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

[debsgreys]

I work on a m/b unit. 29 yrs. OB, We generally start with 4 couplets, maybe you will have a high risk ante. We also have post op gyn. I work days, having discharges and admits, ongoing, sometimes not even counting how many pts. you actually have. We assign by acuity, of course thats in the beginning of the shift. We also take into consideration continuity of care.

Lets face it our floor is 90% education. We have lactation 6 days a week, about 5 hours a day. I agree with earlier mention, you can be in one room for 2 hours assist with brstfdg. Oh do not let me forget all the documentation and serving hot tea with lemon on time!

Add that to administration saying we are always over budget, compared to other floors in the hosp. A wise administrator, who no longer works here, said" please" the moms they are the ones who make the choice which hospital a family member will go to.

I could go on and on

[mitchsmom]

I didn't look through all the posts to see if someone wrote it already, but if not, be aware that the staffing guidelines were updated last year (2010) --> *to our advantage* --> for example, pitocin patients are now supposed to be 1:1.

I will try to post the new guidelines when I can.

[mitchsmom]

Article regarding the release

Guidelines can be purchased here, but as I said before I'll try to post sometime:

[Elvish, BSN, DNP, RN, NP]

You are right, mitchsmom. Thanks for the links!! :)

[LDRNMOMMY, BSN, RN]

If you are an AWHONN member you can download the guidelines for free.

[skdauriaRNC]

Joining in. I tried to read many posts before I replied so sorry if I am asking the same question someone else did.

We are pitching to Administration our need for increased staffing so we can meet the updated AWHONN perinatal staffing guidelines. We do not currently have a staffing matrix for L&D. We've never had one in policy/procedure. Generally we staff 1:4 AP, 1:2 Labor with or without pit, mag or complications and 1:3 triage/obs.

We have 6000 births a year. We do our own C/S assist, scrub and circulate. We schedule up to 20 procedures a day (inductions and c/s, cerclage & d&c) We run at least 2 ORs at a time and do back to back cases once the rooms are cleaned and restocked by the scrub and assist RN.

We staff right now 4 scrub RNs, 3 circulating RNs, and 1 OR charge.

3 AP RNs for the 11 AP beds.

10-13 RNs and 1 Charge for 20 L&D rooms and 5 Triage Rooms.

Our volume keeps us full and overflowing. We see a huge outpatient load. We keep anyone on delivered on mag or with complications in L&D or AP.

We have no techs or support staff.

Does anyone have comparable or higher numbers that you can share your staffing matrix? Have you been able to upstaff to meet the latest AWHONN perinatal staffing guidelines?

Thank you in advance.

[Fyreflie]

I don't know if we have to follow AWHONN staffing up here but it really seems to vary by province and budget.

In Ontario I worked at a level 2 facility with 13 LDR rooms, 2 ORs staffed by us (1scrub/1 circ), 4 AP beds and 18 PP beds. Our staffing when I started was 8 RNs in LD and 5-6 in PP (including AP coverage) on days, usually 6/5 on nights. One of those LDs was Triage and one was "meant" to be charge and not take patients. We did about 3500 a year with average 2-3 sections/2-4 inductions/day on weekdays. Central monitoring. By the time I was laid off 2 years later we were staffing 4-5 on nights and 5-6 days on LD consistently. It was a nightmare. 3 of us on the floor meant that in an emergency c/s one person was left to watch all laboring pts at once. We routinely turned all pit off in those situations. Big nightmare by the end, I ended up quitting before my term was up and they fired the manager not long after I left. We filled out unsafe workload report forms on every shift for the last 6 months I was there. From what I hear now it's better but still not great.

Second job: low risk rural with about 80-100 births a month (100 was super busy). We had 2 LD on a shift for 3 rooms and a two bed Triage/NST clinic. Did our own assessments even when we had three in labor. Called people in for ORs when needed with an approximate 25 minute wait if it was the middle of the night. Had support from 3-4 RNs in the PP/Gyne/Peds floor across the hall. We were sometimes busy but rarely did I feel we were unsafe or under supported. We did however have to be creative about moving staff around especially if we had active laboring patients in 2-3 rooms and 3-4 assessments come tromping in at once!

Now I'm in a big level 2 facility and we are projected to hit the 7000 mark this year. We have 11 labor rooms, 8 bed triage, 5 bed AP and 2 ORs. No central monitoring. Staffing on days is up to 16 (2 triage, 1-2 AP, assigned charge and 13 LDs) and usually 12-13 on nights (they start calling for staff if we go below 12) and I've seen us balloon to 20 if it's really busy (like--PARR set up as an emergency delivery room busy). We also send 3 to the OR for all sections--scrub, circ and one dedicated patient care RN whose job is to assist anaesthesia. I feel like we're usually very well staffed. We definitely are 1:1 for most if not all pitted patients and medically complicated patients as well.

So strange how it's so different in different facilities. You'd think it would be non negotiable.

[PinkNBlue, BSN, RN]

Joining in. I tried to read many posts before I replied so sorry if I am asking the same question someone else did.

We are pitching to Administration our need for increased staffing so we can meet the updated AWHONN perinatal staffing guidelines. We do not currently have a staffing matrix for L&D. We've never had one in policy/procedure. Generally we staff 1:4 AP, 1:2 Labor with or without pit, mag or complications and 1:3 triage/obs.

We have 6000 births a year. We do our own C/S assist, scrub and circulate. We schedule up to 20 procedures a day (inductions and c/s, cerclage & d&c) We run at least 2 ORs at a time and do back to back cases once the rooms are cleaned and restocked by the scrub and assist RN.

We staff right now 4 scrub RNs, 3 circulating RNs, and 1 OR charge.

3 AP RNs for the 11 AP beds.

10-13 RNs and 1 Charge for 20 L&D rooms and 5 Triage Rooms.

Our volume keeps us full and overflowing. We see a huge outpatient load. We keep anyone on delivered on mag or with complications in L&D or AP.

We have no techs or support staff.

Does anyone have comparable or higher numbers that you can share your staffing matrix? Have you been able to upstaff to meet the latest AWHONN perinatal staffing guidelines?

Thank you in advance.

Holy cow ?

[copelald]

We do 1200-1400 depending on the month but similar situation

[JhoustonRN]

This sounds very much like my unit. We are a separate PP unit, with 46 beds and between 500 & 600 deliveries per month. Our hospital has the only level 1 NICU in a 13 state region so we get all the truly high risk moms. Just my last shift, I started with 4 rooms and only 5 patients, but those patients included a baby under double phototherapy and a 12%weight loss, a 6 day post mag mom with CHTN who's blood pressures had been running 180-200/90-120 and had been receiving IV Labetalol as often as hourly and required manual BPs q 10 minutes plus 800mg PO Labetalol q8h & 90mg PO Nifedipine daily, a 3 day post mag mom with pressures in the 170-180/90-100 with an insulin pump due to type 1 diabetes (who also had a couple of low blood sugars), and a fresh csection mom (