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venting...

NICU   (3,988 Views 17 Comments)
by scrabblern scrabblern (Member)

scrabblern has 10 years experience and works as a RN.

2,569 Visitors; 42 Posts

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All right, tonight is my 3/3 in a row, night shift and last night was probably one of the worst nigths my unit had, the only worse thing would be a patient dying.

On my 1st night the unit was busy and understaffed. I started out with 2 patients, but by 2300 I ended up with 3 babies out of which one was a term Grade 3 IVH on HFO/NO, double pressors and multiple meds, a term on HFNC and fluids/abx + bradys and a 32 weeker on NC/fluds and bradys. I should have had a 1:1 assignment. Lost 2 IV's in the middle of the night. I got help with one assessment. I thought my 1st night was awful until my 2nd night.

We're a level iii, no ecmo... 2nd night we started with 26 babies with about 4 nurses w/4 pts, rest had 2 to 3 pts. Our unit has individual rooms and it's very long and spread out. We lost a nurse at 2300 who had 3 pts (she did a 16h shift), then another nurse fell ill (she was ill the previous day and decided to come to work) and was literally green in the face. She walked away and we had to absorb her 4 pts. By 2300 i ended up with the same assignment from the day 1. By 0200, I got another 32 weeker because we got 2 admits, a term with seisures and a 27 weeker who didn't look very compatible with life who also ended up on HFO and pressors. At 0200 since we had to absorb 7 babies + 2 admits everybody except for a nurse who had 2 babies on HFO/pressors had 4 patients, she had 3. :eek:

Our charge nurse (who had 4 pts herself at this point) had called everyone who was at home and nobody wanted to come in. Finally at 0500 the manager showed up to be helping hands, and I transferred my "feeder-grower" to level ii which is in another building. Level ii nurses wouldn't take a HF baby so we stuck her on NC at 1L.

The girl who got the 27wkr was drowning. I fed one of her babies and helped with admit just minimally and felt really bad that I couldn't help more. I knew that because of the situation we were in, everyone was providing pt care that was unsafe. I felt really unsafe, my back was in knots. I was writing down everything I did because I was so scared that I'd forget something. We all made it through the night and most of us were able to chart out by 0800 except for the nurse who had the 27wk admit and the charge.

I love my job and love the unit, but dreading coming to work tonight. After two days of this I am physically and mentally exhausted and will probably have to face having the same assignment as day 1. I just hope that everything will be ok...

Our unit is in process of training 2 new orientees (none were working last night), we have no techs on nights and currently we're using one traveller.

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Penelope_Pitstop has 13 years experience and works as a Registered Nurse.

45,577 Visitors; 2,365 Posts

I'm sorry to hear that, Scrabble. I'm not a NICU nurse (I did my preceptorship in a Level III at a non-maternity hospital when I was in college, so I understand NICU lingo, but that's it :)) but I agree that your assignment was too much. I know from experience that nights like that are that much worse when you know you have to turn around and come back again in less than 12!

 

I'm glad that the NM did come in (albeit @ 0500!) and that you were able to transfer one patient. Is there no per diem staff available? (Maybe there isn't if you take travelers; my institution doesn't use travelers but uses per diems as a an "internal agency.)

 

I'll be thinking of you.

 

You can do it!

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SteveNNP has 9 years experience and works as a Neonatal Nurse Practitioner.

2 Articles; 25,563 Visitors; 2,512 Posts

Unsafe, unsafe, unsafe....

At the very least, the nursing supervisor should have floated staff from other units to at least feed/change/VS on some babies to offload those of you who had critical pts.

A night like this needs a debrief.

2 babies on HFO/pressors????

4 babies in a non-stepdown unit????

Insane. Plans need to be put in place to prevent this from happening again. This is a sentinel event waiting to happen.

Listen, I've worked in level III units for 5 years now. Crap hits the fan, and we nurses adapt, kids get the basic care they need to survive the night, and everyone's ok... what scares me in this situation is that everyone had 4 patients, including the charge nurse...and the manager DOESN"T COME IN UNTIL 5am????? geez. I wouldn't jump ship right now... but something has to be done to prevent this from ever happening again.

I work in a 58 bed unit with an ADC of 68-75.. occasionally we hit 82. When the cardiac, ECMO, HFJV, HFOV, head cooling admits/transfers come in, and the transitional nursery (in-house admit/stabilization) unit fills up, we make room, pick up an extra kid, and adapt. But nursing admin does EVERYTHING they can to make sure we get bodies. PICU floats, Peds floats, OT, they pull people off the next night, etc....SOMETHING!

Whoo.

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babynurse428 has 28 years experience and works as a RN.

2,198 Visitors; 30 Posts

Unfortunately this is one of the reasons I left the NICU 10 years ago. Having had a 1:1 pt., four vents (all on pressors/2 on HFO), and four feeder growers with 3rd, 7th and 10th admission proved too much and too unsafe for me. It made me crazy! I understand your feelings for dreading another night! Hang in there. Is it like this a lot or is this an isolated incident? Not that it makes it acceptable under any circumstances! Although I miss the babies and want to go back, it is stories like yours that make me hesitate to go back. I couldn't take the unsafe numbers again! Please know that you are in my thoughts and you can do it, even if you don't like it. Those babies need you!!

