labor and delivery nurse-patient ratio - page 3
by magz53 20,875 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
- 0Jan 1, '07 by HappyNurse2005Intrapartum:
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
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.
- 0Jan 1, '07 by magz53The 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.
- 0Jan 2, '07 by enfermeraSGThanks 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
- 0Jan 18, '07 by deehaverrnwe 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
- 0Jan 18, '07 by magz53Oh 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.
- 0Jan 18, '07 by nrse4evrAt 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.
- 0Jan 19, '07 by deehaverrnIn 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.