labor and delivery nurse-patient ratio - page 2

by magz53 | 21,377 Views | 39 Comments

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 secretary on 3-11. I am not... Read More


  1. 0
    I work in a little hospital, and I guess we are lucky to have a pneumatic tube system to send labs. If that is down..I call the nursing supervisor, and she usually finds me someone that can do it.
  2. 0
    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.

    How is teamwork where you are? That is the key to safe care for patients. When one of your patients delivers, do you have a nurse covering the other, for example? This is certainly something critical.
    I must learn to navigate that website better! I couldn't figure out where to find that info. Anyway, I'll just ask you instead....is being on pitocin for induction/augmentation bump a pt into high risk? I would love to know where to look for these guidelines and others on that website if you could give me some hints! Thanks, SG
  3. 0
    Re: AWHONN web site, I couldn't find guidelines for nurse-patient ratio either. I think if I reported everything up the chain that I probably would be fired somewhere along the line. Two years ago I tried that to say that using RN's as cleaning staff, runners, secretaries etc. was not cost effective. ( I thought if I went that route I would be heard as $$ talks ) I never received an acknowledgement of my letter. Now, 2 years later tho, we do have housekeeping available to us and we are getting a tech/aide which will be of great help.
  4. 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
  5. 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.
  6. 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.
  7. 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
  8. 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
  9. 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
  10. 0
    1:1 here


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