[eden]

It is getting to the point where I love my job but I am scared something will happen to a mom or baby before someone listens.

Today we had 5 nurses, 6 if you count the charge nurse, 4 in active labour and 12 postpartum moms and babies. We all missed breaks, which has become a regular occurence as of late. Assessments were not done on people more then 24 hours postpartum and patients had to be more or less ignored in favor of the labouring patients. It was crazy and we didn't have enough equippment to go around.

I am getting frustrated with management because anytime we request a workload or fill out a heavy workload form it seems to be ignored. A letter was drafted to our manager and has yet to have a response. Does a mother or baby have to die for them to believe us.

Is there any suggestions anyone has to improve safety when chronically understaffed? We have tried closing but there are only 2 hospitals that deliver in my city and we are averaging 5000-6000 births a year.

[htrn]

Unsafe staffing??? How about insane, crazy, oh my God!! understaffing!! I know I am lucky where I work with the staffing we have, but I have never heard of anything so dangerous. We have, bare minimum, one nurse for up to two active labor patients that have no complications - but really work hard to have 1:1 in active labor. We usually have one PP nurse and a CNA for up to 8 PP patients, and 1 nurse for up to 4-5 healthy newborns in the nursery. The worst I have had it on nocs is me and a CNA with 8 PP and 1-2 labor patients - and most of the time the off going shift will stay and get the 8 PP assessments done for me.

[SmilingBluEyes]

www.awhonn.org

staffing levels by acuity discussed there. Check it out.

[fergus51]

5 nurses....

4 active labors takes 2 nurses getting 2 of the active patients each.
12 postpartum couplets takes 3 nurses getting 4 couplets each.
The charge is still free to help with the active laboring patients.

That's standard staffing in many hospitals. How did your unit divide up the assignments?

I see that you're in Canada. When I worked there active laboring women were 1:1s. It's the main reason I don't do L&D now that I live in the US.

[tntrn]

In our unit, all of the labor patients would be on pitocin, there all would be
1:1. 1 rn for 4 couplets; the OB tech would be present; charge nurse to run the show; and a triage queen. I'd be screaming loudly there. And we do about 900-1100 deliveries a year.

[nursie-babie]

Been there done that...only worse. Your staffing actually seemed pretty good! LOL! I came from a small (30 deliveries a month) rural hospital. We had 3 ldr, 5 pp rooms and 4 rooms for gyn surgeries, peds, med surg over flows, or whatever they needed room for. Typically we had 2 nurses scheduled..one LD & one PP/NN. If we were busy and lucky they might float us a med surg nurse in. One night we started with a 6 hr post fetal demise (and a lot of drama going on with it) and a couplet. 2 nurses, not bad. @ 2100 get a 12 y/o post surgical repair of tib/fib fx, q 1 hr neuro checks, etc. @ 2215 get a 6 y/o 4 dyas post op T & A, had to have surgery to stop excessive bleeding. Now going to get 2 units of blood post op. @ 0045 got a drop in no prenantal care 3/100/-1, bloody show, ctx q 3 min. Then @ 0115 6 monther, c/o vag bleeding. Pushing drop in @ 0230, ER calls, 26 weeker hasn't felt baby move today. Now remember I am the ONLY labor nurse in the building, and there is only one other nurse on this floor(the house sup does come to help out) Finally deliver drop in @ 0315, but now we have to do cbc/blood cultures on baby due to unknown GBS status of mom. Othere to antepartums are fine, thank goodness. But we still have our 2 peds(1 getting blood trfx, one with q 1 hr neuro checks), one couplet, one pp fetal demise(understandably needy) fresh svd, newborn in recovery, and 2 antepartums. And unfortunately this shift isn't that unordinary. Guess you can see why I am no longer there(or even in L&D for that matter!)?

