We are a good size city hospital and our accuity can be pretty high, not to mention the elderly gyn pts with long medical hx. When you have your assignment changed several times in a shift, I'm concerned about safety, things getting missed. For example you may start with 4-5 couplets and a "cervidil pt"(getting ripe for her induction). Your cerv pt may become active, so you pass your couplets to another nurse whoalready has at least 4 couplets--but hey, they say that's ok cuz you have already made rounds on them(and they won't need anything else?!). Your cerv. pt delivers and another labor pt needs a nurse, so you "turn-over" your delivery to the nurse who has 8 couplets already, and she has to finish up the "checks"on the fresh delivery, get her up... And the on-call nurse is already there, maybe scrubbed for a C/S. So now you are in with your labor pt., and the other nurse is trying tostay afloat caring for the rest of the floor. What continuity did the cerv pt get? And the couplets that you started with? Or you could be on the C/S&gyn wing with an assignment, and suddenly they are doing a stat C/S and need another nurse. You may be pulled to care for a labor, or to cover some couplets on the LDRP wing, or perhaps srub for the section and do the RR. Meanwhile your assignment is divided up between the nurses left on the C/S wing. Not to mention that they frequently don't have a sec/tech to help, not that any of them do much anyway. You rarely have the same pts twice, or even for a whole shift. The new hires get so overwhelmed with learning the LDRP's the OR, and the Gyn's. Some of them are new grads. Needless to say many newhires leave within 6 mos of finishing orientation. If we were a smaller hospital I could see the cross-training working better. Knowing the LDRP's is enough cross-training, and the OR. But then to be able to do the sick gyn/AP pts too, and constantly switch is a bit much. Some nurses are "Jack of all trade, master of none". We do have some nurses who are excellent everywhere. But they have been around for a while and have had time to gradually master these skills. I am thinking that a "core" staff for the Gyn/AP/CS wing and one for the LDRP's would be good. Of course the nurses from the C/S wing could do couplet care on the LDRP wing if needed. All the nurses are able to do the well-baby nursery, which at times will have 13 babies in it. I think the major hurdle is trying to get management to consider a change, and we all know that has to meet the budget restraints. Sorry so wordy, guess just feeling frustrated with the chaos, and the constant complaining I hear from all the staff.