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- by SmilingBluEyes Mar 6, '07The 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:
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).
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
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
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 situationsLast edit by SmilingBluEyes on Mar 6, '07
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- Sep 15, '07 by vandermomI have a question about the ratio of 1:2 when using pitocin. Is that ratio assuming central fetal monitoring? When we are running pit we are in the room with the patient about 90% of the time.
- Oct 1, '07 by AlabamaLegalRNOkay, here's the problem, what happens when you eat lunch. I know, who eats lunch or pees, but all of these rules are broken when someone "watches out for you". I see it every day or night. When you are Pitting 2 patients and so is your co worker, what happens when you get an epidural? Or start pushing? There is NEVER someone just standing around with no patients waiting to take yours. THIS is why they are striking in California, well, one of the many reasons. But where there are unions, there are better staffing ratios. What we do can get dangerous very quickly, and that person on call can't help. If it hasn't happened to you yet, just wait. Something needs to be done, because as nurses all we hear is "stay within the budget", but let the hospital write just one check to the family who's baby dies, and how many extra staff members could they have paid for instead????
- Oct 2, '07 by SmilingBluEyesThe places where such ratios work best have "charge nurses" who take no assignment whatsoever, or a "floating" RN who takes no assignment, but instead, covers the others when their patients become 1:1 for some reason, as in epidural placement or pushing or c/s. This I have come to learn, anyhow. Otherwise, such ratios quickly become unreasonable. Where I am, we try to keep it 1:1 for labor, even assigning a stable pp couplet rather than another active labor patient to a labor nurse. Being in an LDRP, we get away with this, and it works very well. Rarely do we have to have 1:2 active labors unless it's very busy.
- Oct 3, '07 by Nurse LindaI shake my head in dismay when I am reminded once again of such staffing "guidelines" published in 1998. I have worked on the same (19 bed) LDRP unit for 10 years as well as helped to establish a new (5 bed) Birthing Center for a local area hospital. I am aware of the current staffing trends in a number of hospitals in the Detroit area. As I read the previous threads Alabama Legal RN has the most realistic idea about what is going on in the OB department staffing world. Our unit has been recently blessed with a new manager who's main objective was to and did increase staffing. However, these guidelines are far from being met. Mag patients are often not being treated as a 1:1. I have managed 3-4 antepartum's and ran NST's along with doing other nursing duties. As an efficient postpartum nurse it is not unusual for me to be assigned 6 couplets. Our midnight charge RN who has this "super nurse" mentality will assign herself all of the pospartum couplets. We have a nurse that is assigned as charge nurse, but she is still accountable for an assignment.
In all actuality, I am frustrated with both staffing and the work styles of individual nurses. Honestly, I would love to see future studies on staffing solutions in regards to nurse work ethic, attitudes and ideas. As all workplaces do, we have an uncanny blend of worker bees and lazy bees. You know who I am reffering to. There are those that run around the unit jumping in to the action, helping to make a bed, recover a patient, or bathe a baby. Then there are those few that manage patients by watching the monitor at the nurses station, increase pitocin slow so the delivery occurs on the next shift, minimal charters, or leaves their patient's rooms a mess after the delivery/recovery. The combination of staff can make or break a shift during busy days.
To be quite honest, when I look at the suggested staffing I think I would be bored. Most of the nurses I work with are conditioned to handle more of a patient load which is not good especially if you try to fight for improved staffing.
That's what's on my mind.. sorry for the rant.
- Oct 4, '07 by SmilingBluEyesOf course, the guidelines do not take well into account individual nurses' skills, attributes nor, even acuity very well. That is a problem when you staff "by numbers". Where I am we do fairly well at being a team. The numbers don't tell all. We don't assign all the "fresh" or "difficult" patients to one nurse----we spread the wealth, so everyone is treated fairly, most importantly, the patients. And I am sorry, but 6 couplets is way too many if they are to get any real quality of care. Just ONE couplet having big breastfeeding issues can take hours of my time.
- Oct 8, '07 by mbobrnQuote from keasc20Believe it or not...where I work, we rarely have more than one patient at a time. I have been here about 3 yrs now, and I have never had more than one if my patient was in labor. The head nurse and/or clinical instructor come to help out until back up staff can arrive. Unfortunately, I had to leave the USA to find this dream job!I actually work in a hospital that follows these guidelines!!!! Can you believe it?
- Oct 24, '07 by Treasure30These numbers seems reasonable. I haven't worked in the Detroit area in a while, however 18 yrs ago on the L & D unit this is what they used. The charge nurse was not assigned patients. She was resource & made sure the pt's were covered. It worked. Again this was LDR, this unit has know been change to an LDRP unit.
The other hospital in Dearborn, Michigan, which has the 2nd largest numbers of delivery in the state of Michigan practices those same nurse-pt ratio. It worked over there in 2006. Patient are always covered, however you do have to beg the charge nurse for a break or lunch on nights. Days do get their breaks & lunches.
- Jan 21, '08 by pbrtrailsI am a new nurse to the L&D department. I went to this floor 3/07. I graduated from school 5/06. I could not imagine having 2 patients in labor. Most of the time you cannot keep track of the baby, or the mother on the monitor. When you get the mom up to the bathroom, our policy is to never leave the mother alone by herself. How in the world do you handle 2 laboring moms at the same time, especially if they both want an epidural at the same time, and then there is all of this charting every 15 minutes. Yikes. I have been pulling some shifts in our emergency department, not nearly as much paperwork, and the patients down there get turned out either on the floor or they go home. My department co-workers remind me all the time that standards are 1:2 ratio in labor. I just do not know how long I will be staying on this floor. I just do not feel that I personally could provide safe and accurate care to a patient without guilt every night when I go home. Our charge nurse takes a team, we do not have a nurse that floats. This is a tiny hospital, we do not have physicians in house, they are available by phone. Our ED physician does not come to our department unless there is a CODE BLUE OR PINK. I often ask myself, "what in the world have you gotten yoursef into this time?" We do not have central monitoring either.