[webbiedebbie]

I am working in a rural hospital in L&D. We are not too busy, so are only staffed with 1 in L&D, 1 in PP, and 1 in Nsy. However, both in PP and Nsy are qualified in L&D. I have heard horror stories of emergent pt's coming in and delivering (one had to be sectioned under local!) I am scared to death! Last week I had 3 patients! I couldn't keep up with everything because I was having to run from room to room to "find" the fetuses on the monitor.

We are doing computer charting. I MISS the old fashioned way of writing my nurses notes! Nothing prints on the fetal monitor strip. I always jotted things on that so I could go back and chart to catch up since I was so busy with the delivery. Now I don't have that luxury. I am missing important items that should be charted because I can't remember them later. It's worse when the doctor asks me a question on what time I did something. I have to drop everything and scan through the computer notes. It is very frustrating to me!

[L&D_RN_OH]

Originally posted by webbiedebbie
I am working in a rural hospital in L&D. We are not too busy, so are only staffed with 1 in L&D, 1 in PP, and 1 in Nsy. However, both in PP and Nsy are qualified in L&D. I have heard horror stories of emergent pt's coming in and delivering (one had to be sectioned under local!) I am scared to death! Last week I had 3 patients!

Were these 3 active pts? That doesn't sound safe to me. What if your other nurses were tied up in the NSY or PP? How many pts do you normally have in L&D, just 1? I don't see how it would be safe to staff one nurse in L&D. What about CS's? Don't you have a scrub and a circulator? How does that work?

As far as computer charting, we do it too. It does not print on the strip, however, you can still make notes on the strip as it prints at the bedside monitor and come back and make notes later. I think that is safer than missing documentation.

Do you ever get out of work on time? I know when I have to catch up charting, I never get out whenI should.

[rdhdnrs]

Dear Debbie,
The short answer to your question "Should I worry?" is YES!!!
All it takes is one bad outcome while you are the nurse trying to take care of three pts on the monitor. If you are sued in a negligance or malpractice case, short-staffing is not an excuse. Especially if you have not done all you can to bring the problem to your administrators' attention.
What I would do is start with your nurse manager. Advise her of the unsafe situation that exists, and have your census and staffing documents to prove it. If that doesn't work, go to the DON at your hospital. If still no response or remedy, go to the Medical Director. Go to the CEO of the hospital if you have to. And if after all that, the problem is not taken care of, I think you should find another job. You worked much too long and too hard for your license to be in jeopardy everytime you walk on the floor.
There are no guidelines anywhere that ever call for only one nurse on any size of labor and delivery unit.
Good luck.
Lisa

[mark_LD_RN]

you should be very very afraid. no way should you be left alone like that! hope you never find out why,things can go bad very fast and one nurse with 3 patients is just down right dangerous and crazy

[webbiedebbie]

Thanks for responding. I was planning to start writing on the strips starting tonight. No, I didn't have 3 active patients. One was an OCT whose fetus was not cooperating (she was very fluffy!). She ended up being on the monitor for 4 hours! Then, she went to Radiology for a BPH and flunked it. She was 36 weeks. She was sent home and came back 2 days later and delivered. I asked how everything went. Everyone said baby was fine. My other one came in with abdominal pain. She was being monitored. Her fetus was not cooperative either! My other one was a Pitocin induction. She was behaving. We had 3 other patients and I had another nurse. While she was busy, I was running around taking care of her other 2. One was preterm labor who ended up getting brethine. The other was a labor check.

My first night alone, we had no patients. One came in at 4 am in active labor. I was rudely told by the PP nurse that she and the nsy nurse were qualified for L&D and would help, which they did, but it made me nervous to think that their patients/babies were not covered. The nsy nurse took care of the baby at delivery, and the PP nurse had 4 patients and 3 babies. They seemed comfortable with this. Yes, I had a nurse at home on call.

Granted, this may have been a one time situation and I hear that most nights are not busy. But, I have 10 more weeks on this assignment and it would only take one bad situation to really mess things up.

For C/S's, we have the OR staff. We are only in the C/S with the Pediatrician to assist with the baby.

I trained in L&D in 1989 in a small hospital. We had 4 LDR's. I was told at that time, that we ALWAYS had to have 2 nurses in L&D even with no patients in case of emergencies.

My main question is that how are other units staffed if there are no patients?

[fourbirds4me]

We do about 1000-1100 deliveries per year. We have 4 LDR's, 2 smaller LDR's that we use for r/o labor, ptl, pih, repeat c/s, etc. We also have a "treatment/triage" bed and a room with two recliners and monitors for NST, overflow, etc.....

We staff 3-4 every night with 3 being the minimum. We scrub for our own sections so 3 is the minimum number for that. Sometimes 3 is not enough and we are slammed.... and sometimes we sit and look at each other because we never see a patient.

Someone posted AWHONN staffing guidelines not too long ago so this may be of help to you. But I know that guidelines state that pit pts are 2-1 and 1-1 in active labor. So I agree with other's that your situation sounds dangerous.