Staffing level in NICU?

[RNDreamer]

Hello all:

In the others forums, I read about how the staffing levels are low and the nurses are taking care of too many patients because hospitalsd do not want to hire more nurses. Does this happen in the NICU as well? Or do the nurses always have a limit to the number of babies they care for, like no more than 2 or 3 per shift? What is the maximum number of babies you can take before it becomes a threat to your license? Thank you very much in advance.

[elizabells, BSN, RN]

Our staffing depends on the acuity of the individual babies, at least in theory. The max is usually 1:3 for like stable CPAPs, feeders, etc. Occasionally in the stepdown part of our unit you could get four kids. Conventional vents are usually 1:2, but that doesn't always happen. Oscillators and ECMO are supposed to be 1:1, but I have more than once gotten an ECMO or oscillator plus one. I generally fill out a Protest of Assignment form to protect my license when that happens. Fresh post-op cardiacs are also supposed to be 1:1, but sometimes when we're really short you get a second. We've been badly shortstaffed lately.

[GoldenEagleRN]

The staffing level really depends on your facility. I was a tech in a NICU in Oklahoma, and the nurses had 3 Level II or stable feeder growers and no more then 1-2 Level III or critical babies. I moved to Florida after graduation, and am an RN in a NICU here in Florida, and nurses have 5 Level II babies and 2-3 Level III babies! And I would say that I would take no more then these numbers because they are very busy assignments. So it really depends on your facility, and it is definitely something you need to ask about in an interview! Good luck!

[RainDreamer, BSN, RN]

I think it depends on your hospital and how well they can retain their staff.

I work in a hospital where we don't have staffing problems, as the hospital has great staff retention and they aim to please their employees, therefore people stay because we're happy for the most part.

I work in a level III NICU, in which we staff ICU babies as 1:2 or 1:1, depending on their acuity. Each shift we add up acuity points and the total number of points determines if the baby is "high", "medium", "low", or 1:1. So a high/low, medium/medium will usually be how the assignments are paired off.

Then in the intermediate nursery, we always have 3 babies. I've never seen it anything other than 1:3, except sometimes you'll see one of the nurses with an open spot, only have 1:2, then if a kid needs to be moved to intermediate, that nurse would then pick up the kid moving in.

Sometimes even with good staffing of assignments, your night could still be insanely busy. A couple of weeks ago I had a 1:1 that was so busy, I had people helping me constantly all night. So, a good support of co-workers is a must! Do you guys ever see a really sick baby that is assigned more than one nurse?!

[Jolie, BSN]

The NICU is not protected from short staffing and heavy patient assignments any more than any other unit.

I've worked in 5 hospitals in 5 states, and the absolute worst staffing I endured was in the NICU of a prestigious children's hospital.

[preemieRNkate, RN]

Do you guys ever see a really sick baby that is assigned more than one nurse?!

Last summer I took care of a baby that had NEC, perf'd and then went into DIC after surgery. I took care of him 3 nights in a row, and the second night from 7-11 he was a 2:1. We had an "extra" nurse that helped me out. It was great to have someone else at the bedside with me to help change IV fluids, check blood, etc. More lately, we've been so busy and understaffed so we wind up with what should be a 1:1 and another baby (usually a feeder/grower or a R/O sepsis or something). Our new nurses should start coming off orientation next month though!

[wjf00]

Ratios in the unit I work in are probably as good as it gets. Vents are automatically 1:1 (NCPAP is a vent) CN never has an assignment, we have a nurse for deliveries with no assignment and 1 or 2 break relief nurse(s) with no assignment. The unit keeps hiring and hiring, so we usally are fully staffed. The only downside is that there is a lot of floating. The areas we float to seem to be chronically short staffed, so there is a lot floating whenever it slows down.

[EricJRN, MSN, RN]

Ratios in the unit I work in are probably as good as it gets. Vents are automatically 1:1 (NCPAP is a vent) CN never has an assignment, we have a nurse for deliveries with no assignment and 1 or 2 break relief nurse(s) with no assignment. The unit keeps hiring and hiring, so we usally are fully staffed. The only downside is that there is a lot of floating. The areas we float to seem to be chronically short staffed, so there is a lot floating whenever it slows down.

Wow - that does sound nice. Do you just float to NBN/PP/women's areas?

[SteveNNP, MSN, NP]

Ratios in the unit I work in are probably as good as it gets. Vents are automatically 1:1 (NCPAP is a vent) CN never has an assignment, we have a nurse for deliveries with no assignment and 1 or 2 break relief nurse(s) with no assignment. The unit keeps hiring and hiring, so we usally are fully staffed. The only downside is that there is a lot of floating. The areas we float to seem to be chronically short staffed, so there is a lot floating whenever it slows down.

Wow...you're really lucky.... aren't you bored to tears sometimes, with just one CPAP?

[Preemienurse23]

Ours sounds about the same, the Hifi's and unstable vents 1:1. Sometimes the stable Hifi's are 2:1. the CPAP are usually 2-3:1. It really depends on the staffing and level of the babies we have. We have a 4 room isolation suite that we put a lot of our feeder/growers in and have our LVNS take care of.

I had a 4 baby assignment the other day with a 28-30 wkr who was a twin of a fetal demise. He was 4 days when I had him, not acting right, kind this grayish/green color. I was so busy, my hands on was 2 hrs straight, and by then time I was done with the last one I had to start over again. If anything had happened to my twin, unless it sounded an alarm, I would not have noticed until a hands on. That scared me more than anything.

[wjf00]

Wow - that does sound nice. Do you just float to NBN/PP/women's areas?

Yes Peds and PP are the choices, and floating is quite frequent at times.

[wjf00]

Wow...you're really lucky.... aren't you bored to tears sometimes, with just one CPAP?

I read policy's /procedures if it is really slow, but in reality if everything that needs to be done is being done, like changing out isollettes, allowing parents to Kangaroo their CPAP babies, all the double checks, reinforcing parent teaching, etc then there really are things to do most of the time.