Private rooms for NICU babies

BittyBabyGrower, MSN, RN · Jan 17, 2008

If you do a search we had a few threads about this. Personally I would hate it. When we are really busy and have sick kids with other sick kids this could be a set up for a problem.

As for the parents spending the night....we have ones that would think it was a hotel and we would have to have strict rules. I would think if you have a very sick kid, the parent wouldn't be able to sleep anyways and most likely be underfoot at some time. And it would have to be just one parent, not two. We have rooms that our moms can have, but they are limited to 2 nights since our patient population figures that they are owed treatment as if they were at the Ritz. Good luck to them! I'd be interested to hear how it goes.

TeenyTinyTotRN · Jan 17, 2008

Hi! I'm new to posting...

I currently work in a Level III in TN (60+ beds). Last year, we completed a multiple million dollar project building private rooms for our babies. We built the first phase (two coves) with the intention of using it for our sickest...long term babies. Unfortunately, due to issues with the monitors, etc...we have been using it as an IMCN for the past year. The sickest babies have been in our "old" unit (we remodeled it), and we have no plans to move the sicker babies into the new area as of yet. Due to safety reasons (frequent alarms, oscillators, etc.), no one feels comfortable leaving their super sick baby in a room alone. It hasn't worked out for us. Hopefully, in the next few years, we plan to built the second phase (two more coves) and actually work out the kinks enough to move our really sick babies into the private rooms. Who knows...

Also, we don't allow our parents to stay overnight. We allow two in the room at a time (unless there are special circumstances). We have comfy recliners, etc., but we don't allow them to actually sleep in the room. This is the only part that has actually worked well for us!

Good luck to them!!! :nurse:

preemieRNkate, RN · Jan 18, 2008

We're scheduled to have this in 2010 (which probably means like 2015). Most of us feel like we're going to hate it, at least initially. Right now we're still set up in big rooms with 8-10 (sometimes more) babies in them. Our policy is that an RN must be in the room at all times. I'm not sure how it's going to work when we move.

littleneoRN · Jan 18, 2008

Right now we do not have private rooms, but it is on the horizon. TeenyTiny mentioned that they don't feel comfortable putting their sickest kids in a room alone. At our hospital, those really sick kids--oscillators, etc. would be one-to-one assignments anyway, so they would not be in a room alone. I almost would have a harder time with some of your least acute, feeder-grower types. These kids don't find themselves in trouble as often, but as a nurse, you might be caring for three, maybe even four of them. This makes it much more likely that you might be in one room giving a bath and have your little feeder start into a bad spell down the hall. I know that the wireless systems allow for alarms to backup nurses when your hands are full, but even the 30+ seconds it might take for you to indicate that you're busy and signal to your backup could be significant for a severe spell. This might translate into a minute plus before anyone even makes it to the bedside. Nurses with private rooms, would you say this is an accurate perception? And how does it work for you with, for example, a big rule-out sepsis term kiddo (or a crazy little 900 gram-er for that matter) who is kicking all over the place, setting off their pulse oximeter because it won't pick up? Right now I can glance across the room to their monitor, know it's a false alarm, and not feel such a great sense of urgency to respond to this false alarm. Maybe part of this is my background--I have never worked med-surg or any other setting with rooms. I've always worked in a nursery with multiple babies per room, where there is always a nurse in the room. And every single patient is on a monitor. The idea of having infants on med-surg alone in rooms without any monitors makes me panic. :)

acerila · Jan 19, 2008

We have private rooms with beds in them. No issues with the private room but the beds never get used. I can't imagine what it would be like to have parents spend the night. It might be in the best interest of the parents but definatly not in the best interest of the baby (and I wouldn't want to work at a place that caters to parents first before the baby).

elizabells, BSN, RN · Jan 19, 2008

(and I wouldn't want to work at a place that caters to parents first before the baby).

No, no you wouldn't. It's not a lot of fun.

RainDreamer, BSN, RN · Jan 19, 2008

I think that'd be awesome for a level II or a NICU that doesn't have many high acuity patients.

