labor and delivery nurse-patient ratio labor and delivery nurse-patient ratio - pg.2 | allnurses

labor and delivery nurse-patient ratio - page 2

Can anyone give me guidelines and/or references regarding nurse to patient ratio on labor and delivery?? I work in a small hospital with no ancillary staff such as aides, techs, runners or even a... Read More

  1. Visit  SmilingBluEyes profile page
    0
    If you were fired for calling to attention a dangerous situation would that be so horrible? Could it be, there are worse things that could happen than being fired in some situations? Sometimes, we have to stick our necks out to do the right thing.

    I remember when I was a new nurse out of school, I had a physician do a very dangerous and stupid thing on my watch, during night shift. The Chief Of OB was there, and I told him about it, and he shrugged. But I could not let it rest.

    I wrote up exactly what I saw, gave it to my manager, who agreed it was grievous and worrisome, and she elevated it up the chain to the OB committee. This doctor told me in clear terms, "he would have my job for this" and I did get upset and cry. However I knew if this kept up, one day, someone would get hurt or my license would be history. Not a good prospect.

    The outcome was, the physician was told never to do this again, and I was thanked by my manager and Chief of OB (the same dr who did nothing on the night in question) for calling it to their attention and it stopped. Eventually that physician hung himself (not by my hand) and his priveleges revoked.

    Yes, it is scary to stand up and stick your neck out. But let me ask you this:

    How scary would it be in the wake of a tragic outcome to have the lawyers rip you apart, asking you why you did nothing to change things? You see, dangerously low staffing is our concern but will never wash as an excuse with the lawyers. It's very unfair for us, yes....but if we just sit by and do nothing and never document it, it's like we don't care in their eyes. You won't have a leg to stand on if you are in court, with your charting up there on the big screen, for all to see. You can bet you will be asked about "blank times" in your nurses' notes as to why nobody was caring for the patient at critical times.

    Where I work, you bet I do document it if staffing is inadequate and dangerous (which thankfully, is not that often). Even though nothing bad happens, I do write up poor staffing each and every time it occurs. They know we are paying attention, and taking the time to get on paper, what is going on. This could save our hides someday.

    So yes, if things are as unsafe as you describe, then you should be documenting it. Or else you risk the safety of your patients, and your own licensure in neglecting to do so.

    Either that, or perhaps, you can try to find a situation where staffing is not so dire.

    Either way, you have made it clear, you are not prepared to go on as you are. I wish you the best, whatever you decide to do.
    Last edit by SmilingBluEyes on Dec 31, '06
  2. Visit  SmilingBluEyes profile page
    0
    The AWHONN staffing recommendations are published and can be purchased. I would start by asking anyone who you work with who may be a member about this, or try your manager. Each OB unit should have this publication on hand, period, as we are held to their standard, if we are practicing in the USA.

    I also recommend any nurse who is working in L/D or Mother-Baby become an AWHONN member.
  3. Visit  mitchsmom profile page
    0
    The ratios are in this book, if you have it on your unit or can just copy the page at a library:
    Amazon.com: AWHONN's Perinatal Nursing: Co-Published with AWHONN: Books: Kathleen Rice Simpson,Patricia A Creehan

    I wrote it in a previous post, let me see if I can find it. I don't think it addresses Pit'd patients - I think you can still do 2 Pit labor patients until they become active/pushing.
  4. Visit  SmilingBluEyes profile page
    0
    Thank you Mitchsmom. I think all units should have this book in their library. I do know both of the ones I work on, do. If they don't, ask your manager to purchase it. It should be a resource available on every OB unit. For the life of me, I could not remember its title, which is crazy, considering I own a copy, albeit an older one. Time for me to update. I do know the newest one is on the units I work right now. It's a great resource. Thanks again for your contribution. AWHONN members get these books cheaper, and also get updated reference lists from AWHONN as they are made available. This alone, for me, makes membership well worthwhile.
    Last edit by SmilingBluEyes on Dec 31, '06
  5. Visit  mitchsmom profile page
    0
    You're welcome

    Ok, here's what I posted in the other thread (and notice that it does address Pit, which is 1:2):

    "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).

    I'll try to type it:

    "Intrapartum:
    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

    Antepartum/postpartum:
    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

    Newborns:
    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 nrusery. 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 situations."


    PS - I'm a member of AWHONN as well .
    A hint for about-to-be grads who know they'll be going into OB - the student membership rate is a good bit cheaper (I think maybe half), if you can grab it before you're done with school. The regular rate is less than the nurses on my team at work had remembered it being.
    Last edit by mitchsmom on Dec 31, '06
  6. Visit  ragingmomster profile page
    0
    "Intrapartum:
    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

    Antepartum/postpartum:
    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

    Newborns:
    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"

    Thanks for the great numbers!

