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?
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!
WOW-totatly way unsafe, understaffed, danger danger....
and did I read that your attending is in just for a couple of HOURS?
I would get out and run to a well staffed place!!!!
I am from a level IIB NICU where we keep only traditional vents. We have a minimum of 2 nurses on at all times (even with just 1 baby). We then have a Neo on call 24/7 with an in house Peds Intensivist at all times. They can go to all deliveries the Neo doesn't think he needs to come in for or if he can't get in soon enough. He would then take over once he got there. A nurse goes to deliveries like decels, the intensivist comes for things like mec along with a NICU nurse. If we have a vent or cpap, the neo then stays in house the entire time. I feel pretty safe with this, maybe just what I'm used to...
In my unit, there are 4 teams. I have trouble remembering specifically how many staff each team during the day but generally, the least sick have PA's and pediatricians (level II), then the next sickest have attendings and residents (some level II, some level III), the next sickest have attendings and NNP's, and the sickest have attendings and fellows and maybe a NNP. At night we have 3 people cover in house...an attending or sometimes a fellow as an acting attending overseeing everything, a fellow or NNP overseeing the 2 sickest teams, and a resident overseeing the 2 least sick teams.
We have an attending on during the day who rounds and takes care of daytime stuff, and then we have a doc on call at night. We also usually have an NNP in-house for either 16 or 24 hours (either 7A-7A or 3P-7A). The NNP attends most deliveries where someone is needed and can do just about anything the MD can do (intubate, write admission orders, surf, place lines, etc.). If we have a really sick kid, the doc may come in to insert a chest tube or to back up the NNP. Otherwise, for a more routine admission, the doc will consult with the NNP over the phone and come in if he or she is needed. We have four neos and four NNPs currently. We do not have residents.
Our L&D units also have nurse resuscitators who are able to resuscitate and intubate...they are trained further than just NRP. Our NICU nurses also sometimes attend deliveries with the NNP or MD if asked to...but it's less common now that the nurse resuscitators are in place.
We are a level III 23-bed unit with vents, nitric, oscillators, and jets, but we don't have a surgeon, so we have no surgical patients. We also have started doing head cooling. We keep anything that comes in the door...our earliest so far has been 23 weeks on the nose...didn't survive, of course. We have sent home at least one 24ish weeker after nine months in the hospital, and he is doing pretty well. We do ship some kids out...surgical cases, NEC, overwhelming sepsis from an unknown source, ECMO.
Our usual ratios are 2:1 in the NICU and 3-4:1 on our intermediate side. We sometimes have a 3:1 ratio on the NICU side if we are more on the short-staffed side, but those are always stable NICU kids (something like full feeds and CPAP...that kind of thing). Our oscillators and jets are initially 1:1 when in the beginning of treatment, but once they are stable on the oscillator or jet (i.e. off drips and on feeds), they may get a second baby in the assignment...but always a very stable baby.
Sorry this is so long...hope it's the information you are looking for!
Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.
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.
I work in a 40 bed (can be up to 43) Level IIIc NICU (once called a Level IV, but now the max is Level IIIc) in a large teaching hospital. We have inborns as well as transports and our own transport team.
We have four teams consisting of a resident and an intern and the occasional M4. There are a couple of float NNP's on the day shift and we have six fellows. There are usually two or three fellows on the unit in the daytime.
There are a minimum of two attendings around on the day shift. At night we have either a fellow or NNP who acts as a fellow in house, along with a resident and an intern. The attending does not stay in house but is available by phone or comes in (only) if the poo-poo hits the fan. There is a "second" attending on call at night as well if the poo-poo REALLY flies. I have seen two attendings in here at night only twice. Once for triplets, once for a REALLY bad airway kid that anesthesia was trying to trach after we couldn't get him intubated at birth. (Turned out he actually had no trachea below the "cords.")
Our transports are picked up by either a fellow, an RT and a NICU RN, or if the baby isn't terribly critical, a flight RN and an RT can go, and occasionally the fellow might ride along.
We staff "feeder growers" at 3 per RN, rarely we might have to do 4 per RN. Our intubated but more simple kids are 2 babies per RN or the really really sick PD or cooling or maxed on every pressor kid will be 1:1. ECMO's that are fairly stable are paired.
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.
Level 3 unit with approx 40 beds.
NNP's are not on staff 24 hours/day, only during day hours.
A neo is in house at all times. Usually, another one is on call if needed (but not in house).
We have a dedicated delivery team that attends all deliveries. NNP or neo attends deliveries that are expected to end in admission to the NICU or if the OB requests.
We never have a time when there are NNPs in house but not neos.
We have roughly 100 beds total for Level II and III. We have 5 NNPs and 4 Neos during the day. There is always always always a neo in the house and at least one, usually two NNPs 24/7. No residents or fellows here. Level II babies are 2-3 per RN, with the occasional 4 to 1 for a short-staffed shift. In our Level III, babies are never more than 2 to 1, even if they are Level II just waiting for a bad. Stable vents may be paired, but most definitely not jets, oscillators, PD, or ECMO. We always have a circulating nurse without an assignment who helps in the unit and attends deliveries and transports. A circulating RN and NNP and/or MD and sometimes an RT depending on the situation attend any deliveries that are expected to result in admission to Level II or Level III. L & D also has a NNP staffed to cover C-sections, chorio deliveries, mec, etc. Our charge does not have assignment and does not leave the unit except for breaks.
I work in a level three nursery in a children's hospital, so we do not have deliveries, all the babies are transported in. We do all surgeries except transplants, and have ECMO, jets, HFOV, head-cooling and nitric oxide.
We have 37 beds and recently have had a waiting list from the neighboring hospitals to transport the babies in, so we're very high census and busy.
Usually there is at least two or three neos on 7 a-7p, plus three house officers (interns or residents), one medical student and approx. two or three NNP, sometimes more. 7p to 7a there is one or two neos (if we have ECMO, then there is another), maybe one NNP and fewer house officers, one on each 'side' of the nursery.
We always have a charge nurse, at least one transport nurse, a break-relief nurse (what we used to call the team leader) and usually an ECMO nurse either on shift or avaliable. Nurses all have either one or two baby assignments. most work eight hours, a few work twelves and the staffing nurse asks for doubles or half doubles every single shift.
NICU_babyRN, BSN, RN
306 Posts
WOW-totatly way unsafe, understaffed, danger danger....
and did I read that your attending is in just for a couple of HOURS?
I would get out and run to a well staffed place!!!!