Staffing in a level III NICU

RM-RN · Sep 27, 2009

We staff by acuity. We've gone back and forth with regulations like, "CPAP infants should have no more than 1 additional stable, room air patient," but we end up back to basic acuity.

I'm still holding out for adding the level of parent care into the acuity guidelines, but no luck yet. :chuckle

SteveNNP, MSN, NP · Sep 27, 2009

I think ours is based on HPPD. We have a staffing grid that spells out how many nurses we need for a certain # of pts. For instance, with 75 pts, we should have 36 nurses.

dawngloves, BSN, RN · Sep 27, 2009

Our staffing is based on, "How many people can we call in on their day off?"

Imafloat, BSN, RN · Sep 27, 2009

We plan by acuity.

By this I mean that we know how many nurses we should have. We rarely have the number of nurses we need and sometimes our assignments aren't the safest.

If you can't tell, I'm getting a little sick of it. Part of the reason I love the NICU was that it was closest to the ivory tower nursing we learned in nursing school.

With the economy and hiring freeze we are suffering staff wise. We have lost a lot of nurses because they are burned out, and they haven't been replaced so we have to do more with less staff.

I had a kid on INO and 2 feeders the other day...yes you read that correctly.

neonatal_nurse · Sep 27, 2009

our staffing is based on how "toxic" our unit is for the day. of course we have the official on duty nurses for the day, but if more patients are being admitted someone definitely has to do overtime, or someone who has the day off could be called in. just a day in the life of a nicu nurse.

NeoNurseTX, RN · Sep 28, 2009

I think it's by acuity. Oh, WeeBabyRN, we can have an ECMO patient and be on admit &/or have another patient on a vent or something.

RainDreamer, BSN, RN · Sep 29, 2009

We staff by acuity. Fortunately the unit I work in is well staffed and our assignments are usually staffed the way they should be.

We have "acuity sheets" that each baby has in their chart. We score them based on a number of things (type of vent, unstable or stable, number of lines, IVs, number of meds, labs/gases, ECMO, INO, post surgical, drips, feeds, teaching for parents, etc, etc.) Whatever their score is will give an idea of what kind of assigment to put them in (3:1, 2:1, or 1:1).

Of course it doesn't always work out perfectly, as there are admits, transports, stable kids that get sick, etc. In those cases we just do the best we can and help each other out.

Coffee Nurse, BSN, RN · Sep 29, 2009

We staff by acuity. We don't use any formal system of grading (maybe we should; it would probably have saved me from getting stuck last night with a 24-hour-old micropreemie plus "sharing" a 3-month-old, who refuses to eat, with my preemie's twin's nurse), but we always have adequate staffing for what the acuity level dictates. See, there are (some) perks to living in California!

grinbyrd2 · Sep 30, 2009

Can you tell me what your hours per patient day (HPPD) if you do use this to justify you staffing needs? Thanks

SteveNNP, MSN, NP · Sep 30, 2009

I think our HPPD used to be 13, and just got bumped to 19-20 this fiscal year. It opened up an additional 25 RN positions. We are almost fully staffed, and assignments have been VERY doable recently, except for the 81-baby census blip we had a few weeks ago. Our per diems and OT-hungry staff loved that, and we still remained fully staffed.