I'm curious what everyone's nurse:pt ratios are lately on your respective NICU's.
Are you 2:1? 3:1? (for Level III babies)
4:1? 5:1? 6:1? (for Level II babies)
Do you have mixed assignments, i.e., 2 vents (L.III) and 1 feeder-grower (L.II)? If you're 2:1, do you do 2 vents, or 1 vent and 1 HFNC, etc.? What about oscillators? N.O.? Post-Op?
What are your unit "boundaries"? At what point does the assignment become too heavy and require redistribution amongst staff? When do you balk? I realize it's difficult due to acuity to speculate, but examples are welcomed.
The reason I ask is that we're overwhelmed, but have been told again and again that this is "the way it was always done" and "it's not going to change" or else we're fed B.S. about "when we get enough staff for 2:1..." but "we don't know when that will be". Coming from another state with better ratios and staffing, I feel like I'm the only one who KNOWS this isn't true. Many of the staff I currently work with have been at this facility for many, many years and seem to think that what we do is the norm.
In my unit, a level III + ECMO, our ratios are never more than 2:1. A vented baby is almost always 1:1, very occassionally we might have a very stable baby with a vented baby. The charge nurse does not have an assignment, and the transport nurse does not have an assignment. We also have a backup transport person who has an easily absorbed assignment, and a first admit nurse who will have an easily absorbed assignment. Admits are always 1:1. In our level II unit, which is separate from level III, and staffed by it's own nurses-assignments are also never more than 2:1. We are very lucky compared to what I have read hear from other units, but overall we are well staffed, and the reason we are well staffed is because we are well taken care of as employees at my hospital.
I could not imagine a baby being 1:1 just b/c he is vented. What I like about the unit I work is that there is no seperation of level I's or level III's. If they are in our NICU (2 nurseries divided into 2 rooms) they are divided by common sense. OK, this kid is on a vent but has no other issues....not a constant desatter. Pair him with a sicker kid who may need more care. Or a feededr grower with a 24 weeker on a dopa and HAL/IL. Or three stable kids with 2 feeder growers and a vent. The good thing about having them all in the same room is that you can divide the assignments to be easier and using your staff more efficiently. Four feeder growers is a horrible assignment. Especially if they are PO feeding some of the feeds.
Doesnt that "this is how it has always been" excuse just drive you nuts!!
I can't imagine a baby being a 1:1 just because of being on a vent either. Usually if the kid in our unit is that sick (to be a 1:1) they'll be on a jet or oscillator, not just a conventional vent (I'm saying usually, not always).
A BPDer could be vented, but on full feeds and otherwise low acuity. I would get bored just having that 1 kid.
Of course there are times when a vented baby could be 1:1, but other factors would come in to play ...... based upon our acuity tool.
Ditto Nell! I am very grateful as well to work in California. My hospital, located in San Francisco, implemented staffing ratios well before it was required by law. I am suprised to see how different California is compared to other states, especially on the east coast. From what I understand, there is quite a difference in pay. Also, the average of a nurse in California is approximately 55! Yes, 55! So there is definetly a shortage and it will be around for years to come! Job security is not a problem, the laws are strict but they favor the nurses (mostly), and it's a beautiful in and around the San Francisco Bay Area!
I can't imagine a baby being a 1:1 just because of being on a vent either. Usually if the kid in our unit is that sick (to be a 1:1) they'll be on a jet or oscillator, not just a conventional vent (I'm saying usually, not always).
A BPDer could be vented, but on full feeds and otherwise low acuity. I would get bored just having that 1 kid.
Of course there are times when a vented baby could be 1:1, but other factors would come in to play ...... based upon our acuity tool.
One of the best reasons to keep assignments 1:1 is so when 23 week triplets suddenly deliver, the assignments can easily be combined and nurses are freed up to help. I agree that if things are static, a 1:1 vent may create some free time. But 1:1 vents mean you are almost never caught short. We usually have 3 nurses out of the count to take admits, and transports. Even with those extra nurses, we still are short by the end of shift at times.
I have worked in units where vents were 3:1 if stable or 2:1 unstable. It was not a matter of the assignment being overly taxing, but no one was able to help anyone else. They were entirely absorbed in their own assignment. When vents are 1:1 and nurses are out of the count, IV's get started quicker, admits get stablized quicker, and the pt going south gets caught quicker.
A 1:1 assignment should rarely make me 'bored', rather it makes for better teamwork.
One of the best reasons to keep assignments 1:1 is so when 23 week triplets suddenly deliver, the assignments can easily be combined and nurses are freed up to help. I agree that if things are static, a 1:1 vent may create some free time. But 1:1 vents mean you are almost never caught short. We usually have 3 nurses out of the count to take admits, and transports. Even with those extra nurses, we still are short by the end of shift at times.
