Quote from BarbNY
1) Staffing ratios
A full load on my floor is considered 6 couplets. It's extremely rare to get through an entire shift having 5 or less. Not uncommon to wind up with 7 before the night is over or early in the shift before they can get someone else to come in. Is this the norm out there?
Our load is considered no more than 4 couplets and even then, that's not too common. Usually 3 couplets is our load. Have had up to 5 at one point, but that is VERY rare here.
I don't know if that is what they are called everywhere but at my hospital, PCA's do vitals, bloods (can draw on mommy and do heel sticks on babies), keep drawers stocked with diapers, sanitary napkins, etc, keep water pitchers full, do peri-care, assist with first time ambulation, empty foleys - you get the picture) If fully staffed, they usually have about 10 patients/rooms. In my hospital/experience, as a whole, their work ethic and attitude stinks! A night never goes by without doing a lot of the above work at some point ourselves.
We don't have any PCA's. We have one nurse extender who does a lot of stuff for the babies getting them ready to go home like metabolic tests, hearing tests, blood pressures, etc. They will help us by taking patients out, picking up food trays, but we don't have them do vitals or anything else like that.
3) Covering breaks
Our unit has 2 sides and the nursery so people are always moving around/leaving the floor to cover somewhere else for breaks. So, what may seem like an adequate staffing ratio is often deceiving because there is so much time, especially between 12 and 5 am that nurses and pca's are either on break, or elsewhere covering someone elses break. So for example, if we have 3 nurses on 1 side with 18 patients, there's often a time period where 1 nurse is in the nursery covering a break and the other nurse is on her own break leaving only 1 nurse on the floor with those 18 patients. By the way, although most of the patients are either postpartum or c-sections, we also have antepartums on my floor. In my opinion, this is not safe!
I believe since we don't have the patient load you do, our breaks are taken pretty much all night. We don't have a formal nursery that the parents can send their infant to, but we do have a holding nursery that the infants can spend a couple of hours in while parents catch up on sleep. Our nurse extender usually takes care of those infants.
The nurses work 12 1/2 hour shifts and the PCA's work approximately 8 hour shifts. I'm not saying that this is what is "legally" alloted but the nurses and the PCA's alike take 2 hour nap breaks. It's the way they have been doing it for many years on this floor. Because we are so busy in the early part of the shift, all of these breaks happen between 12 am and 5 am. Starting to see the problem? There's a skeleton crew during these hours and as we all know, babies come when they are ready! So, it's especially problematic getting admissions during these hours. Not to mention that the phones could be ringing, the doorbell ringing (it's a locked unit) and call bells could be ringing and if we're in a patient room or running around, there's no one to respond. There is just no support.
Some nurses can take cat naps, but nobody sleeps for 2 hours. Cat naps are about 15 minutes, less than 30 minutes. If one of their call lights go off, it's just an unwritten rule that they answer their own call lights. I've never had a problem staying awake on any of my night shifts. Other nurses however, have very small children and their sleep habits during the day aren't that great.
What happens if you have a bleeder? Who can you depend on? Is there anyone there that can look after your patients while you're dealing with a problem patient? When my license is on the line, I prefer to work in a place that nurses work as teams and not a "that's not my problem" type of attitude. I'd fill out a complaint type of form and send it through the proper channels where maybe things can change. It sounds like a dangerous place to work.