Postpartum staffing? (and other traumas I need to vent about)

Specialties Ob/Gyn

Published

Question: In your postpartum unit, what is the usual staffing ratio? We try not to staff more than 1:6, sometimes with a tech, sometimes without. We also put in all our own orders and juggle the phone as well (no secretary). It's usually not too much of a problem...

Until lately. I am a fairly new nurse, a little over a year out of school, and *I believe* I prioritize my time quite well. I combine trips to the supply room and such like that, but I still spend much of my time running from room to room b/c I've got this one asking for something and I'll sit down and chart all of two words and here's somebody else wanting something. So after I've done that then say that there's this patient in L&D that they're about to section (hopefully not stat...) and they need a circulator b/c there's umpteen other patients on the back that need watching. So somebody (sometimes the house nursing supervisor) listens for my call bell while I'm in the OR and then recovering my patient (all together a 2 hour distraction, more often than not). Or, I'll be on the code team and get called away to a code while I've got six patients on the floor and I'm the only nurse out there -- our unit is designed so that L&D, PP, and Nsy are all huddled together so we can float back and forth, but still! I was in a code the other day for nearly an hour and a half!! :eek: My BP goes up just after reading that.

**And then I think: My God, what if one of my patients (who I'm ultimately responsible for) had started to PPH on me? Or a PIH'er starts seizing? Or if something really bad comes in and we have to crash section?**

Then I get back to *my* patients (and I don't really like terms like that b/c they're supposed to be *our* patients, like a team, but I don't often end up on the receiving end of our unit's "teamwork" -- we pull together in a true crisis and function well, but that's almost the only time it happens) and they're all wanting this that or the other. I try to make "pain rounds" twice a shift (8 hr shift) when I'm making rounds for assessments and vital signs (if I don't have a tech.) so that I can get everybody medicated so that I can sit and chart in relative peace for two consecutive minutes.

And some days it takes two hours after my relief comes in to finish my charting - and it's not *just* me -- there are other nurses who have been there far longer than I have that have problems like mine. :o And often, the nurse that relieves me comes in griping about this and that that she finds hasn't been done, simply b/c I did not have the help or the time or I've prioritized it so low that it just didn't get done (like taking trash out of the rooms for instance -- I don't like rooms full of trash and I usually go around with a trash bag and collect, but some days it's just not realistic.) But at the same time, I *know* I've done my very best to get what I've got done, and my patients are all alive and comfortable (the *most* important thing, right??)

And then my nurse manager will target me for having so much overtime. I like a big check as much as anyone, but most days after running around like I do, I'm *ready* to be out the door as soon as I can possibly get out. And I tell her so. She's even followed me around for a shift to see what *I'm* doing wrong. :( And wouldn't you know it, that day turned out to be an easy day, with a low census and nothing going on in L&D (we deliver around 600/year btw..we're rural) and she basically had no suggestions for me. And ever since then, it's this major stressor for me, trying to get out semi-on-time. My immediate supervisor can be very inflexible at times; she's a control freak...common knowledge at my facility. :rolleyes: And, my DON seems to be one of those people that doesn't want to hear about -- or recognize -- problems, they only want to hear how wonderful everything is. I don't know her all that well, but this is the opinion I've formed in the few dealings I've had with her (she's fairly new.)

So, I determined that one of the medications I'm on (an antidepressant) was not working for me anymore, and I've gotten that changed and we've all noticed a change in my general demeanor. I started taking better care of myself -- I had lost about twenty pounds w/o trying and while I can definitely stand to lose the weight, it just seems like a lot to lose w/o trying. My best friend (also an RN) says I need to quit and find another hospital with "adequate" staffing.

So, what is adequate? :confused:

The worst part of all is I *like* my job. I like most of the patients (hey, you can't love everybody), the doctors are fabulous (with the exception of one that none of us like), it's a very short drive from my home, and the pay is decent. I really like most of the people I work with, and sometimes stay over (off the clock, of course) just to chat when there's nothing going on.

Please, I welcome any suggestions (and criticism) for my problem. Like I said, I'm taking better care of myself than I had been and we got my medication straightened out, so it doesn't seem completely hopeless (as it did at one point and I was very, *very* depressed), but I am always trying to improve my -- and my patients' -- situation. And, thanks for letting a frustrated nurse vent. :nurse:

Specializes in LTC, assisted living, med-surg, psych.

(((((ADN2002)))))

Sounds to me like a disaster waiting to happen, with the staffing ratios you've described. I frequently float to the postpartum unit, and the worst I've dealt with was 4 couplets (thank God two of the babies were in the nursery that night so I didn't have to be responsible for their assessments, VS, feedings etc.). Most of the time I have 2 couplets, or a couplet and a GYN, or 2 GYNs and a peds pt. Sometimes they can be really busy, particularly when breastfeeding is going poorly or there are pain control issues, but for the most part the staffing is safe........a LOT safer than it is in med/surg, my home department!