I have worked in units where vents were 3:1 if stable or 2:1 unstable. It was not a matter of the assignment being overly taxing, but no one was able to help anyone else. They were entirely absorbed in their own assignment. When vents are 1:1 and nurses are out of the count, IV's get started quicker, admits get stablized quicker, and the pt going south gets caught quicker.
A 1:1 assignment should rarely make me 'bored', rather it makes for better teamwork.
Out of curiosity how many beds is your unit? Level? How many nurses do you staff per shift?
One of the best reasons to keep assignments 1:1 is so when 23 week triplets suddenly deliver, the assignments can easily be combined and nurses are freed up to help. I agree that if things are static, a 1:1 vent may create some free time. But 1:1 vents mean you are almost never caught short. We usually have 3 nurses out of the count to take admits, and transports. Even with those extra nurses, we still are short by the end of shift at times.
I have worked in units where vents were 3:1 if stable or 2:1 unstable. It was not a matter of the assignment being overly taxing, but no one was able to help anyone else. They were entirely absorbed in their own assignment. When vents are 1:1 and nurses are out of the count, IV's get started quicker, admits get stablized quicker, and the pt going south gets caught quicker.
A 1:1 assignment should rarely make me 'bored', rather it makes for better teamwork.
Interesting. We always have "extra' nurses not in the count that go on deliveries and help with admissions ..... the high risk and swat nurses are available to help out with admissions, procedures, etc.
There's also assignments that are less busy and when we have an assignment like that we help out and pitch in with other assignments that are busier. But like I said before, we do assignments based on acuity ..... not just because a baby is intubated.
Wow...we have a 52 bed unit and there have been times that we have had 20 some vents....we could never staff with 20 plus nurses! We run with 14-17 nurses usually with a census in the 35 range. We have never done 3 vents, ever. Although, sometimes I'd rather have 3 vents than 4 poopy feeders!
In a nutshell, we usually have half as many nurses as we do patients. If our census is 40, we've probably got 20 nurses on. This is just like a ballpark figure. Depending on acuity, we could need more or less. Sometimes we'll only have 30 babies but will be working with 20 nurses because we could have a dozen 1:1 critical assignments at that time. Other times we'll have almost 45 or 50 kids but only need 20 nurses because there are many more grower-feeders. But yeah, overall it's pretty safe to say that our normal ratio is 1 nurse to 2 babies. The most babies we'll ever have is 6 grower-feeders per nurse, but that's only on shifts were it's hitting the fan. Usually we'll only have 3 or maybe 4 grower-feeders, and usually a sick vent (pressors, transfusions, frequent labs, new admit or post-op, PPHN) is going to be 1:1. A stable vent will be paired with a non-intubated baby.
in a nutshell, we usually have half as many nurses as we do patients. if our census is 40, we've probably got 20 nurses on. this is just like a ballpark figure. depending on acuity, we could need more or less. sometimes we'll only have 30 babies but will be working with 20 nurses because we could have a dozen 1:1 critical assignments at that time. other times we'll have almost 45 or 50 kids but only need 20 nurses because there are many more grower-feeders. but yeah, overall it's pretty safe to say that our normal ratio is 1 nurse to 2 babies. the most babies we'll ever have is 6 grower-feeders per nurse, but that's only on shifts were it's hitting the fan. usually we'll only have 3 or maybe 4 grower-feeders, and usually a sick vent (pressors, transfusions, frequent labs, new admit or post-op, pphn) is going to be 1:1. a stable vent will be paired with a non-intubated baby.
we are working towards 1-2 baby assignments, with mostly 1:2 except for very very sick. but sometimes the nurse with ecmo will have a feeder grower with tube feedings. that is not the nurse running the pump, but the one caring for baby. we always are able to help each other while having the 2-3 bby assignmemts. when an admit comes everyone swarms the bedside taking on tasks and some one else is usually reading everyone elses pumps.
either way, to me, 2 baby assignments are perfect, except my assignment last 2 nights where had a po feeder and a 24 weeker with sympomatic pda on dopa and insulin with frequent labs and q1hr accuchecks aqnd constant up and down on dopa and insulin, and grew out some germies within 13 hours of his bld cx.......horrible 2 nights!!
cswain12000
63 Posts
In my unit, a level III + ECMO, our ratios are never more than 2:1. A vented baby is almost always 1:1, very occassionally we might have a very stable baby with a vented baby. The charge nurse does not have an assignment, and the transport nurse does not have an assignment. We also have a backup transport person who has an easily absorbed assignment, and a first admit nurse who will have an easily absorbed assignment. Admits are always 1:1. In our level II unit, which is separate from level III, and staffed by it's own nurses-assignments are also never more than 2:1. We are very lucky compared to what I have read hear from other units, but overall we are well staffed, and the reason we are well staffed is because we are well taken care of as employees at my hospital.