

(4) Oh, and there are glass doors connecting the rooms to each other, so if your NCPAP baby decides to rip it off of his/her face and desat....you don't have to "walk all the way around" to get to the bedside...it really is a nice setup

We love our private rooms and I think we could use more!

HTH

Jenny

[helpthebear]

I work in an NICU that made the transition four years ago. We were all very concerned before and it was by no means a seamless transition but now, I cant imagine it any other way. We have a different type of alarm and buddy system that rings to a handset so you always know when your baby is alarming, even on break! Our staffing did have to increase to maintain 2-3 patient assignments. The parents love it and I think the babies do better because of less noise. It is really a lot better for very critical babies or when a baby dies. There is so much more privacy for the families. We have an "assist" button for staff in the room that you use if you find yourself in a declining situation and need help. There are so many safeguards! It does work and you will adjust and love it!