Question about your unit

elizabells, BSN, RN · Nov 20, 2008

I was wondering if anyone can give me insight on how the NICU that you work in is staffed?
Meaning, do you have NNP's 24hours a day?
Do you have a neo on staff at all times (in the building or on call?)
Does a staff nurse go to high risk deliveries? Do you have an NNP or Neo attend all high risk deliveries?
What protocols do you have if you have an NNP on staff and not a neo- meaning what can't your NNP do that he/she would have to have a neo be either on hand or on phone?
Thnks
any info greatly appreicated.

Our kids are divided into two teams - the cardiacs go to the NNP/PA/HD team, the residents get half of the remainder, and then the balance rounds out the NNP team. NNPs, residents, and fellows in house 24/7. Days we have 3-4 NNPS (or PAs or house docs), three fellows (one per team and one for transport/deliveries), and around four residents. Nights is 2-3 NNP/PA/HDs, one resident, one fellow. Four neos during the day (two per team), one on call overnight, might stay around if things are nuts, has to come in if the fellow has to go out on transport. Staff RNs don't go to the actual delivery, but we have a room on the L&D floor that's a mini-stabilization NICU and the NNP/PA/HD or resident assigned to deliveries goes to all high-risk, CS, or mec deliveries while we wait in that room. I don't really have an answer to the last question, as I've never seen a situation where a Neo had to do something an NNP wasn't permitted to.

NeoNurseTX, RN · Nov 21, 2008

We have a neo on 24/7 and during the day there are:

3 attendings

4 NNPs

2 fellows

1 resident

transport team goes to deliveries

NICU_babyRN, BSN, RN · Nov 21, 2008

We have a two-three neos on during the day and at least one neo IN HOUSE at night.

4-6 NNPs during the day

3-4 residents during the day (yes, in addition to NNPs)

At least one resident or one NNP are on at night WITH the neo.

Transport resident is always an on-call resident, so it doesn't take away from the staffing in our unit.

RNs, neo, resident and nnp attend deliveries depending on the kind of delivery. If admission to NICU is imminent, then neo, RN and either an nnp or a resident attend the delivery.

EarlyAdditionRN · Nov 21, 2008

I work on a small level 3 unit of 16 beds.

We have 1 NNP on 24/7- available if and when we need her.

We have a Neo that is on "call" if we need him. He is there usually a couple of hours in the day, does rounds and then is off campus.

As far as deleveries go- An RT, and an RN go to all high risk deliveries ( preterm, C/S, mec, vacuum,). If we feel the baby needs to be admitted to the NICU we call the NNP for backup.

We are a community hospital and therefore do not have residents or fellows. Our Labor and Delivery/postpartum unit is 54 beds.

In the NICU- we will have 2-4 RN's working 7a-7p shift and the same with the 7p-7a shift. This depends on census. If we have 2 nurses working- one of those RN's will be charge nurse and the other will be high risk. Both have an assignment. If there is a high risk delivery/admit that the High Risk RN has to attend that leaves just the charge nurse in the NICU alone with all the babies. Do you feel that this sounds safe? Would you be comfortable working with these conditions? Any input greatly appreciated!!

elizabells, BSN, RN · Nov 21, 2008

Level 3 like... vents? Oscillators? Nitric? Surgical patients?

Holy hell, no.

EarlyAdditionRN · Nov 21, 2008

We don't have surgical patients- they are shipped out. But yes, all the rest. Our NICU has patients from 26wks-term

elizabells, BSN, RN · Nov 22, 2008

I'm sorry, I don't mean to be obtuse, but I want to make sure I'm understanding you properly. You have a 16 bed unit with vents/HFOV/Nitric, down to 26wkrs, and AT BEST four RNs and one NNP? And sometimes one RN and an MD only available by phone?

EricJRN, MSN, RN · Nov 22, 2008

40 bed level II/III (with census mostly in 20's, mostly level 2)

At least one doc and one NNP in-house during the day, with a third person (MD or NNP) in-house assigned as a floater that can pick up slack with procedures, deliveries, see nursery babies, etc. At night, one doc is always on the unit.

For high-risk deliveries (anything from maternal fever to light mec to severely preterm) we send an RN, an RT, and an MD or NNP.

babyNP., APRN · Nov 22, 2008

2-3 attendings, 3-4 residents, 1-2 fellows, 2-3 NNPs during the daytime.

At night time, I'm not really sure. I know there is a resident and a fellow, but haven't seen an attending yet on nights--maybe he/she is sleeping! : )

EarlyAdditionRN · Nov 22, 2008

I'm sorry, I don't mean to be obtuse, but I want to make sure I'm understanding you properly. You have a 16 bed unit with vents/HFOV/Nitric, down to 26wkrs, and AT BEST four RNs and one NNP? And sometimes one RN and an MD only available by phone?

Actually, yes that is what I am saying. I really don't think it is safe!! I am trying to find out if other small units in the country are run this way...I hate to say it but I don't think that they are. Back up is critical and I feel I don't have it.

Thanks for your response!

elizabells, BSN, RN · Nov 23, 2008

The NANN recommendations for staffing are posted in our break room, and I looked at them today. AAP/NANN says that intermediate babies should have a ratio of no more than 1:3, and critical 1:2. It's a NANN position statement; you may be able to download it from their website.

So yes, your unit is ridiculously understaffed, and were I you I would get out if possible.