Closing the unit - page 2
We are stuggling with management in our small hospital about "closing our unit" when it is slow. "Closing" would mean no nurse (or any other staff) would be on the unit. A unit, by the way, which... Read More
Feb 7, '07I have never heard of locking shut an OB unit that has a census of zero. this is very interesting to me. And I have worked in rural settings where we did about 220 del/year. yet we never LOCKED shut a unit. The nurses were floated but subject to being brought back to OB the minute a labor pt showed up.
Feb 7, '07i can see a permanent closing because those mothers will be told before hand where they should go
but if they close a unit d/t census it won't be long before they cancel that nurse instead of pulling her elsewhere
alson if they have an ob nurse working else and she has to return to er unit it will leave that floor with one less nurse..report will have to be given and the patient load redistributed
Feb 7, '07Deb: they do want us to float to other units. My beef is that we have no one to answer the phone and no one to be here if someone comes in unanounced. Our patients often just kind of 'wander in' without checking at the front desk first.
Plus, our unit would be totally unguarded making it very easy for someone to steal something.
Feb 7, '07Our hospital recently completed some major NICU renovations. During that time, we weren't accepting level 3 or level 4 babies or any OB patients with the potential to deliver such babies. If we did have such delivery or a "well" baby or level 2 baby deteriorated they were transported to the hospital down the road.
During the renovation, sometimes we didn't have any NICU babies. During those times, the NICU nurses would "help out" on other units but were not counted in staffing because you never knew when they may be needed to attend a delivery or admit a baby to NICU or stabilize a baby until the transport team from the hospital down the road arrived.
I guess one of my questions would be how do patients enter your hospital? Do they come in through various entrances or do they enter through an ER entrance or another entrance that is constantly monitored by someone who can direct a patient to the correct area? If your hospital is going to temporarily close the OB unit, they need to ensure that everyone entering the building is able to be immediately directed to the correct unit. Also, the OB nurses need to be instantly available to attend to any emergent OB patient who enters the building. This means those nurses should not have an assignment wherever they are helping out so that they can respond immediately to an OB patient. I would be asking TPTB what the gameplan is for when an abruption or other OB emergency presents to the med surg unit or whatever area a panic-stricken dad can first find a hospital employee.
Feb 7, '07Qoute form matchstickxx above, "Also, the OB nurses need to be instantly available to attend to any emergent OB patient who enters the building. This means those nurses should not have an assignment wherever they are helping out so that they can respond immediately to an OB patient. I would be asking TPTB what the gameplan is for when an abruption or other OB emergency presents to the med surg unit or whatever area a panic-stricken dad can first find a hospital employee."
This is exactly what administrators fail to consider. If a nurse is floated out to another unit, she can't possibly leave that unit fast enough to respond to an OB emergency, even though she is probably the ONLY nurse in the hospital qualified to do so. Even without a patient assignment, she would still need to find a fellow RN or charge nurse to report off to, then shower and change before returning to OB.
Infection control practices do not allow staff to go from "dirty" units such as med/surg, ICU or peds to OB without showering and changing clothes.
Feb 7, '07When our unit has no patients (does not happen often, but interestingly enough just this week) we have 2 nurses staffed (we usually have 5). You just have to have someone there in case someone walks in and slips by security/registration/anyone. There are phones to answer all the time, and well..its just not safe. I can't count how many times I have been "floated" just to help and when it comes time to go back for an OB patient, how long it takes to float back. There is always something. Why oh why can't administrations get it thru their heads that OB is an extension of the ED!! You never ever know what is going to walk in at any time. We should be treated as such.
I would be hesistant to deliver at any hospital where I can walk in at any given time and find it CLOSED. What message does that give???
Feb 7, '07If you have no means to close/lock unit (through controlled access) then you do have a problem. But I think somebody should then be available 24/7 for anyone who shows up for a labor check or is lost. Don't they have to come in through your ED at night? Every place I have worked, there is only ONE way to gain entry to a hospital at night, and during the day, even then, they check in at a desk. So if that person is an OB patient, there was a means right away, to get an OB nurse there to check her out. NObody could just "wander" onto the unit without being seen first when entering the hospital or like nowadays, where I have worked, having a locked unit where they have to be buzzed to get in.
Either way, there DOES need to be somebody there to catch wanderers or OB patients who need checking, you are right. Admin is wrong here, I think.
Feb 7, '07Quote from babyktchrI heartily agree.I would be hesistant to deliver at any hospital where I can walk in at any given time and find it CLOSED. What message does that give???
Feb 8, '07Maybe you should sent a letter to local media about the situation highlighting the issues not being addressed by administration. If your hospital advertises OB services I think the public has a right to know that the hospital may not actually be prepared for an OB emergency. I also think whatever units are closest to your closed OB unit should be equipped with precip trays and inserviced on how to use them. A lot of laboring patients tend to just go straight to labor and delivery without stopping in admitting first. If they find the unit empty, they will probably show up on whatever unit is closest to OB and open. I think the staff on the other units need to realize the ramifications of having a closed and unattended labor and delivery unit. Those unscheduled pregnant women will have to go somewhere. I have found that most non-OB nurses are extremely skiddish about the possibility of having an active laboring patient in front of them. If the nurses on other units in your hospital realize they could potentially have a laboring patient show up on their unit, the nurses on other units may get behind your effort to keep your unit open 24/7.
I hope you can get TPTB to see the light before something bad happens.