Peds (and picu/nicu) nurses- tell me about your unit!

JadedCPN, BSN, RN · Jun 26, 2018

Hey there! I've been a peds nurse for over 12 years, have worked at 4 different hospital systems and two of them have consistently been ranked the top 5 pediatric hospitals in the country. I'll answer your questions based on my experiences at all of the facilities over the years

1. All pediatric-only hospitals

2. I've worked PICU, on a Surgical/Trauma floor, and then I have been Float Pool for the past 5 years. In the PICU the ratio was only 1 or 2 patients depending on acuity. On the surgical/trauma floor, it was usually 4 patients - possibly 3 if there was a complicated trauma or spinal fusion. As a float, I usually have 3 or 4 patients. In all of my years at all of my facilities, I've never had more than 4 patients at a time - this is one of the reasons why I specifically love pediatric nursing in general.

3. At all facilities I've worked at, I've always had RT, Pharmacy, IV/Vascular Access team, and CNAs. My current pediatric hospital is the first facility that has had inpatient phlebotomy.

4. At my first hospital on the Surgical/Trauma floor, I was the night charge nurse and yes I took a full patient assignment for some years. Eventually that changed that to where I would only get a "small" assignment of 2 kids, or would try to leave me without an assignment when possible. At the other facilities, it all depended on what floor - for the most part none of the charge nurses took an assignment unless absolutely desperately short staffed - and even then, it would be the "lower acuity floor" that made the charge nurse take an assignment versus, for instance, the BMT floor.

Feel free to PM me with any other questions!

KelRN215, BSN, RN · Jul 1, 2018

I don't work inpatient anymore but I will answer from when I did:

1) Do you work in a children's (only) hospital or on a peds floor at a general/adult hospital system? Which area of the country (state or region)?

Children's Hospital

2) What type of floor/unit do you work on? What are your typical patient types and patient ratios?

Neurology/Neurosurgery. 3:1 days, 4:1 nights. Occasionally there were kids that demanded 2:1.

3) What kind of ancillary staff do you have? (RT, pharmacy, IV team, phlebotomy, CNAs, etc)

Respiratory worked in the ICUs and were available to the floors only on demand. If we had kids, for example, with demyelinating diseases or Guillain Barre syndrome who required q 4 or q 6hr NIF and Vital Capacity, we had to page Respiratory q 4 or q 6hr. IV team 24 hrs/day, pharmacy 24 hrs/day, CNAs typically 2-3 per shift, phlebotomy 7-3 only.

4) Does your charge nurse take a patient assignment?

No, not under normal circumstances.

PeakRN · Jul 11, 2018

I'll give two sets of answers one for my former 'top 10' free standing children's hospital and one of my current system. Both are in the mountain/west region.

Current system:

1) Do you work in a children's (only) hospital or on a peds floor at a general/adult hospital system? Which area of the country (state or region)?

Peds ED in a large hospital medical center (though I do adults on occasion when scheduling needs arise) with both an adult and pediatric hospital on campus.

2) What type of floor/unit do you work on? What are your typical patient types and patient ratios?

Emergency department. Our children's hospital specializes in congenital heart disease, high risk OB/fetology/neonatology, and pediatric cancer care. Most of our peds ED patients will either be cardiac kids, ex-NICU kids, or cancer kids. We do a smattering of the more typical cases, although they tend to go to the freestanding system.

ED caseload depends on census, typically 1:2 to 1:4, 1:1 for critical cases.

NICU depends on care level. Level 3/4 is typically 1:1 to 1:2. Level 2 and nursery are typically 1:3 but can be 1:4. PICU is 1:1 to 1:2.

PICU is typically 1:1 to 1:2. ECMO cases are 2:1 to 3:1.

Peds BMT is 1:2. Peds floor kids are 1:3 to 1:4.

3) What kind of ancillary staff do you have? (RT, pharmacy, IV team, phlebotomy, CNAs, etc)

The NICUs and PICU have dedicated RTs other units share from the peds RT pool. We have PICC during daytime hours, they are on call 24/7; we have ultrasound trained nurses for IV placement, but they are staffed in various units with a patient load. Lab can come and draw samples if requested. With the exception of the ED all units have CNAs.

PICU and ICU had dedicated pharmacists, we then have adult and pediatric specific pharmacists for the rest of hospital. If there is a critical care case (codes, trauma, patients on insulin drips, pressors, et cetera) in the EDs it falls on the ICU or PICU pharmacist, all others go into the pharmacy pool.

4) Does your charge nurse take a patient assignment?

If the ED is surging, yes; inpatient will until the on-call nurse(s) make it in, they have one hour to report after being called. Travelers do not have call.

Former system:

1) Do you work in a children's (only) hospital or on a peds floor at a general/adult hospital system? Which area of the country (state or region)?

Freestanding children's hosptial.

2) What type of floor/unit do you work on? What are your typical patient types and patient ratios?

ED. The hospital certainly had specialty programs and we got kids from that but most were just average community cases. Respiratory disease, minor trauma, sore throats, et cetera.

ED was 1:1 to 1:2 for critical care and trauma, 1:4 for everywhere else. Census was always so high that we rarely had less than 4 kids per nurse, the waiting room had patients from 0900 to 0300.

PICU was usually 1:2, but they held onto kids that didn't need to be in PICU. Step down was 1:2 to 1:3. ECMO was 2:1.

NICU was 1:2 to 1:3, they only had one NICU and didn't move graduates prior to discharge.

Onc/BMT was 1:3.

Floors were 1:4.

3) What kind of ancillary staff do you have? (RT, pharmacy, IV team, phlebotomy, CNAs, etc)

ED, PICU and NICU had dedicated RTs. All other shared from an RT pool. Dedicated pharmacists for ED, PICU, and NICU; all others shared from main pharmacy.

No IV team, PICC was only available weekdays during business hours. PICC wouldn't poke a kid under 7, those had to go to IR. You could beg anesthesia to come poke a kid but they typically wouldn't come down until the kid had been poked at least 5-6 times.

Lab could come and draw, but typically nurses drew samples. CNAs were on every unit except for the ED.

4) Does your charge nurse take a patient assignment?

No. If they didn't have a nurse they wouldn't fill a bed. No call schedules for staff nurses.