labor and delivery nurse-patient ratio

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    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 comfortable taking care of 2 active labor patients with pitocin running, epidurals, internal leads, IUPCs etc. We also get many "labor checks" which 9 times out of 10 are not in labor but require monitoring, assessments, UA's ( which we must enter in the computer and run to the lab which means we leave our labor patients unattended ) Granted, being small means this does not happen every shift but I think my license is on the line many an evening. Of course if it is more than one care provider, they think they are the only one who matters. A primip pushing is a one on one in my opinion but I am often treated as "old fashioned" as I am the oldest nurse on the floor. I think I hold my own and am capable of working to the max......but I am not inflating my ego by taking on more than I think I should. I just don't feel right about it. Help.
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    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.
    Last edit by SmilingBluEyes on Dec 29, '06
    Elvish likes this.
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    In my hospital it is 1:1 on active labour and 1:1 even in early labour although there have been times when it has been 1:2 in early labour but it is rare. Unfortunaltely that means our pp moms often get the short end of the stick if there are too many labour patients because they are more easily forgotten. The rality is though, that we really do need to be 1:1 in labour because things can go sour so quickly.
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    As far as I remember without having it in front of me, 2 labor pts is acceptable (not with added labor checks) but it becomes 1:1 with pushing and during epidural placement. Check the AWHONN standards & discuss with your manager if you think that would go anywhere. Ours tries to staff adequately but often there is no one to come in or it gets crazy quickly and there's no one to come in (we had a huge growth spurt in # of deliveries right as I got hired!). Do you guys keep people on call? Does your manager have a matrix for staffing that you can see and compare to AWHONN standards? I guess ultimately it ends up being a decision to stay or quit if it's not up to standards and/or unsafe.

    Mag pts are of course supposed to be 1:1 too - which is my thing I've had to deal with this week - they never end up being 1:1 on my unit and I hate that. My mag girl yesterday was very complex and I ended up doing a labor ck and delivering with another pt too in addition to her - usually we cover each other pretty well but the thing is that the other nurses at my work don't assess mag pts adequately or according to policy (not even close).
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    You have to take your own specimens to the LAB???? What is up with that? You don't have any kind of transport system?? That would be first and foremost for me...I would be calling someone to take specimens for me, because you CANNOT leave laboring patients unattended. Your manager is ok with this practice?? Your risk management department? YEESH. I am sorry you are being put in this position, and you are right to be concerned.
  9. 0
    We take our own specimens to lab as well. This is very common in smaller hospitals, particularly on nightshift when volunteers are unavailable.
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    Thanks for everyone's input. We have recently hired a tech/aide who hopefully will be doing many of the non-nursing duties which we now do. Until recently, we also did all of our own cleaning ! After a patient delivered, we stripped, cleaned, mopped ( including toilet and shower ) and remade the unit. Often there is one L and D nurse on with 2 nursery nurses....one of whom is working postpartum. So there is no one to "watch" our second patient when we get tied up with an epidural insertion or pushing. Forget trying to keep up with notes which becomes so crucial when things go bad. We do not have anyone on call as hospital not willing to pay. So when we get "slammed", we also have the job of going down the list to call someone in. Very stressful at times. Our manager is young and is keeping costs down so she shines with administration.
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    I would take it up the chain of command to get someone to listen. We had similar problem with staffing and after several attempts to increase our staffing we had to take our complaint to the hospital and nursing committe. They agreed with all the data we provided them and mandated that our baseline staffing be increased. Our manager had to comply and though we are still short staffed alot at least we were listened to so we know that we will be taken seriously should we have to continue to carry on further actions so that our patients are protected.
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    If nobody is watching a given active labor patient, then standard of care is being violated. I would be documenting each and every single incident of this (as well as other clearly unsafe practices on your watch) on an incident report, cc'd to your manager , the acting OB chief of staff, as well as the risk management department, and the assigned house supervisor of that given shift. All you can do is CYA as much as possible in this situation. Short staffing is becoming a grave concern across the board but who hangs out to dry if something bad happens? You guessed it, nursing.

    Then as Eden says, I would also elevate this concern up the chain, personally.
    Last edit by SmilingBluEyes on Dec 29, '06
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    For active labor, we attempt to do 1:1, though on days it has been 1:2 on occasion. we are good about watching patients for others, though. maybe 1:2 for cervidil inductions, or maybe 1 active labor and 1 PP ready to move up to mother/baby floor. we also have antepartum patients, and ratio is 1:2 up to 1:4 depending on census, staffing, acuity, etc. never had more than 4 AP patients at night.
    and we are good about changing assignments if someone becomes sicker, needs a stat section, etc.


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