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littleneoRN has 6 years experience.

6,931 Visitors; 459 Posts

Are you a union facility? Do you have any method for safely lodging complaints of unsafe staffing. Your facility needs to have a backup plan for when you're that short staffed. This sounds like tragedy waiting to happen. A baby on HFOV and double pressors in my unit would absolutely be 1:1, and if staffing was an absolute nightmare, it maybe would be possible that person would also have one feeder grower. That's like next to never though.

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BittyBabyGrower works as a Nurse of course!.

12,652 Visitors; 1,823 Posts

Ok...

1. The charge nurse should have made it clear to the nursing supervisor that it was clearly unsafe...she is in charge and ultimately it is her head on the platter so to speak.

2. If no floatability...then the super calls the unit manager...until the UM comes in supervisor is to be in that unit doing what she can.

3. Your charge nurse also has to be sure that every single body was called to come in before deeming it unsafe.

4. I've been a charge nurse on a 50 bed unit for some time now...I have only uttered those words "It is unsafe" once in my career. And when you do, it has to be logged as such. The charge nurse should also write up an incident report, as should every single one of you working that night, to cover your asses in the case that something from those nights go to court for anything. They will always look at staffing and then question the assignments given.

I am so sorry you had nights like that. Once in a while crap hits the fan where I work and we do what we have to get by, but like I said, only once was it truly not safe.

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scrabblern has 10 years experience and works as a RN.

2,569 Visitors; 42 Posts

our state does not have unions. this has been a chronic situation, it's been happening over the past several months. nurses have been to manager and complained about assignments and safety multiple times. everyone is required to work 8 extra hours per pay period which is putting stress on staff. we have been pulling staff from other units when they're available. our census has risen two months ago and the babies keep coming and coming. still we're about 2-3 nurses short every shift.

yesterday the manager told the new orientee that she had to show up extra over the weekend even though the girl had planned an aniversary vacation with her husband. the orientee is young and this is her first real job so she said yes. the girl is not even on the matrix yet. she'll end up hating it here.

tonight - a day nurse working a 16h shift with two HFO/NO/pressor babies, a nurse w/HFO/NO/pressors and a feeder grower who is to possibly pick up another pt, nurse w/a post-op vent and 2 feeder growers. A whole lot better than last week.

Edited by scrabblern

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twinkletoes53 works as a former pediatric RNC; worked NICU for 30 years; no.

11,745 Visitors; 202 Posts

That assignment was a nightmare from hell.:mad:

At the start of the shift, I would have called the hospital Supervisor to the unit, and had her sign a form on which I wrote that I felt the assignment given me was a dangerous assignment; it put the patients at hish risk of morbidity or mortality, and was an unsafe assignment. Make sure she signs and dates it, along with you.

If a baby's condition had deteriorated, or worse, because of the staffing situation, you can bet that the first license they would go after would be the staff nurse's.

You MUST protect yourself legally.

God bless you for sticking it out. I would be raising holy hell if I'd been given such an assignment. Is this the norm where you work? If it is, I advise you to look for another job somewhere else, and fast.

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1,751 Visitors; 75 Posts

Two words:

SAFE HARBOR

Pull up the policy on calling safe harbor or go to your state's board of nursing website.

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SteveNNP has 9 years experience and works as a Neonatal Nurse Practitioner.

2 Articles; 25,563 Visitors; 2,512 Posts

our state does not have unions. this has been a chronic situation, it's been happening over the past several months. nurses have been to manager and complained about assignments and safety multiple times. everyone is required to work 8 extra hours per pay period which is putting stress on staff. we have been pulling staff from other units when they're available. our census has risen two months ago and the babies keep coming and coming. still we're about 2-3 nurses short every shift.

yesterday the manager told the new orientee that she had to show up extra over the weekend even though the girl had planned an aniversary vacation with her husband. the orientee is young and this is her first real job so she said yes. the girl is not even on the matrix yet. she'll end up hating it here.

tonight - a day nurse working a 16h shift with two hfo/no/pressor babies, a nurse w/hfo/no/pressors and a feeder grower who is to possibly pick up another pt, nurse w/a post-op vent and 2 feeder growers. a whole lot better than last week.

based on this information, i recommend you start applying elsewhere....get out while you can.

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theatredork has 6 years experience and works as a Registered Nurse.

6,025 Visitors; 229 Posts

I pretty much echo what SteveNNP said.

Put it this way, you can get another job, but not another nursing license.

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scrabblern has 10 years experience and works as a RN.

2,569 Visitors; 42 Posts

FYI... I moved to a Union hospital on West Coast in 2014. I can't even describe how much better our working conditions are. We're taken care of, our assignments have been fantastic and that really reflects in patient care we provide. 

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