[One tired mama]

Hello all you OB experts! I have a quick question about nurse-patient staffing ratios. First let me explain my situation:
I am a prior critical care nurse (7 years experience) who started working on an L&D/PP floor just 3 months ago. After a very brief and not very thorough 6 week orientation, I was set loose to fend for myself. Today, I worked a 12 hour shift. I was assigned 3 laboring patients all on Pitocin drips (one was an oligo induction admitted the day before and 2 were primip SROMS who were being augmented). This is a fairly common assignment on our floor and I was wondering if this is typical of the places you work for?
If so, I'm thinking OB may not be for me after all. I run myself ragged in this place and have no time to do anything but go back and forth between patients all day, charting, charting, and charting. I haven't had more than a 20 minute break since the day I got there. Forget bonding over the birth experience--it was all I could do to keep from drowning.
So I guess what I'm wondering is...do I just need to suck it up and get used to it b/c that's what most OB units are like? Or do I need to seek employment elsewhere? I was thrilled about finally transferring to OB, but not sure I can keep up with that sort of pace every day.
Any advice you may have to keep me going would be much appreciated!

[L&D_RN_OH]

Just a question, what would happen if all your pts were complete at the same time?

IMO, 3 laboring pts are too many for one nurse, especially if they are on Pit. We generally only take one laboring pt each, two at the most, and that's if one is early on in labor.

[SmilingBluEyes]

UNSAFE UNSAFE UNSAFE----no, honey DO NOT "suck it up"....or it will SUCK YOU UP.....let me tell ya------

3 STABLE pit-induced laboring patients is too much!!!!!!!!!!

but you are talking about UNstable patients in the mix. (oligo can be VERY problematic for baby-----

How do you watch and evaluate THOROUGHLY 3 strips????? I don't think you CAN, do you? I know I could NOT and I have 6 years' experience in labor and delivery.

Nope, would NOT work for me----I would not take such a heavy assignment.

Clearly, the patient care there is suffering greatly if this pattern of staffing is the norm and that would concern me greatly--along with dangling my license over the litigation flames----

OB is one of the most, if not THE most highly litigious areas of nursing.

Another concern I have:
You got a very inadequate orientation, it sounds to me, and have been given a very short end of the stick. 6 weeks???? Hmmm...very sad. I am so sorry to see you treated this way. Sorrier still to hear how bad patient care must be where you work. Think if those were your mom, sister, daughter in such care. How would you feel????? Sounds as if you are VERY conscientious and KNOW this is not right.....your instincts are correct! Ok so whaddya do????

A couple of things come to my mind:

Speak candidly with your manager about your grave concerns regarding unsafe staffing policies/nursing practices and let her/him know you won't practice unsafely.

Or walk......

WE all have had "those days" where the LABOR BUS pulls up and we are overwhelmed...yes we do. But IT SHOULD NOT BE THE NORM ---if it is, you have a real problem on your hands and...

Trust me, this is NOT safe practice---and your inexperience in OB makes it only more dangerous.

I wish you well, whatever you decide to do. BUT DO SOMETHING, or you may very well end up regretting it. You are right to be concerned! Good luck!

[kimmicoobug]

At my facility, staffing ratios are pretty good. Labors are one to one. If by chance a nurse has to take two labors, it is not for very long. A nurse is found somewhere, anywhere. In fact, we had this scenario last night. I got called to work OB because there were two labors going at the same time, and only two OB nurses. So, me and a float had the PP end of the unit with four patients each.

[fourbirds4me]

Our induction protocol says "no more that 2 pit patients per nurse" But I rarely see this happen we usually only have 1. We do q 15-30 minute vitals on pit patients depending on condition and stage of labor so there is really no way we could do 3 and definately no way to do it safely!

[fergus51]

Amen to what deb said! I have taken 2 stable laboring patients, but that was a rarity. One is the safest and best way to provide care.

[One tired mama]

Thank you so much for your advice and words of encouragement. I wish I could say that this situation was unusual where I work, but it's not. In fact, yesterday (one day later), I had 5 couplets (with 2 moms and 2 babies on IV abx) and also had to watch a laboring woman on Pit while her nurse was in pushing with another patient. I've moaned and groaned but the only response I ever get is "you're doing a great job though." Did I mention that I have never received any formal training on FHT monitoring nor am I NRP certified yet? It just stuns me that the powers that be felt that this is type of staffing is appropriate.
I will do something about it...I just needed some advice from expert OB RNs before I went forward. Thanks for providing that and letting we know I'm not just a whimp. I'll keep you updated.

[SmilingBluEyes]

WOW YOUR SITUATION IS SCARY!!!!!!!!'

for both you and the patients.

I would get OUT.....

If you are inadequately trained AND over loaded, that spells POOR patient care. I would not want to be associated with such a place, period.

Perhaps it's time to go job-hunting.

Everywhere I have worked, NRP is required PRIOR TO EMPLOYMENT----

And no one takes on a patient load like yours.

Sounds like hell to me...

Good luck to you. You instincts are good, your good conscience and care ARE needed elsewhere. I just feel so bad for the patients there......it's a crime.

[AmberL&D/RN]

I agree 100% with the other posts. Maximum 2 pit inductions at one time, NRP required prior to coming off orientation (which by the way should be a minimum of 12 weeks) including intense training on EFM tracings.
Amber

[CIVICgalz]

Honey, where is this happening?? Third world hospital? Please don't say this is a North American standard!!