labor and delivery nurse-patient ratio - page 3

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  magz53 profile page
    0
    Oh My ! I agree that sounds terrible and so unsafe. I think bottom line with us is that most of us are women, no union.......thus no say with the "bigwigs". We are constantly reminded that we are an "at will" institution, which means we can be fired for NO reason with NO recourse. Believe me, I have seen it done. Also, the CEO's ( as they like to be called ) have NO clue of our scope of practice . Last evening I had a vaginal delivery which thank heaven went smoothly and 2 pit patients......one of whom was a primip who had psych problems. The other was a multip with prolonged ROM who had to be admitted by me and the pit started etc. She did not respond to the pit in any way but of course has to pee every 30 minutes and refuses a bedpan, then she wants an epidural just in case labor actually happens. Then one of our "favorite" docs sends an FDIU over from the office for cytotec. She is crying in the waiting room and no way I can get to her to admit her. Called the supervisor for help, she eventually sent up an ICU nurse to admit the fetal demise and care for her. What a mess. Amazingly, it only took me an hour to "catch" up on my charting and get out of there. I really thought I would be stuck for a double as one of the night nurses called in. Our nursery nurses see what we do and no way will they cross train. Two of our labor nurses are out indefinitely on disability. I don't see any nurses pounding at our door for a job. It is somewhat "comforting" to read this board and see that the problems are universal in the field of nursing and happen all across the country.
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  3. Visit  mjsobrn profile page
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    I guess it depends on where you are in CA it is 1:2 active labor without having to do Labor checks
  4. Visit  nrse4evr profile page
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    At my institution we usually have 1:2 pit with or w/o epidural. Of course, everybody tried to have 1: but in a perfect world....... One way we try to help ease things is to have a free float CN who typically does not take pts and is therefore avail to help take care of the 'other' pt when assigned RN is pushing, epiduralizing or whatever. It's not perfect but it works for us. As is true with other places budget is always a concern and CNs have the additional task of fiscal responsibility, but attempting to secure High Reliability Unit status has helped us keep staffing ratios livable.
  5. Visit  deehaverrn profile page
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    In fairness when i've had 10 pts on our antepartum unit some of them were overflow from medsurg and gyn, although when they're difficult (we always seem to get the gyns who end up with blood transfusions) and since we don't do a lot of med surg sometimes you spend half your time calling depts about how to do their orders, you're not sure how to explain their diagnostic tests 'cause you've never heard of them yourself, and you have to look up so many meds that you're not familier with..you end up suddenly realizing that its been over an hour since you looked at any fetal monitoring (my manager seems to think its fine "cause it will alarm for decels," I guess she's been away from the bedside too long to remember having to watch for baseline changes, contractions (preterm labors) or late decels. Its scary.
  6. Visit  nrse4evr profile page
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    I think it's a bit scary to have med surg pts mixed with antepartums. These folks have so much wrong with them and are potential infectious agents when nurses have to go back and forth between their rooms to provide care. I haven't taken care of a M/S pt is so long that I probably would have no clue where to start and frankly I like it that way. I do L & D for a reason and it's not to take care of med surg. Wish I could be more empathatic but there it is. We used to have an antepartum unit but have long ago disbanded it. I work in a teaching facility and we Mag PTL only long enough to get Celestone on board then ship them to the floor (OB/PP/GYN). The attendings tell us that there is no advantage to keeping PTL pts on Mag for extended periods of time as it has no advantagous effects for the baby. Been in this business so long now that what was old is now new!
  7. Visit  deehaverrn profile page
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    Yeah, I forget a lot of my med surg too, plus it has changed completely since I used to do it in the early 80's, however they don't give us a choice. If the "house" is full they just keep bringing them in, also they insist they have to "decompress" the ER so they don't have to close to trauma which is a big moneymaker for them. They don't really care if we know what to do with the pts or not. In fact, even though we are often called upon to do FHTS or fundal checks on pts who require telemetry or something on another floor ( I understand if they had a fetal monitor but that stuff you should have learned in school anyway). The point is that I think we should get help from med surg when we need it but we don't--its a one way street. Obviously if we are getting the pts that means that the other units are full (unless they're closed for holidays and the like) but then the supervisor should help out. The other day I had a transfer to a SNF, I had no idea what to do at all...but no one wanted to help, until my relief came in and she was new to OB so she remembered. Its really scary.
  8. Visit  nrse4evr profile page
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    Good luck getting help from another floor. Wehn our unit was not closed we had to go help out PP,NBN, etc and although we could do their jobs not a one of themknew how to labor a pt. It seemeed as if we were just a glorified resource pull pool. glad there was enough staff involvement that we soon got that changed. Now they still don't come to help us but we are not tasked with staffing their unit. Although PP does have a unique way of getting back... They refuse to take PP pts because of short staff. While we on the other hand cannot tell ER to hold our pts in the ER until we can handle them, we just do it. I suppose that every unit has gripes unique to them about staffing and caring for pts that they know nothing about. In that I am sure we are not alone.
  9. Visit  kRNky profile page
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    i googled the subject and y'all came up. On my unit currently 2 labors, has become standard, and now due to shortage, we are being given 3, and told to "do the best you can." yes THREE, and this is without regard to pre-eclamptics on mag and pit, multiple gestations, pre-termers actively laboring, VBACers on pit, or "regular" patients with medical comorbidities. I have personally had 2 sets of twins laboring simultaneously!! (Couldn't make this up if i tried) Recent scenario, co-worker of mine got a "talking to " because she spoke up when she, with THREE LABORING PATIENTS, was told to increase the pitocin, get the patients delivered because we had a full board . How about this, 13 laboring patients on the board, 4 nurses on the floor...Do the math. Every other week, someone resigns, sometimes in couplets. New hires have left before completion of orientation.
    Know what i need to do, was just hoping it would get better, thanks for the opportunity to vent!!
  10. Visit  magz53 profile page
    1
    I only wish the "public" knew what really happens behind the scenes. They are the only ones who can make a difference. Nurses are powerless. Therein lies our frustration. We know how to give good care, rare is the shift when we are not spread dangerously thin. $$$$$$$$ is what it is all about from the hospital's perspective, but a good lawsuit can erase the profit quickly !!! One of the first things looked at in a deposition is the staffing but I guess that they are willing to take the risk.
    hexoptic likes this.
  11. Visit  OBNurseInFL profile page
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    Quote from SmilingBluEyes
    Ratios are defined very well in AWHONN. Check AWHONN Homepage

