does research support cross-training?

  1. About 10 yrs ago my hospital decided to cross train the mother/baby staff to L&D, and vice versa. The unit in my opinion has not run smoothly since. We have an18 bed wing that is for c/s and gyn pts, also the sick AP pts. The next wing has 16 LDRP's, with the nursery at the far end. The next wing is the surgical/triage area-C/S and Gyn's done here. The last wing is the Spec Care Nursery. Despite cross-training, most nurses favor one type of nursing, and usually are put there. The hospital sited the continuity of care as one reason for this type of care delivery. That is a farce. In an 8hr shift you may change assignments/units many times. There is a big difference in caring for the 80+yr old gyn pt. and the complicated labor pt. Deciding how to place the staff is a constant issue. Sometimes too many "L/D" nurses and not enough for the C/S's, or not enough to cover the OR/RR. Realistically the staff is not "cross-trained". There are few nurses that have good skills in all areas. Now I hear I will have to cross-train to the NICU. It's a zoo! Staff is always miserable and the turnover is high. The new cross-trained staff feel overwhelmed and frequently quit as they are pulled around too much. I would like some hard results of how to best manage this unit. Would core staff for each area and a float team work? I am trying to find documentation so we can put together a proposal that will meet pt needs, budget restraints, and keep staff happy. Thanks for input, any research, or creative ideas.
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  2. 8 Comments

  3. by   2banurse
    Wow! That does sound chaotic. I would think that your suggestion of a core staff for each area and a float team is a good idea. This gives both, the nurses the option of cross training if they would like to learn different areas and the nurses who have preferences for specific areas, a viable option. Not to mention how expensive this is since you have such a high turnover in some areas. I hope something works out for you.

    Kris
  4. by   L&DTami
    Just my two cents- we are cross trained but there is a core group of nurses that ONLY do PP or Labor or Nursery Special care. They never learned to be comfortable with everything and therefore aren't forced to. So far no problems. I do everything and so i end up with a variety, so I never feel bored. ( I am new tho, only 1 year under my belt.)
  5. by   SmilingBluEyes
    Whether it supports it or not, in most smaller hospitals ya don't have a choice. In my world, it's a non-question. We are all cross-trained out of necessity. Makes me quite marketable in most areas, I believe.
  6. by   Buggs
    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.
  7. by   fergus51
    It sounds like the problem isn't really crosstraining, it is poor management. The last hospital I worked at crosstrained people, but only after at least one year in their area. Usually they start in AP or PP, then L&D, then LDRP, then high risk L&D, then OR/PAR. The process takes a few years to complete, but it means that staff has the time to get comfortable in their areas. We NEVER switch patients in the middle of a shift barring an emergency. And cross training is optional. If you have staff who only want to do a certain area, they will never be good nurses if they are forced to be in another area.

    I would think core groups of nurses in certain areas would be an excellent idea and would save money in the long run through retention.
  8. by   L&DTami
    I agree that it is probably a management issue or could there be a staffing issue? We never have more than 4 couplets assigned to one nurse unless we are shorthanded. When this occurrs it is usually because the main unit is full and the PPs have been transferred to our overflow unit which is near but not near enough to share nursing staff, once you are there, you only take care of patients there. WE don't send the PPs til after their 2 hour recovery is done.

    We are small- 100-130 deliveries a month. We sometimes have to switch gears in the midle, but not very frequently. Usually we keep the same assignment, and structure them so that a few are designated for next admit and they help the others until that next admit comes,or if we are rocking, we may have a few couplets plus a labor and the techs will help keep an eye on the couplets. We do have fairly good teamwork here.
  9. by   Buggs
    Thank you for the input. It seems there are many issues. I remember long ago in nursing school that after you implement something, you go back and assess it and fine tune it. I don't think this has ever happened. Once the wheels were in motion, no one has tried to adjust it. I hope I can come up with some proposals that will be taken seriously. You also brought up techs. Ours do stocking and desk work, but fight you when it comes to any patient care. If the nurses had attitudes, or spoke the way some do , we would be shown the door. I love being an OB nurse, but want to improve the environment I face at this institution. We need to make changes to improve the overall running of the unit so morale will improve. Wish me luck.
  10. by   Jolie
    I understand your frustration. I used to work in a 18 room LDRP unit with an 8 bed NICU. All staff members were cross-trained to every area, except NICU. There was a small core group of NICU nurses who also did PP so that they could take an assignment on the rare occasions that NICU was closed.

    A new manager came in and decided that the NICU staff would have to be cross-trained to all areas. (Don't ask me why, it was working fine the old way.) To make a long story short, we NICU nurses all spent 3-6 months orienting to L&D and the OR, with none of us feeling the least bit comfortable, because we never had an uninterrupted period of caring for these patients. Whenever a baby looked the least bit sick, we would get pulled back to the NICU lickety split. So much for being able to learn. The final nail in the coffin came when a new policy went into place stating that all L&D staff would be required to be ACLS certified since we recovered our own C/S patients. That would have required all the staff to have NRP, fetal monitoring, and ACLS certification. Management finally agreed that was just too much to require of all the staff, and acknowledged that it was better to have some specialization within our own unit. At that point, each staff member was identified as either L&D or NICU. Everyone was expected to care for antepartum, post-partum and well baby patients. That worked out just fine for us.

    I think my greatest source of frustration with the whole experience was the amount of time and money wasted on the half a**ed orientation we got to L&D. It was a shame it couldn't have been better thought out tin the beginning and that money and time spent on something useful!

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