AWHONN Staffing Guidelines Please check this out:

[/quote]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........[/quote]

As a neonatal nurse and an NRP instructor- the guidelines put forth by NRP state that one person trained in NRP should be at each delivery whose total focus is the infant. Now, with that being said, I think that person should be an RN, but the guidelines arent that specific. Thats what gets me about the guidlines...we play with people's lives and in my opinion, the AWOHHN standards for staffing are too vague, management uses them as an excuse to "skeleton crew" the place, and then you end up in a hot mess if the crap hits the fan.

I took the issue to my management the other day about a staffing level being unsafe and was told "well, we didnt have a bad outcome." and "we just staff by the standards" and my favorite "what, do you want nurses to just sit around until something happens?"

Well, if it was my wife, my daughter, or my friend having the baby that could be a potentially dangerous outcome...you bet your rear I would want a nurse "just sitting" around until something happens.

Just my two cents worth.

Does anyone know what kind of things would qualify as a "complication" for a postpartum couplet? I'm stressed about having 6 PP couplets! I find no one ever gets quality care especially if there's more than one post-op c/s, or more than one mom who needs breast feeding help....
Our unit has been dangerously short-staffed lately, and now management is threatening to take away our CNAs. We only have 2 to begin with, usually only work with 1 (or none) per shift, on a 27-bed LDRP unit.

Last week I had 2 labor-checks in triage, a laboring pt who delivered, a failed-homebirth walk-in at 8cm, and a antepartum with gallstones in PTL. HELP!
How can I get the attention of management to please hire more staff???

I don't know why, but somehow looking at these numbers/recommendations always gives me hope of what my work could be like!

I'm a new-ish grad (started work in Feb.) and on our Postpartum Unit at night we rarely have less than 5 couples, regardless of complications. Basically 5 or 6 couples is a dream night that happens maybe a third of the time, but getting 7-8 couples is more of the reality most of the times. Now I'm definitely coming off of one of the worst nights ever, but I feel like I needed to just vent and get some reassurance that I'm not crazy. Last night was: 8 couples total, 2 moms on triple antibiotics, 2 fresh c-sections, baby under the lights, mom who had 2500 EBL and had been transfused before coming up, needy teen moms, needy breastfeeding moms, etc. It was out of control. Even with the ample help of my charge and fellow nurses, I still came no where close to doing everything that these patients needed. Last night wasn't a rare occurrence, just last week my fellow new grad was stuck with 9 couples. 9! 18 patients to chart on! We also never have a nurse in the nursery, only a nursery tech, so even if your babies are in the nursery, you're still fully responsible for the care excluding bottles and diaper changes.

I feel like management is aware of the issues here and we're definitely a very busy hospital (average 24 births in 24 hours, 68 bed postpartum unit that is full at least half the time), but I feel like this is just plain unsafe. Does anyone have ideas about how to approach this? I have my 6 month evaluation coming up soon, and I definitely want to talk to my manager about some of my concerns - I was thinking of trying to keep a record of how many patients I have each night, and how the night goes in general to get a nice objective view of things. I think our main problem is that we don't really have a float pool - it's crazy, if two people call out sick, the only thing the charge nurses can do is beg the regular nurses to take overtime, which people aren't really that fond of doing. There needs to be an emergency back-up plan. Or just better staffing in general.

Thanks for letting me vent! Here's hoping for a much better night on Monday.

What you are dealing with is UNSAFE. I did find out that we can not refuse to take our team but we can state that we feel unsafe with the assignment and it needs to be changed. After all who will be in court with you or pay your bills etc if there is a major occurance? Nobody. It is unfortunate that nursing is no different than being a cashier at a grocery store. The patients are our customers and that is it. It is ashame you being a new nurse has to deal with this so early in your career. I want to continue to take care of my patients like I was taught many many years ago. I keep that with me everyday. If it ends up my hours are over budget so be it. At least I know I gave the best care possible and if it was a horrible day my manager and house supervisor are aware of that too. I am seriously considering home health. For the one on one. So we will see. Keep your chin up, voice your concerns by email at least then you have a copy if something does happen. And keep with you the good that you have done for your patiients.

On our unit, which is 19 ldrps/level 2 nursery(crosstrained staff), our minimum staffing is 4 nurses. This can be either all RN's or 3 and 1 LPN. This is if our level 2 nursery is closed. If it is open, even with one kid, staffing needs to be at 5. This in theory gives us enough people to do a stat section if one were to walk in. (one for the floor, one for the baby, one to scrub and one to circulate-hopefully we have a resident to assist!) Our unit never closes- we are self sustained so we cant be floated out elsewhere.