Travel RN, IS THIS CHARGE? , safety, Nursery / NICU

[JacksGirl]

I need help deciding if this is or isn't safe.

I'm a seasoned travel RN , specialty NICU, nursing many, many years. A highly competitive busy urban region for NICU came up, I interviewed, was offered the job, but the pay was less than my agency had said and while they were working that out, the job morphed to the original higher pay but now in the nursery. It's been tight, I accepted. I'm flexible and I've been floated to nursery before, and figured it wouldn't be so bad and that it would segway to the NICU as they got to know me and needs there beefed back up.

The hospital usually hire for mother / baby but this is strait nursery because of course I don't do adults. I was to be cross trained to NICU and my impression from the NICU manager (different from the PP/ Nursery manager) to be 'shared' to some extent. My impression after one day when I asked for NICU orientation, was from the PP/ Nursery manager "her numbers were too low".

I have concerns. To address them I have to describe environment. I have done one orientation shift and am not certain, though I have never not completed a contract, concerns about whether I feel this is safe.

The floor has between 30-40 mother/ infant pairs-I don't know yet--there wasn't time in orientation for that kind of question. The nursery is at the end of a long hall of patient rooms, far away from the Post Partum Nurses desk. . The nursery is assigned one RN and one PCA on days, and one RN , two PCAs on nights (so I am told...I have my doubts...this may be because there is a clerk on days and evenings and not one on nights...I don't know yet. I have been hired for nights).

The nursery involves a very small area for a (tough urban clerk's) desk and three rolling chart racks. There is a door to the right of this clerk's space that leads to a small room. At night all mothers (although this is couplet care) send their babies to the nursery. This is the room they come to. It is also the room for boarder babies--two of them on the one day I worked this unit thus far. On my one orientation day (7AM-7pm) 30 babies were in this room, and I was asked to chart their HR and Resp , change them , and send them out to their mothers. The PCA took their temps and delivered them to the mothers. It was suggested I might fill out the systems check list (assessment) 'to help the floor nurses'. I didn't .

On the other side is a room with four radiant warmers (rec'd at 7 AM and each one filled and labor and delivery already calling. two babies were warming post bath, two were to be admitted and just arrived) , two chairs (one used by a provider) , a computor , a code cart, a supply cart and two isolettes. The isolettes are apparently for Bili Babies. On my one orientation day, there were four babies on the warmers, two post bath, two to be admitted--7 AM. 8 more babies would arrive during the day. THis is obviously the transitional nursery.

Remember, I was on orientation. But on that day it took till 10:10 AM to get the babies out of the one room...and there were 10 admissions total. The labor nurses call report demand to give it immediately send the baby down and have pushy, pushy urban attitudes. I can deal with that, but this is the environment.

The PCA feeds the babies, and the nursery RN is expected to fill in the chart from what the PCA writes on the (not for chart) log. That one RN was expected to do all of those admissions, receive every call from L and D, address every Pediatrician wanting help and report, address and get supplies for every MD wanting to do a circumcision, and the HR / RR of all those babies, and any bili baby that might come in, and the boarders is crazy. It's hectic, frantic, and ...dare I say, unsafe?

I am to understand that at night, there will be two PCAs and one RN (me) in these two rooms. THere is a code cart, I was not oriented to who checks it, but the PP charge didn't come to do it. I believe that the 'charge' nurse is on the floor, I'm certain she is not free charge.

I suspect since the babies 'All room in--all the mothers send them in'....that regardless of whether I take the stance that I do NOT chart on them because they are in couplet care and I can not be responsible for them (which is most assuredly the stance I will take), I am the RN in the 'room' without visual field of them while working in the other .

I think it looks like that since I am the sole RN in both a nursery and transitional nursery with two PCAs to work with, I am in a position of supervising them...or charge for the evening. I think any responsibility for the code cart cements that role.

I have never seen anything like this. I feel it is a two RN area, and I am uncomfortable.

The RNs state they used to have two RNs there, but for poor patient satisfaction surveys, now its routine to staff only one and put the other on the floor. They asked physician help in pushing for management response without effect. They feel it is unsafe. They are obvious harried. In regards to admissions...10 and 11 is busy not usual, but happens, 8 happens and is normol, 5 is common. I kept asking what was on the board at L and D and never was given a way to determine that. The calls just kept coming to accept babies and I was never really oriented, but instead helped the RN and still left an hour late with her.

[litbitblack, ASN, RN]

I have no experience in post partum or nursery but what i remember from school....i would RUN....You can get out of your contract if the situation is not safe. and this is not safe

[neonatal_nurse]

Yes, the welcome to the world of "normal" babies! Woohooo!

People think that Nursery nurses sit on their asses all day and feed babies, but their dead WRONG! Upon my first few days in the unit, I actually believed that this is one of the non-toxic areas in the hospital. But NO. I have to do 20 million things all at the same time, sometimes without breaks. I couldn't even drink water or sit down!

10 admissions? OMG, after the shift, you'll feel like you're the one needing Oxygen. Haha. I have this streak of having straight admissions of 5 babies with like a few minutes interval-- and it's so CRAZY! It feels like it never ends and to top that, I have more babies waiting for their meds, etc...

This situation is not safe, as my situation is, obviously a single person cannot be expected to do ALL of these responsibilities in one shift. But sad to say, due to the economy, etc. this unit is not really prioritized as with OR, adult ICU or etc, when in reality, THIS is a SPECIAL area, staff nurses have to have SPECIAL skills to perform well. My unit has been understaffed for years. Sad to say, my colleagues and I have to endure all the toxicity during these hectic times.

Maybe you can talk to your unit supervisor/manager or whoever is in charge. Although they are not placing new staff in Nursery, most of the time, they float nurses from overstaffed units so they may help you out.

Good Luck!

[piscesguy]

Honestly, I wish nurses would get together and file class action lawsuits against these crook corporations. Seriously. They need to be held accountable. They're holding you accountable!