You may want to consider looking for another position, as it is YOUR license on the line; even though unsafe staffing is often cited as contributory when something goes wrong, the individual nurse can be held responsible if s/he accepts the assignment anyway. It sounds like poor staffing is a chronic, rather than occasional, problem where you work. I sympathize with you on the overtime issue, too; I got ripped a new one by my nurse-manager a few weeks ago for the same reason (well, damn me for wanting to finish what I start and not leave a mess for the next shift to clean up!). The trick is NOT to take it personally; the manager got on you about the overtime because she has to answer to somebody else higher up the food chain about the overtime. And we all know cost-cutting is the most important thing in health care these days, don't we??

Good for you for taking charge of your life and losing weight, as well as dealing with your depression. That's probably the biggest favor you can do yourself.

Best of luck to you. Keep us posted on how you're doing, and if you need to vent some more, well, that's what we're all here for.

Yes, I'd have to agree that your unit sounds like a disaster waiting to happen. Ours can be bad but after reading your post, mine sounds lke a walk in the park.

I'd find another facility. You're new and are not heavily vested at all yet. Do yourself a favor and look around. You can do so much better.

E-mail me privately and I'll give you the address of the perinatal nurse list online. There are some wonderful contacts on there.

Betsy RNC

CT

[email protected]

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

What is UP with these lousy, horrible units people work??????? Seems a lot of this traffic around here lately. Is this the future of inpatient OB nursing or is this just a bad few units?????? I hope the latter is true, for Heaven's sake.....

I must be working in paradise. (reminding myself how lucky I am)

Where I work, we are an LDRP/GYN unit. We do about 75 del/year. We also take care of post-op gyn patients and the occasional level-2 nursery baby.

The average couplet load is no more than 3-4 per nurse unless it's an unusually busy day. We try to balance high-needs patients evenly (you know, ones who are recovering from PIH/Mag drips, fresh csections, etc). I just have to wonder, HOW CAN ANYONE GET DECENT CARE, teaching, etc when a nurse is assigned 6-7 or more couplets???? This is 14 patients!!!! Seems so unsafe and unfair for the patients and nurses.

I would look around for other opportunities. Maybe a smaller community hospital? . If this is the norm where you work, it's a disaster- in- waiting.

I wish you well. You have good instincts; follow them!

Specializes in Maternal - Child Health.

OK, this may seem completely impertinent given the other problems at your place of employment, but why in the heck are you on a code team? Does your administration fail to recognize that L&D is a CRITICAL CARE area and that draining staff from critical care is completely inappropriate short of an all-out hospital-wide disaster? Not to mention that you are exposed to God knows what in terms of infectious diseases and then returning to your new moms and babies to share CMV, chicken pox, etc.

Get out while the gettin' is good!

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

good points, jolie!

Originally posted by SmilingBluEyes

The average couplet load is no more than 3-4 per nurse unless it's an unusually busy day. We try to balance high-needs patients evenly (you know, ones who are recovering from PIH/Mag drips, fresh csections, etc). I just have to wonder, HOW CAN ANYONE GET DECENT CARE, teaching, etc when a nurse is assigned 6-7 or more couplets???? This is 14 patients!!!!

Whoa! Back up a minute. I'm talking about 6 moms only (or mixed moms and GYN surgeries or antepartum) - 6 patients only. When we do couplets, it's usually 2 or 3 -- I haven't even seen anybody do 4 at my facility. Never would I accept a patient load of 14 patients. Sorry I didn't make that clear. That does sound real bad when you think of it that way.

I did get good news today. My supervisor introduced me to a new RN that she's hiring for the night shift, a girl about my age (I'm 24) and she wanted to kind of hook her up with me b/c she knew I'd be able to help her find an apartment and get established here in town (I'm guessing she's from out of town).

Oh, and I know what you're saying about the code team thing, Jolie. That code I was in for so long the other day was for somebody with Hep B and MRSA (!) and I was having to assist with an art line and a central line (among other things, of course) and I was like, and I have to go back to OB? I went back and told my charge nurse that I could absolutely under no circumstances go scrub or circulate a c/s -- you can't take that crap into an OR!! -- and I was very careful the rest of my shift. I changed my clothes, but that irked me pretty good.

The hospital I work at is actually the small community hospital that is the best, and we're growing -- too big for our space, sometimes. The hospital in the next closest town is so small it doesn't even DO OB and the next closest one after that has some even more unsafe practices than those I've described (but they'd hire me in an instant, I hear...lol...b/c they can't seem to fill the positions they've got available - can't imagine why.) :rolleyes:

Sounds like staffing is a definite probelm at your facility. I believe our Mom/Baby nurses take a max of 5 couplets. But, they do not circulate or recover, only do postpartum care.

And our code team is ICU and CCU nurses only.

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