Staffing OB units with 2 nurses?

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    i work in a rural setting. our unit has about 150 deliveries/year. we currently will work med/surg, er, etc. if we have no patients and have 1 OB nurse on during a delivery. an RT attends each delivery but we are it for our unit for the entire time until then, no CNA, no one to answer phones, etc.

    we are looking at becoming a designated ob unit and are trying to figure out what that looks like. what will we do during our down time with there is no one in labor or pp pt? i would love suggestions from other nurses of like units and how they stay "active" during their down time, as we organize our ideas to bring to our management.

    also, the general theme amongst our staff if the safety concern with having only 1 nurse present for the intra-partum period. it would be nice to have an extra set of hands in case of an emergency such as a dystocia, pp hemorrhage, neonatal resuscitation, etc. but do you always staff 2 nurses for the "just in case"? some have mentioned that is either an AWHONN or ACOG guideline-to always have 2 OB nurses available, but i can't find the specific recommendation.

    any help/suggestions would be very much appreciated!
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  3. 5 Comments so far...

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    My first job was at a small OB unit very similar to what you are describing. When our L&D unit was seperate from our postpartum unit (and actually, the unit was for postpartum patients and non-infectious med surg patients), we had a primary nurse that stayed in L&D no matter what. If there were no patients, she would stock, clean, work on chart packets, etc. If one patient came in and she needed help, or a second patient came in, she would call the secondary nurse. The secondary nurse, if not needed, was on the med/surg unit usually acting as med nurse, they never had their own patient assignments in case they got pulled. We would also have a tertiary nurse who would actually take a patient team, usually the postpartum patients, and they would have to find relief for her if she was needed in L&D.

    When we changed to LDRP, we kept 2 nurses minimum, and there were times when we might not have anything to do. Rare, though. We took care of our own instruments up to the point of sterilization, so you could usually find some instruments to scrub and then run through the instrument washer. Or, as before, stocking, cleaning, putting together chart packs, working on continuing education. What finally forced me to leave my much-loved job was when they would try to force us to work alone. Their reasoning was that we had a nurse who lived 5 minutes away who agreed to be on call for us, but that wasn't good enough for me. If I had a prolapsed cord, how would I call for my help?
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    I am on a small rural unit too. We schedule 3-4 nurses a shift, but when it's slow we put nurses on call but always have two nurses on the unit even if we do not have a single patient. Sometimes we will have a nurse float to med Surg but they can not take a team because they must be retrievable, and even then we still have to have two nurses physically on the unit. We do not have a ward clerk or CNAs either. It can be really busy at times and we have to be ready to go from zero to sixty very quickly.
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    I worked for a spell in a high risk L&D and antepartum unit.

    We did about 3500 births/year but still had SLOW days/shifts.

    If we had no patients we had an RN on the floor with another L&D in house assisting in other units. If a patient came in the second RN reported stat to the L&D. We always had 2 RNs available if we had a labor patient.
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    Thanks for the responses!
    Sounds like many units have at least 2 OB nurses in house. Does anyone know if this is an AWHONN or ACOG standard? Or is this just good simple logic?
  8. 0
    I have been out of OB/GYN for quite a spell, you will want to check...

    There is something to be said for reducing the liability of the hospital with a labor patient where the negative results could involve not one but two patients...

    And the youngest patient has a really long statute of limitations in the legal world.


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