Staffing in NICU...HELP!

[NICURNMOM]

I am the Patient care coordinator (low level manager) of a small Level 2 NICU.

We have been fighting upper management about staffing. I know AWHONN has set minimum guideling for staffing, but they don't say if a NICU can by staffed by only 1 nurse. We are often staffed with 1 and only 1 nurse! Even with a baby on a vent! We also attend C/S's and high risk deliveries, and there is no well nursery...we are it!

Can anyone help me with laws, regulations, anything? Thanks so much!

[Mimi2RN, ASN, RN]

I don't know about laws or regs, but you need at least two staff available even if you only have one pt. Who would cover if you had to leave for a delivery? Any less than two is a law suit waiting to happen. Breaks have to be covered , even potty breaks, without compromising the care of a patient.

We don't keep vent babies, but also do c/s and high risk deliveries. We can do with 2 rn's up to 5 pts, after that we need 3. Our usual census is a lot higher, average now at least 10.

How is your OB unit staffed if they have only one pt in labor? Do they staff for the "what if's"?

[NICURNMOM]

Oh, of course, OB is ALWAYS staffed with 2, even with NO patients. You have a great ratio....2 nurses for 5 babies is appropriate, to me, to provide optimal care. Thanks for you input!

[prmenrs, RN]

To me, if you have a vent pt., you are an ICU; I don't know what state you live in, but in California, that means 2 people, 1 an RN. In the level II where I now work, ! RN is designated (and qualified) ACLS; she goes to any deliveries, transitions all NBs, goes to the ER if they need her for a baby, etc. The other RN is back-up for a second delivery, takes care of the other baby(ies). If necessary, a 3rd and 4th RN will be scheduled. This is a 10 bed unit. They do NOT keep any baby needing to be ventilated, or even one considering the option. (Those babies!!!)

Somethings not quite kosher in that unit. No offense. How do you plan on changing it?

[NICURNMOM]

I'm starting by tring to find info. My hospital is very money-based. I've been in this NICU since it opened8 years ago, and did the well nursery there or 2 years before that. We always had 2 nurses in the well nursery. It has slipped to now staffing wih 1 nurse most of the time. WE are a 10 bed, level . We keep some pretty sick babies. Last week we had a kid with 1-1-1 APGARS (supposedly) who was vented, on Dopamine and Dobutamine, got 3 transfusions, with another 30 week grower/feeder and they wanted one nurse on!! We all refused!!