[equijen]

Hi everyone--I am a new CNO for a rural hospital in texas. Our OB department is not staffed 24/7 with L&D nurses, but rather these nurses are on call. Right now I have 2 RN's who share the schedule 50/50 and we do about 120 deliveries a year. I think this is entirely too much on these nurses and am trying to gather amunition to hire a 3rd to put into the rotation. I am seeking any insight into structuring a call schedule for 3 nurses including info on how reimbursment should be for a system like this. I.E. call for 12hrs. pay for 8hrs., or would a salaried position be a better option. If anyone works an on call schedule please let me know about your system. Also, I am looking for an P&Pif anyone is willing to share

Thanks, JENN

[HappyNurse2005]

My hospital is a much larger one, 3300 deliveries a year, but on call is required. Require 4 hours per week. Pay $3 an hour to be on call, whether called in or not. If you aren't called in, you get the $12. if you are, you get your pay, any OT you accrue, plus the $3 extra.

[bagladyrn]

In reading this I am concerned about your OB unit coverage. Who covers your OB patients until your on call nurse can make it in? I'm asking because precips are not unusual - had one just the other night - 16 minutes from the time she walked in the door to delivery. This could be a big liability issue if you offer OB services but do not have qualified personnel in house.

[equijen]

Currently-the ED staff checks the patient in and does an initial eval while the L&D nurse is on her way in. Im not happy with the system either, but have to make due with what I have until I can get something better in place. My ultimate goal is to have 24/7 L&D within 6 months. I have hired a 3rd nurse today and am trying to figure out the best way to rotate them so that we get the best coverage for our money....ie is it better to pay them hourly or salaried while they are still doing this on call rotation. I also need a better policy to very CLEARLY state what our expectations are during this interim.

Thanks, Jennifer

[MemphisOBRNC]

I, too, have great concerns about the non-coverage of the unit as well as the ED staff checking in the patient and doing the initial evaluation. Are the staff trained with documented qualifications in the things they are doing? Do they listen to fetal heart tones? Do they apply a fetal monitor? If so, do they interpret the findings? Have they been trained to do this? Do they perform vag. exams? Is this a hospital where EMTALA applies? If so, are the staff in the ED designated in the bylaws as QMP's (Qualified Medical Personel) to do Medical Screening Exams? Are they qualified to handle the emergencies that often present in OB?

Our OB staff does take call if a shift is short. Our goal is to schedule 3 nurses on days and at least 3 on nights. (We have LDRP's and to Mother/Baby care) If a shift is short, there is somoone on call.

We are paid $15.00 per 8 hour shift to be on call. If we are called in, we are paid the $15.00 plus all time worked is at time-and-a-half with a minimum of 2 hours pay.

[LizzyL&DRN]

I just started at a small rural hospital that sounds very similar to your unit. We do 10-15 deliveries per month. Our nurses are also only ON CALL. We actually have about 7 nurses that work on our unit. We are scheduled for 12 hour call shifts just like any other schudule. However, we are paid $10/hr to be on call and time and 1/2 when we are called in. Some nurses like to do 5 call shifts per week, others only do 2-3. We even have one nurse who does one 24 hr call shift per month. This system works well for our unit. We have 30 minutes to get to work once called although we are usually there in 15 or less. We have a wonderful working arrangment, we all support each other, our nurse manager is more than willing to come in when things get hairy(as are everyone else). Hope this helps. It really is a system that can work but I think you definetly need more than 2 nurses. Thats an awful lot of work for two people.

[bagladyrn]

Regarding your question of salary vs. hourly, what do the nurses in question prefer? Yes, you really do need more staff covering this as it's a good way to burn out and lose the staff you do have if they are on call for too many hours/days without adequate compensation.
If they are not already, you should be sure that all of your ER staff become NRP certified. That should be minimum requirement for anyone who might have to handle a precip delivery.
I've worked many small rural facilities as a traveler and they always had one qualified OB nurse in house even if she was helping out with clean pts. on another unit.

[equijen]

Thanks everyone for your replies. I think I have what I need. I will keep everyone posted on how things turn out.

Jennifer