    I do know 1:2 in active labor (not very high risk) is the standard they currently recommend.
    Hi, SBE -

    I've searched & searched the AWHONN homepage but cannot find the position statements that CLEARLY define what they consider to be appropriate staffing levels for L&D. I work in a small military facility, and our new CNS thought that it was just fine & within AWHONN/AACOG standards for me to labor an AMA grand multip with hx of multiple DVTS & PE's who had been off lovenox for less than 24 hours (being induced) AND a preterm induction for mild pre-eclampsia on pit & MGSO4. I can't believe that's considered SAFE! I just can't find anything to back up my opinion. Do you have any links to the actual pages or PDF's from AWHONN that are very clear-cut on this sort of thing? THANKS! I've been an L&D nurse since 1985 and I have loads of common sense, which apparently doesn't always match up with what the higher-echelon dictates... ahhh, well!

    Thanks for your time!
    KC
  12. Visit  tammy777 profile page
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    Quote from OBNurseInFL
    Hi, SBE -

    I've searched & searched the AWHONN homepage but cannot find the position statements that CLEARLY define what they consider to be appropriate staffing levels for L&D. I work in a small military facility, and our new CNS thought that it was just fine & within AWHONN/AACOG standards for me to labor an AMA grand multip with hx of multiple DVTS & PE's who had been off lovenox for less than 24 hours (being induced) AND a preterm induction for mild pre-eclampsia on pit & MGSO4. I can't believe that's considered SAFE! I just can't find anything to back up my opinion. Do you have any links to the actual pages or PDF's from AWHONN that are very clear-cut on this sort of thing? THANKS! I've been an L&D nurse since 1985 and I have loads of common sense, which apparently doesn't always match up with what the higher-echelon dictates... ahhh, well!

    Thanks for your time!
    KC
    I'm looking for the same thing in California... Seems like the ratio laws are fairly vague and don't specify care/ratios for the higher risk patients... I'm hoping there are more specific posted somewhere... if not, they certainly should be because the scenario you mentioned above doesn't seem safe (in the text books it says a Mag pt should be 1:1, but I don't think that is what happens in the real world...)
  13. Visit  ldcmw1 profile page
    0
    I'm a labor and delivery nurse myself and find that we are constantly out of the AWHONN guidelines!! I feel sorry for the nursing community!! It is sad to hear it doesn't seem better anywhere else.
  14. Visit  laborrntx profile page
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    I think that 1:2 is amazing even getting that! I work at a small hosptial and our unit is set up in a big rectangle where we have 6 labor room, 2 OR's, and 12 PP rooms. Our core for all areas is 3 nurses for ALL THOSE ROOMS! I am a new nurse a little less than 2 years and was charge for my 3rd time. I had 1 labor nurse w me, 1 baby nurse (we don't have a staffed nursery), and 1 floating nurse who'd never done moms by herself taking the moms on PP. At one point during a section which took my baby nurse and my 1 labor nurse I had 7 labors/triages ALONE. I was even pushing hydralazine and couldn't get help. It was the single worst night of my career. It makes me want to quit labor and delivery because I'm sick of feeling overwhelmed and I felt like my license was at risk although under the circumstances all the docs that came through the night and all the morning nurses said I did everything right and did a great job. I was at work for 19.5 hour between not being able to chart on anyones strip all night, do any charting other than real quick when I gave a med etc., I didn't eat, drink, or pee for all those hours. The last 3 of those hours I spent back charting on strips etc. I had some serious scares and some babies going bad, 2 STAT true life and death emergency sections at shift change, luckily dayshift had arrived and nights hadn't left so the outcomes were good but when I got home I was tearful, anxious, shaky. I couldn't sleep for hours and almost felt like I was suffering from post traumatic stress. Any older wiser more seasoned nurses have any advice for what we can do? PS I did a nurse residency program and am contracted to them for another 10 months. ADVICE????


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