    I find this not to be the case in our unit though.

    While the M/B unit, NBN and PP floors all have strict staffing guidelines, in my home unit High Risk, we just keep on getting stretched thinner and thinner and then they wonder why we can't keep staff.

    You see, the M/B unit has 7 beds and may be filled with labors or M/B couplet and each nurse may take only one active labor/one early labor-one couplet/ or 2 couplets.

    NBN has a 5 pt per nurse rule as does the PP unit.

    HR nurses may be taking care of 2 labors and an ante or pp pt. While the ante may only be a PROM'er sitting on a monitor, that is still a monitor that must be watched. It's likely that the PP pt is on mag. If one of my early labors suddenly speeds up, good luck to me to find someone to watch my other pt's because everyone else is tied in knots also.

    Our manager says, "well we can't turn away a labor", and yet there are days when 5-6 of our LDR's have pp moms in them because the pp floor is maxed out on nurses.

    We have recently gone all the way up the chain to the Chief Nursing officer, but nothing changes.

    Makes me want to leave too sometimes
  7. Visit  jenrninmi profile page
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    1:1 here
  8. Visit  NJNursing profile page
    0
    Ours is 1:1 in any stage of labor unless it's a cervadil, then we can take 1:2 with the cervadil and another in active labor.

    Post-partum is 1:4 couplets.
  9. Visit  HappyNurse2005 profile page
    0
    Intrapartum:
    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

    Antepartum/postpartum:
    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


    glad my ratios are better than this. 6 stable antepartum patients? Funny thing bout those ladies, you just never know when one is going to become unstable in a snap.

    and 2 pit pt's. here, pit pt's require q15min strip charting. that, x2 ladies is a darned lot of charting!

    it has happened, that we occasionally have sucky ratios, but as a rule, its pretty good.
  10. Visit  magz53 profile page
    0
    The AWHONN ratios look ok to me except the 2:1 pitocin patients. You know if they don't have an epidural, they are going to get one with pit. They agree that is 1:1 for epidural insertion........well who is with your other pit pt ?? We have to do strip charting and Hollister charting every 15 minutes on pit AND a separate epidural flow sheet with VS, FHR etc. q5min for 30 min. then q10 min x3. So much duplicate charting and IMPOSSIBLE to do on 2 at once. Your pit pts. could be any combo, primips should always be 1:1, then your multip goes quickly........it can be a circus. In our hospital as long as costs are kept down, administration is happy. Respect for nurses and their knowledge is at an all-time low in my career. The current administration believes that nurse-managers keep their nurses "in line" by suspending them without pay for minor infractions. I know my liability in patient care, I am very aware of it. I also know the hospital's liablity as "captain of the ship". I need my job, I carry the health insurance for my family. I hope I am 4 years away from being able to retire. I stand to lose a great deal should I be fired. In another lifetime, it would be wonderful to try to change the world. In this lifetime, I will do my best to take care of the patients under my care.
  11. Visit  enfermeraSG profile page
    0
    Thanks for all the info! Also, I appreciate Mitchsmom typing all of that for us. I agree with another poster, 1:2 on pit is quite a challenge - mostly because of the charting, but bouncing from room to room to bump that pit up every 15 mins and then keeping up with the charting (especially if a strip is not the best). Whew, that's some work. Sounds like there are much worse environments to work in however. SG
  12. Visit  deehaverrn profile page
    0
    we supposedly follow the 1:2 labor rule..but try to do 1:1 when possible, but when we're busy..you end up with everyone having 1:2 and then when they all get pushy at once there's no one available for coverage and we're in too deep..plus our "central monitoring" system has a glitch where we can't see other strips in pt rooms only at the desk areas, as far as nursery, they're pretty much the "princesses" here, almost always have less than 1:7 ratio and even have the newborn resuc. nurse to do most of their admissions for them..but they still grouse, antepartum can have anywhere from 1:5 which is usual to 1:10 and we get overflow gyn and medsurg(which sometimes we haven't a clue what is going on with them) but no extra staff for it, postpartum is sometimes 1:9 which can be awful if you have a lot of complications, The worst is our eval, which is 1:4 and is sometimes done by the charge nurse who also has to troubleshoot for everyone else especially for a stat c section or baby resuscitation..then still have cervidils, labor admits, or someone abrupting in triage...its crazy! You feel like Indiana Jones just hanging on by the skin of your teeth some days
  13. Visit  HappyNurse2005 profile page
    0
    deehavenrn-
    10 antepartum patients? seriously?
    wow.

    i'd find another job. that sounds like it sucks!

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