(Position) Clinical Component

Comparing Two NICU Facilities: Level III with Cardiac Surgery Capabilities vs. Level II for Expansion and Neonatal Abstinence Syndrome Program

There are two NICU's you would be covering. It is my understanding you’d only be dedicated to one facility per shift.

The first facility is a 40-bed NICU with Level III capabilities, which means it provides advanced care for premature and critically ill infants. However, the facility does not offer Extracorporeal Membrane Oxygenation (ECMO) treatment, and for that specific procedure, patients are transferred to the Pediatric Intensive Care Unit (PICU). The average daily census at this NICU ranges from 28 to 32 patients. The average length of stay for patients is 25.7 days. This NICU offers services related to cardiac surgery as well as other pediatric subspecialties, excluding ECMO.

If a true Level IV NICU is needed, patients would be transferred to Phoenix. However, Banner’s Level III meets all qualifications to be a Level IV, with the exception that ECMO is located in the PICU, not the NICU.

The second facility is a Level II NICU. This Level II NICU will provide 24-hour coverage and care. It has 16 beds and typically accommodates a census of 5 to 12 patients. The average length of stay for patients in this facility is not specified. However, it's worth noting that infants born before 28 weeks of gestation are not admitted to the Level II NICU. Unlike the Level III NICU, this facility does not have pediatric subspecialties available. Their desire to acquire a Level II NICU is driven by the desire for expansion and the upcoming retirements within the organization.

They also have an established neonatal abstinence syndrome program: average length of 7.5 days. Compared to the rest of the country at 28-30 days.

2 Teams round during the day:

One resident team rounding – they carry 20 patients. NNP is on the team as a safety catch and teach.
One NNP team rounding: anything after the 20 patients. They don’t write their daily notes. Attendings write the daily notes!! They just provide the data for them in the mornings.

The night nurse gathers the numbers and goes to any high-risk deliveries. The NNP attends all high-risk deliveries (including repeat C-sections). Some of them provide any emergency care that arises. The attending on-call is within 30 minutes if he needs to come in. So, the nurse will stabilize, and the attending will receive the baby once admitted.

Volume/Frequency of high-risk deliveries: High-Risk deliveries are on the increase because we have increased our OB group. On average, you go to 2-4 deliveries per shift. More if its nights because of the 16-hour shifts (longer shift, higher probability).

Procedures

Procedures: all bread-and-butter procedures. No circumcisions. Chest tubes, PICC lines, super-pubic taps, lumbar punctures, intubation, central lines.

(They can help provide training if there is any you are not comfortable with)

Hours

Hours: ~40 hours/week. They put out the schedule, you fill in what you want and then there is a lead person that works out any overlap. Self-schedule. No set shifts.

Very cohesive group, so there’s not really any issues with adjusting or making the schedule

1 FTE: 2,080 hrs./year or 160/month

Professional Development time (16 hours/month), this is a part of your 160 hours/month
PDT examples: teaching NRP, reading journal articles, research, journal article clubs. Lightens clinical load, focus on things that spark joy for you.

Research: 3 studies – necrotizing enterocolitis, ROP, ??

They are all city trained so they can get consent for the study. They gather the data and track the data.

APP’s can obtain a specialty instructor title. Most NNP's on staff are NRP certified instructors. It’s not a requirement of the position but they like being able to grow professionally and are dedicated to ongoing education.

Transport Team – not run by the NNP’s. Bringing in kids from all over Southern AZ. There are RN’s and respiratory therapists available to assist. Accepting the patient when they get there and set up as they come in. They don’t transport out (forward transports).