I work in a 24-bed Level 3 with a separate 11-bed Level 2. We do pretty much everything short of organ transplants and ECMO, but cardiac surgeries (besides PDA ligations) go elsewhere in the hospital to recover. We're moving to a 50-bed, single room unit in less than a year.(with Level 2/Level 3 still somewhat serapte but no longer separated by other units!)
I don't know our actual rates, but I'm told our NEC and IVH rates are low. Something our docs are VERY good at is not supporting futile care. The Neos and Neuros are very upfront with the parents and most of the time, when it is appropriate, the parents choose to take these kids off the vent- and are supported by medical & nursing staff. Evidence-based practice is encouraged by medical and nursing, but a lot of change has to be nursing-initiated. If a nurse is willing to make the effort to find the evidence, changes can be made. We have a strong core of experienced nurses- some who have been in our unit for 20-30+ years. Many of the experienced nurses are the ones who initiate these changes- unlike other floors/other hospitals where it is more common (in my limited experience) for such experienced nurses to just go with the flow, awaiting their retirement.
Areas of change:
Developmental care. Going to the new unit in itself will help. Nursing input has been valued in the development of the new unit, BTW. One of our most experienced nurses is also waging what was once a one-woman war to make these developmentally appropriate changes.
Pain control. We have a new Neo who came from a unit that was more aggressive about pain management and I was joyfully surprised to see that our other Neos are not just allowing him to practice as he is used to, but taking a page from his book.
Family-centered care. This is a hospital-initated change... change comes slowly. People seem to be waiting for the new unit to magically "cure" this.
Initiating breast feeding. The level 2 nursery nurses are excellent at teaching & supporting breastfeeding. Most of the level 3 nurses are scared to death of breasts. We really don't recieve any training in breastfeeding teaching and support during orientation. I came from a "Nipple Nazi" LDRP/Level 2, and even I am loosing my confidence and having trouble with teaching. Apparently the hospital has FINALLY agreed to "give" us a part-time LC when we move to the new unit. Right now, we have to pratically chase them down and drag them over to the unit, when we need their help (not their fault, there's too few of them to meet the need) so that will help. The rest of the change has to come from us.