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Run: NICU Charge Nurse Bed Assignment Worksheet

NICU Charge Nurse Bed Assignment Worksheet for organizing bed census, acuity, nurse-to-patient ratios, and isolation precautions across a shift. Use it to as...

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Shift Details

Shift Date (required)

Date this worksheet covers.

Shift (required)

Charge Nurse Name (required)

Credential / License Number (required)

Required for documentation compliance. Do not enter SSN or DOB.

Unit / Pod (required)

NICU Designation Level (required)

Per AAP Policy Statement on Levels of Neonatal Care (Pediatrics 2012).

Shift Opening Notes

Bed Census

Total Licensed Beds in Unit / Pod (required)

Beds Currently Occupied (required)

Beds Available for Admission (required)

Intensive Care Patients (1:1 or 1:2 ratio) (required)

Infants requiring continuous monitoring, ventilator support, or vasopressors.

Intermediate / Step-Down Patients (1:3 ratio) (required)

Infants on CPAP, high-flow, or IV therapy but hemodynamically stable.

Continuing Care / Feeder-Grower Patients (1:4 ratio) (required)

Infants advancing on feeds, approaching discharge criteria.

Pending Admissions This Shift (required)

Anticipated Discharges / Transfers This Shift (required)

Patient Assignment Worksheet

Bed-to-Nurse Assignments (required)

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? (required)

If yes, describe charge nurse patient assignment

Isolation and Special Precautions

Number of Infants on Isolation Precautions (required)

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? (required)

Describe PPE shortage and action taken

Other Special Precautions or Alerts

Staffing Coverage

RNs Scheduled This Shift (required)

RNs Present / Clocked In (required)

CNAs / PCTs on Shift (required)

Float / Agency / Travel Staff on Unit (required)

Float / agency staff received unit orientation and competency verification?

Open / Unfilled Positions This Shift (required)

Are nurse-to-patient ratios in compliance for all acuity levels? (required)

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? (required)

Charge Nurse Signature (required)

By signing, you confirm that assignments are accurate, ratios are documented, and any deficiencies have been escalated per unit policy.

Worksheet Completed At (required)

Record the time this worksheet was finalized.

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