Is it legal..

[L&DRN93]

So I am a labor and delivery nurse at a hospital with something like 220 beds in the facility, and on labor we do 5 deliveries a day just to give you a background.

The pediatric unit at my hospital has been moved to the OB/labor floor due to them rarely having more than 1 patient and whatnot. Well this caused a ton of peds nurses to leave because they were having to work mom baby. And now peds has to legally move back to their own floor we've been told.

now that they lost almost all their staff, we are being forced to orientate to pediatrics (postpartum and labor nurses) for a 12 hour shift then are going to have to take full loads of peds patients when needed.

First of all, I feel this isn't safe as someone who has only worked Ob for many years. Peds is a distant memory from nursing school years ago, so after 12 hours of orientation would I be a safe practicing nurse to do this? And is it legal? To be forced to work a job that you didn't apply for or be properly trained for?

Any thoughts appreciated! I only have worked at this hospital so idk what other hospitals are like, if this is completely normal and I'm just crazy or what. Thanks

[heron, ASN, RN]

The picture is complicated by the fact that we are, as far as I know, obligated to decline an assignment for which we know we are not adequately trained.

[HouTx, BSN, MSN, EdD]

Cross training is very common. Would you rather be sent home if the patient census drops? That's the only alternative.

I would be more concerned about the infection control issues. The potential for inadvertently transmitting something from those little ambulatory Petri dishes (AKA, peds) to your Mom/baby population is very real.

Most state nurse practice acts are very emphatic - it is the responsibility of each nurse to refuse to accept responsibilities for which he/she is not qualified. If that is the situation for you (with Peds), then can certainly understand your position. However, it is even more stressful if refusal may bring on the risk of termination. This is a classic example of "moral distress" in nursing.

Rather than adopting an adversarial stance, have you thought about engaging both clinical groups to develop a more effective cross training & mutually acceptable staffing process?

[dharlow]

So if they float you to peds - have they ever pulled you back to OB for any reason? I ask this because if you are being floated to peds and take care of sick kiddos and then they pull you to OB, I have a problem with that due to infection control.

[dream'n, BSN, RN]

For me, I guess it would depend on the pediatric population at your hospital. I could handle a 12 year old appy, but a 5 month old with sepsis, no way. I didn't like pediatrics way, way back during school clinical because of all the medication math calculations, everything is so weight based in little ones.

[AliNajaCat]

Your state nursing association can back you on the concept that you cannot be floated to an area where you do not feel competent, and you can get it in writing from them. However, you will not get any backing for the idea of resisting cross-training, because that's an institutional policy. You should insist that there be a paid formal cross-training program (not just a couple of floats and "Good to go!"), with objectives and measurable outcomes, both for your peace of mind and the hospital risk manager's.

[SierraMoon, ADN, BSN, RN]

I think I'd rather have a med-surg nurse cover peds than a L&D nurse. I don't have kids or work with them but adult med-surg seems at least closer to peds type problems.

[heron, ASN, RN]

Whether floating from L/D or adult med-surg, the thing management seems to be forgetting is that infants and children are not mini-adults. Definitely agitate for better cross-training.

[dharlow]

As a former Risk Manager, one of my first days in that role was shadowing my preceptor and she had a med error Incident Report she was following up on and the poor ED nurse had way overdosed a baby on Chloral Hydrate! No good!

[Here.I.Stand, BSN, RN]

Yes, I agree with that. I saw that there was orientation; I missed that it was only one shift.

I missed that the first time I read it too.

[Love2Sleep, BSN, RN]

Check your state's standards of nursing conduct or practice.

[catsmeow1972, BSN, RN]

I'm with the side on infection control issues. An above poster pointed out that hospitalized kids are usually the sick ones with RSV, Pegs, breathing issues and other assorted nastiness. Mother/baby generally is a fairly healthy population. I gather if this is a small enough facility that merging 2 units is considered, than i also suspect that the laboring moms are fairly standard risk and their babies are reasonably healthy. It seems common sense to keep these two units as far away from each other as possible (that includes with staff.)

Considering the necessary amount of orientation? 12 hours...ummm no. I just transitioned to a General surgical floor position after 15 years in the OR. I've needed 4 weeks of orientation and I still lean heavily on my colleagues for support. The OR and post-op floor are very, very different. Just like Peds and OB, right?

[txbornnurse]

This sort of policy decision is why removing dedicated float pools was a bad idea. I can visualize the bean counters rubbing their hands in glee at the idea of removing all of those "overpaid" float nurses. Silly short sighted twits.