AWHONN Staffing Guidelines Please check this out:

[SmilingBluEyes]

The question is posed a lot: "what is a good guideline/AWHONN recommendation for staffing on Labor and Delivery, Nurseries, and Mother-Baby units?" The purpose of this thread is to provide information/staffing guidelines, only, please.

Please, if anyone here gets updates/corrections, feel free to let me know via PM, or place your info and a link/AWHONN source referred (if you have it) in this thread. This information is courtesy of member, Mitchsmom (THANK YOU!!!). I hope you all find this useful and helpful if you are labor/delivery/postpartum or neonatal nurses:

*Quoting Mitchsmom*:

There is a chart from AWHONN's Perinatal Nursing: Co-Published with AWHONN: Books: Kathleen Rice Simpson,Patricia A Creehan

I have a photocopy of the chart, from p.42, it is labeled "Recommended nurse to pt ratios according to the Guidelines for Perinatal Care (AAP & ACOG 1997) and the Standards and Guidelines for Professional Nursing Practice in the Care of Women and Newborns (AWHONN, 1998).

"Intrapartum:

1:2 pts in labor

1:1 pts in 2nd stage

1:1 pts w/ med or ob complications

1:2 Pit induction or aug of labor

1:1 Coverage for initiating epidurals

1:1 circulation for c/s

Antepartum/postpartum:

1:6 antepartum or pp pts without complications

1:2 pts in postoperative recovery

1:3 antepartum or pp pts with complications but stable

1:4 recently born infants & those requiring close observation

Newborns:

1:6-8* newborns requiring only routine care

1:3-4 normal mother-newborn couplet care

1:3-4 Newborns requiring continuing care

1:2-3 Newborns requiring intermediate care

1:1-2 newborns requiring intensive care

1:1 newborns requiring multisystem support

1:1 or greater -unstable newborns requiring complex critical care

*This ratio reflects traditional newborn nursery care. If couplet care or rooming-in is used, a professional nurse who is responsible for the mother should coordinate and administer neonatal care. If direct assignment of the nurse is also made to the nursery to cover the newborn's care, there should be double assigning (ie, one nurse for the mother-baby couplet and one for just the neonate, if returned to the nursery). A nurse should be available at all times, but only one nurse may be necessary, because most neonates will not be physically present in the nursery. Direct care of neonates in the nursery may be provided by ancillary personnel under the nurses's direct supervision. An adequate number of staff members are needed to respond to acute and emergency situations

[my2gsps]

I was wondering if anyone has had the problem in their hospital of leaving one nurse on an OB unit with another on call when the unit is closed. (no pt's) or leaving one nurse on the unit alone with one gyn pt. The call people can be 30 to 45 mins away. I am not comfortable with this, knowing that things can change very quickly in OB and you can have an emergency just walk through the doors without anyone knowing she's coming. I've been trying to find out what the standards are for safe staffing when a unit is closed or with only one pt but have not been able to find anything. If anyone can give me any information it would be greatly appreciated. Thank-you

[vandermom]

Our hospital always has 2 OB nurses in the building no matter what the census. The second my be on another unit as helping hands but readily available to return to OB. You are completely correct that anything can and does walk through the door at any time. I actually delivered a VBAC who arrived and delivered within 10 minutes of arrival. It is always the walk ins that need the care the most it seems.

[my2gsps]

thanks for your reply, what state are you in? We're having a meeting with the hospital administrators on tues and was looking for some documentation on safe staffing in Ob and specifically not leaving one nurse here alone. They just don't seem to get it.

[cradlecrewer]

This is a rediculous guideline. I work in a small hospital, where I AM the charge nurse, and I AM the labor nurse. We have just started using computer charting that is HORRIBLE and time consuming. It is so unsafe to labor two at a time!!! These people that make these guidelines need to come job shadow me. UGGGG!!!!! I work nights, and I am lucky if I have a post partum nurse on call. I'm it people...whatever walks in.

[vandermom]

thanks for your reply, what state are you in? We're having a meeting with the hospital administrators on tues and was looking for some documentation on safe staffing in Ob and specifically not leaving one nurse here alone. They just don't seem to get it.

New York. NY health dept reqires one RN for mother and one RN for the baby at the time of delivery.

[IndigoCarmine]

New York. NY health dept reqires one RN for mother and one RN for the baby at the time of delivery.

I beg of you to find this statistic for me somewhere.

[vandermom]

I beg of you to find this statistic for me somewhere.

NYS title 10 code 405.21 has all of our requirements for perinatal services. There is a lot to slog trough but it is there that RN for mom and RN for baby.

It only makes sense cuz you know when things go wrong they go wrong fast and youneed adequately trained OB staff to handle it. You have a del with a bad shoulder dystocia and baby is compromised and needs close attention if not resusitation and of course because the baby was big (hence stuck shoulders) mom is now trying to bleed out on you. One doc and one nurse is not enough and both can bottom out very quickly in these situations.

Good luck at your meeting. Paying 2 nurses to be present at all times is one heck of a lot cheaper than settling even one law suit for a bad outcome.

[my2gsps]

Thank you, I'll look up that NY code. We always have two RN's when there's a labor pt, but most times it's a Mother Baby nurse not L&D nurse. We are a small hospital and they are trying to cut costs but at the expense of safety in my view.

[vandermom]

Thank you, I'll look up that NY code. We always have two RN's when there's a labor pt, but most times it's a Mother Baby nurse not L&D nurse. We are a small hospital and they are trying to cut costs but at the expense of safety in my view.

We are very small also (less than one delivery/day average). We have 7 beds in the main unit with 4 beds for overflow when disaster strikes and we have a baby boom.

Keep in mind that while they are cutting costs they are risking your licence by not providing safe staffing levels.

[cmrrn78]

Thank you for posting that wonderful information. I live and work in a small town. We are a critical access hospital and have 7 inpatient beds. Normally there is only 1 labor and delivery nurse on duty. I am wondering about the information posted and written. Were those standards written for institutions that have more than one labor and delivery nurse working a shift? We seem to run into the problem of an induction (PIT) and another patient walking in and no other labor and delivery nurse available and so one nurse caring for 2 patients. Most of our patients get epidurals and we all know that prior to 2nd stage of labor that patient will need your assistance and we are told "The standard is 1 nurse to 2 labor patients until the 2nd stage of labor" "Step out of your box" Is that good practice? Sorry I got to rambling a bit. Please send suggestions and they will be greatly appreciated.

CMRRN

[ruralnurs]

cmrrn my place sounds like yours except we are much smaller. We deliver about 50 babies a year. We have only one nurse in the labor and delivery. There is only the doc and the nurse and the doc usually finishes up and its you.

One of our docs now wants the Rt to come to every delivery and be in charge of the baby, after all they have taken NRP. I don't know what standard of practice is elsewhere but I don't think respiratory therapists are trained to assess, APGARs, ect. a newborn.

Makes me want to just quit OB........

[RN0202]

Just to add to your little remarks. Our hospital put our Peds area on by-pass from 4/9/09 0700 to 4/11/09. Now most would think from large amt of children. Take a guess? It is becasue there is no staff available to work it. The 1 Peds rn had to help in different area. Now this is professional right? The frustration of nursing carries on. Have a good day!