NICU Charge Nurse Bed Assignment Worksheet

Structured worksheet for NICU charge nurses to organize bed assignments, nurse-to-patient ratios, and isolation precautions by infant acuity level across a shift.

Shift Details

• Shift Date
  Date this worksheet covers.
• Shift
• Charge Nurse Name
• Credential / License Number
  Required for documentation compliance. Do not enter SSN or DOB.
• Unit / Pod
• NICU Designation Level
  Per AAP Policy Statement on Levels of Neonatal Care (Pediatrics 2012).
• Shift Opening Notes

Bed Census

• Total Licensed Beds in Unit / Pod
• Beds Currently Occupied
• Beds Available for Admission
• Intensive Care Patients (1:1 or 1:2 ratio)
  Infants requiring continuous monitoring, ventilator support, or vasopressors.
• Intermediate / Step-Down Patients (1:3 ratio)
  Infants on CPAP, high-flow, or IV therapy but hemodynamically stable.
• Continuing Care / Feeder-Grower Patients (1:4 ratio)
  Infants advancing on feeds, approaching discharge criteria.
• Pending Admissions This Shift
• Anticipated Discharges / Transfers This Shift

Patient Assignment Worksheet

• Bed-to-Nurse Assignments
  Enter one row per occupied bed. Use infant MRN or crib label only. Acuity: IC = Intensive Care, IM = Intermediate, CC = Continuing Care.
• Is the charge nurse carrying a patient assignment this shift?
• If yes, describe charge nurse patient assignment

Isolation and Special Precautions

• Number of Infants on Isolation Precautions
• Isolation Types Currently Active on Unit
  Select all that apply. Refer to your facility's infection control manual for PPE requirements.
• Cohorting Plan / Isolation Room Assignments
• PPE supplies adequate for all active isolation types?
• Describe PPE shortage and action taken
• Other Special Precautions or Alerts

Staffing Coverage

• RNs Scheduled This Shift
• RNs Present / Clocked In
• CNAs / PCTs on Shift
• Float / Agency / Travel Staff on Unit
• Float / agency staff received unit orientation and competency verification?
• Open / Unfilled Positions This Shift
• Are nurse-to-patient ratios in compliance for all acuity levels?
  Intensive Care ≤ 1:2; Intermediate ≤ 1:3; Continuing Care ≤ 1:4 (or per facility policy).
• Describe ratio gap and corrective action taken
• Respiratory Therapist assigned to unit this shift?
• Charge Nurse Signature
  By signing, you confirm that assignments are accurate, ratios are documented, and any deficiencies have been escalated per unit policy.
• Worksheet Completed At
  Record the time this worksheet was finalized.