Our unit is busy, we have lots of very sick kiddos, and there's always a lot going on. I just don't see how it could work in a unit like ours.

ScammRNC · Jan 23, 2008

We are a Level 3 NICU and have had private rooms for 2.5 years now. After the initial dislike, because of change, everyone loves them. (Nurses and parents). Parents are able to stay the night if the desire, but actually very few of them do. When they do guidelines are set and explained that it is not a bed and breakfast. It has worked out really well. Can't imagine going back to the open space.

elizabells, BSN, RN · Jan 23, 2008

Do you do ECMO and complex cardiac? I'm just trying to figure out how you would do that in a private room from a physical space/equipment standpoint. We have a few private rooms and it can get really tight if a kid is on, say, a vent with iNO.

littleneoRN · Jan 23, 2008

Our PICU has all private rooms. They have a very high acuity level with ECMO, cardiac surgicals, etc., and I have not heard any complaints other than that the rooms should be bigger. I haven't heard anything about it being a problem with acuity. Then again, both our PICU and NICU seem to have more 1:1 staffing than many of you describe in your units. So, you're pretty much camped in that room for your shift. I still think it would be harder to manage private rooms with 2-4 baby assignments, where you could be bottling in one room and your baby down the hall starts having a nasty spell. Or kicks and causes his pulse ox to alarm for no real reason. Right now I can just look over and assess the situation rather than running down the hall. Does anyone have experience for level II sort of kids in private rooms? Are my fears unfounded? I feel like this would definitely put a greater tax on our feet and cause a lot of running back and forth. Not that my feet are more important than the babies. From the perspective of developmental care, I think private rooms could be fantastic. My feelings are mixed.

iyqyqr · Jan 23, 2008

Our PICU has all private rooms. They have a very high acuity level with ECMO, cardiac surgicals, etc., and I have not heard any complaints other than that the rooms should be bigger. I haven't heard anything about it being a problem with acuity. Then again, both our PICU and NICU seem to have more 1:1 staffing than many of you describe in your units. So, you're pretty much camped in that room for your shift. I still think it would be harder to manage private rooms with 2-4 baby assignments, where you could be bottling in one room and your baby down the hall starts having a nasty spell. Or kicks and causes his pulse ox to alarm for no real reason. Right now I can just look over and assess the situation rather than running down the hall. Does anyone have experience for level II sort of kids in private rooms? Are my fears unfounded? I feel like this would definitely put a greater tax on our feet and cause a lot of running back and forth. Not that my feet are more important than the babies. From the perspective of developmental care, I think private rooms could be fantastic. My feelings are mixed.

I have not yet worked in a private room NICU, but I have just completed two travel assignments in Level III NICU's with semi-private or two pts per room. My home NICU is planning their new unit of mostly private rooms. I LOVED one unit, didn't so much like the other. The great unit had 8 rooms organized in a POD. 4 pt rooms on each side of a shared space, and they had three PODs like this. They also had sliding glass doors between rooms, which helps you get to your babies quicker and help each other. One unit used cell phones and you carried phones everywhere since your babies sat limits set off your phone and caused it to ring when he desatted. Then you had to go to the baby, silence his monitor alarm and hit two buttons on your phone. When your buddy went on break you baby sat her phone. I worried about the contamination factor on the phones and all the noise! Great unit had infants grouped on Phillip's monitors. If any of the 6-8 infant's in your 'group ' had a desat, it showed up in a smaller box on your monitor screen. If a nurse attended the baby, she silenced the alarm, but if she didn't or the baby stayed low, then other nurses went to help. It really worked well once you got used to it, and I didn't feel the babies were compromised. The benefits of the quiet for the infant ( they do cry and desat less) and the benefits to the family for K-care and privacy are so worth learning this new set-up. I am now back working in a huge open 44 bed NICU for three weeks between travel assignments and I feel like a poor, overstim'd and edgy preemie. I need ear plugs and a Snugli to cope. I much prefer a semi-private plan, and I am hoping to work in or travel to a private room NICU in the near future. (I travel to explore design and practice ideas.) From what I have read about private room design, it works best when arranged in PODS.