I need your opinions. I work in a small community hospital that does about 475 deliveries/year. We usually have 2 RN's on the evening or night shift and sometimes also an aide. We have a new issue in our department.

Our policy states that if there are ANY patients in our unit, there needs to be 2 OB trained staff (could be a RN and an aide) in the department at all times. Well, our Med Surg unit has been more short staffed than usual, so the House Supervisors have decided that it is OK to pull OB staff to float on M/S, leaving 1 RN alone with up to 4 post-partum moms and babies! Keep in mind that we are LDRP which means there is no one else there! Also, we are a locked unit which requires buzzing everyone in and out every time you turn around. They haven't done it yet to us when we have a labor patient, but I can see it happening. Our Manager is fine with this new way of staffing. (Doesn't help that she and the Med Surg mgr are best buddies!)

OK, so my actual question has to do with working AGAINST hospital policy. What are our liabilities as nurses when we are not following policy? The old policy was just re-evaluated and approved in December and still reads the same as always. We've been told that the policy will be changed, but in the meantime, we're just going to have to do what we're told, basically. Knowing our manager, the policy will never get changed. That would take too much work. They will just continue to staff contrary to policy.

The prevailing attitude seems to be that we are just being "lazy" by arguing this. I assure you that is NOT the case! I've been in too many situations where everything seemed to be going along swimmingly until BOOM, someone is seizing, or you have a baby that is blue and won't breathe, etc. I've been alone with an aide before when something like that has happened and it was not a good feeling. I can't fathom being completely alone if something like that happens!

What are your thoughts?

Please take time and go through some old threads as this is a recurrent theme.......stretching nurses to the max and dangerously. Many nurses have voiced excellent thoughts on the subject which I don't hold out much hope of ever changing. ( I also work in a small facility with 500 or so births per year ) Bottom line for these places is $$$$$$$ and managers who don't belong in management.

You could also contact AWHONN and see if they have a policy re: minimum staffing for you to use.

I did look through some old threads and saw some very similar situations. I know our facility isn't unique in this. Just seemed like most of what I saw in the other threads involved L&D. Not that it makes that much difference, I just wondered what the postpartum nurse:patient ratio is at other places? For some reason, the supervisors don't seem to count the babies as patients. Hello...when their moms don't want them, they have to be fed, changed, bathed, rocked, have vital signs, etc,etc!

Thank you for your response!

Oh, and Amen to that comment about managers!!!

Our unit has about 500 deliveries a year. We staff L&D with two RN's, we are not a locked unit, we do not have an aide or secretary. We have a postpartum unit that is not attached to our unit and it also holds pedi pt. and takes any med/surg overflow that is appropriate, if needed. We always have 2 labor nurses in house, if we have no patients we float to postpartum/pedi. If the house is busy we have an option of floating, if we want and we are paid extra to float! (union contract!) but our manager would NEVER leave one nurse on the floor alone,your manager is asking for trouble!!! Most of the time we dont even get off the floor for lunch,if we have an active labor patient we don't leave unless someone from postpartum can take our place, if no one is labor and delivery trained we don't leave!.. Im sure your QI person might have something to say about the safety of it..maybe you should check with them???

We had this very discussion just last week at our meeting. Even if there are NO patients it is still unsafe. We also have about 450 deliveries a year and are UNlocked. So, pretty much anyone can come in at any time. We had a situation not too long ago that a woman with very limited prenatal care came to our dept with an urge to push. Well of course the nurses working (there were two) threw her in bed and check her and the baby is pretty much crowning. She delivered a 36 week stillborn baby THREE minutes after arriving in our unit. We don't have time to be calling for help and getting our second nurse back there when something like this happens. You're dealing with a hysterical family, a dead baby and a postpartum mother!!

We are also concerned when we have people off the street that know that we are pretty much alone in the hospital without security. Any man could be walking home from the bar and just stop up and rape or assault the nurse that's working and there would be no way for anyone else to know. Plus what if one of us has a seizure or heartattack or chokes on something. or what if we just need to go to the bathroom!! You should never be left alone.

We are a small hospital too with around 5oo deliveries per year. When I worked 11-7, I was many times left alone....and afraid to leave the desk area where the telephone was. Also afraid to not be looking at the entrances to the unit which are not locked and neither is the hospital. Nice inivite for drug seekers and trust me, I would throw them the keys. Also, we just had a 26 weeker wheeled up from ER, no telephone call or anything.......baby was in the lady parts !! Thankfully, we had appropriate staffing to run a code on what we initially thought would probably be a demise, but we stabilized her until the tertiary care center staff came NINETY minutes later to get her. What a nightmare !! Should be 2 L & D and 2 nursery nurses on at all times in my professional opinion. Again, bottom line is $$$$$$$$$$ and that will never happen. It is also why no one I love will ever deliver where I work, now isn't that sad ???

Wow!!! Some of these staffing situations are scary!!! I would be nervous every night at work.

For starters we always have a secretary at my hospital (except for vacation days obviously) We do a few more deliveries than most of you (750-800 or so.) Most nights we are staffed with a secretary, 1 LPN (takes care of well babies/postpartum), and 3-4 RN's. With 1 of these being a charge nurse.

We always have 2 nurses in OB even if there are NO patients. This could be 2 RN's or it could be a RN and LPN. Now if we have a labor patient then it must be at least 2 RN's.

Like so many have said you never know what is going to walk through the door so a minimum of 2 nurses is a must. And if a labor walks in who is watching the babies then if you are a LDRP unit???

And if your other trained person is an aide what can they do for you if a precipitous delivery walks in??? They don't catch babies right???