[RNLaborNurse4U]

I work in an LDR (separate PP/newborn unit on another floor) that contains 14 LDR beds, 3 triage beds, 2 OR's for C/S (or other emergent OB surgeries like rescue cerclage, D&E for retained placenta, emergency hyster, etc), and a 4 bay PACU/triage overflow area.

We usually staff with 9-11 RN's on days, 7-9 RN's on eves, 6-7 RN's on nights. We do a very large number of outpatient testing and prostaglandin gels during the day, plus we have our usual 3-4 scheduled c/s during the day. Add in spontaneous labor pts, unschedule c/s for fetal distress/labor/etc, inpatient antepartum (unstable) and postpartum magnesium sulfate pts, r/o labor, r/o uti, r/o ptl, r/o preeclampsia, and a host of other r/o or treatments (please folks, just because you have the stomach flu and are pregnant, does not mean you need to automatically be in OB!).

We also do everything for our c/s - circulate, baby nurse, scrub nurse (or scrub OB tech if we have one on that day), recovery nurse (who also does baby care during the c/s).

We usually have 5000+ deliveries per year, and countless other outpatient visits.

Our staffing, depending on how full we are, and is usually 1-2 active labor patients per nurse. One nurse can do 2 or even 3 ante/post mag sulfate pts. One nurse to 2-3 outpatients.

Some days it's total chaos - all beds full - laboring pts still coming in by the busload - pts being sent up from the ER - pts being sent in from the office (or from home if it's after office hours) for r/o this or that. Days that it gets like that, we pack them into the PACU, where we have some EFM monitors to at least monitor them. Other times, it's so full at the seams, that we have women waiting/laboring in the waiting room, and we truly take them by a triage type of fashion (sorry, can't take the early labor fullterm patient before the 25 weeker who is bleeding and cramping, even if the FT patient came in first and was waiting longer).

We are pressed to get our normal delivered pts up to PP ASAP (an hour after delivery, versus our normal 1.5-2 hrs). The charge nurse herself usually has 2-3 pts, AND has to manage the whole floor.

I have written the situation up when patient care has been compromised, but we all try our best to make sure it doesn't get to that point.

Thankfully, it's not always so busy and chaotic. Much of the chaos is from dayshift - the scheduled c/s and inductions, NST's, etc. It *usually* calms down towards the end of evening shift, into the night - but not always. Hats off to the night shift staff who sometimes work with only 5-6 nurses, and a full unit (been there, done that, got off night shift due to my inability to cope with sleep deprivation).

[eden]

......

[nurseglad]

[quote=eden]It is getting to the point where I love my job but I am scared something will happen to a mom or baby before someone listens.

Today we had 5 nurses, 6 if you count the charge nurse, 4 in active labour and 12 postpartum moms and babies. We all missed breaks, which has become a regular occurence as of late. Assessments were not done on people more then 24 hours postpartum and patients had to be more or less ignored in favor of the labouring patients. It was crazy and we didn't have enough equippment to go around.

I am getting frustrated with management because anytime we request a workload or fill out a heavy workload form it seems to be ignored. A letter was drafted to our manager and has yet to have a response. Does a mother or baby have to die for them to believe us.

This is what it's like in the NHS on a bad night.. 7 midwives no nurses no nursery nurses no health care assistant...9 labouring women...perhaps 4 on a synto infusion (pitocin) ,post partum 26 women..an average of that figure would be at least 15 will be day1 or 2 c/s, several instrumental deliveries.. some women having blood transfusions. Several babies will be receiving photo RX, some will be having regular BMs as their weight is less than 2.5 kgs, then there will be say 8 antenatal women some with PET some IUGR and some having induction of labour. The babies are not in a nursery, so if the women cannot care for there babies the midwives have to help them. This is all in addition to helping mothers establish breastfeeding, Drug rounds, observations...the list is endless. Ithought conditions would be better in the US...clearly they are not so much better... the hospital u describe...is it privately funded?

[eden]

No it's not privately funded.