staffing

L&D_RN_OH · Sep 13, 2003

Just a question, what would happen if all your pts were complete at the same time?

IMO, 3 laboring pts are too many for one nurse, especially if they are on Pit. We generally only take one laboring pt each, two at the most, and that's if one is early on in labor.

SmilingBluEyes · Sep 13, 2003

UNSAFE UNSAFE UNSAFE----no, honey DO NOT "suck it up"....or it will SUCK YOU UP.....let me tell ya------

3 STABLE pit-induced laboring patients is too much!!!!!!!!!!

but you are talking about UNstable patients in the mix. (oligo can be VERY problematic for baby-----

How do you watch and evaluate THOROUGHLY 3 strips????? I don't think you CAN, do you? I know I could NOT and I have 6 years' experience in labor and delivery.

Nope, would NOT work for me----I would not take such a heavy assignment.

Clearly, the patient care there is suffering greatly if this pattern of staffing is the norm and that would concern me greatly--along with dangling my license over the litigation flames----

OB is one of the most, if not THE most highly litigious areas of nursing.

Another concern I have:

You got a very inadequate orientation, it sounds to me, and have been given a very short end of the stick. 6 weeks???? Hmmm...very sad. I am so sorry to see you treated this way. Sorrier still to hear how bad patient care must be where you work. Think if those were your mom, sister, daughter in such care. How would you feel????? Sounds as if you are VERY conscientious and KNOW this is not right.....your instincts are correct! Ok so whaddya do????

A couple of things come to my mind:

Speak candidly with your manager about your grave concerns regarding unsafe staffing policies/nursing practices and let her/him know you won't practice unsafely.

Or walk......

WE all have had "those days" where the LABOR BUS pulls up and we are overwhelmed...yes we do. But IT SHOULD NOT BE THE NORM ---if it is, you have a real problem on your hands and...

Trust me, this is NOT safe practice---and your inexperience in OB makes it only more dangerous.

I wish you well, whatever you decide to do. BUT DO SOMETHING, or you may very well end up regretting it. You are right to be concerned! Good luck!

kimmicoobug · Sep 13, 2003

At my facility, staffing ratios are pretty good. Labors are one to one. If by chance a nurse has to take two labors, it is not for very long. A nurse is found somewhere, anywhere. In fact, we had this scenario last night. I got called to work OB because there were two labors going at the same time, and only two OB nurses. So, me and a float had the PP end of the unit with four patients each.

fourbirds4me · Sep 13, 2003

Our induction protocol says "no more that 2 pit patients per nurse" But I rarely see this happen we usually only have 1. We do q 15-30 minute vitals on pit patients depending on condition and stage of labor so there is really no way we could do 3 and definately no way to do it safely!

fergus51 · Sep 13, 2003

Amen to what deb said! I have taken 2 stable laboring patients, but that was a rarity. One is the safest and best way to provide care.

One tired mama · Sep 15, 2003

Thank you so much for your advice and words of encouragement. I wish I could say that this situation was unusual where I work, but it's not. In fact, yesterday (one day later), I had 5 couplets (with 2 moms and 2 babies on IV abx) and also had to watch a laboring woman on Pit while her nurse was in pushing with another patient. I've moaned and groaned but the only response I ever get is "you're doing a great job though." Did I mention that I have never received any formal training on FHT monitoring nor am I NRP certified yet? It just stuns me that the powers that be felt that this is type of staffing is appropriate.

I will do something about it...I just needed some advice from expert OB RNs before I went forward. Thanks for providing that and letting we know I'm not just a whimp. I'll keep you updated.

SmilingBluEyes · Sep 15, 2003

WOW YOUR SITUATION IS SCARY!!!!!!!!'

for both you and the patients.

I would get OUT.....

If you are inadequately trained AND over loaded, that spells POOR patient care. I would not want to be associated with such a place, period.

Perhaps it's time to go job-hunting.

Everywhere I have worked, NRP is required PRIOR TO EMPLOYMENT----

And no one takes on a patient load like yours.

Sounds like hell to me...

Good luck to you. You instincts are good, your good conscience and care ARE needed elsewhere. I just feel so bad for the patients there......it's a crime.

AmberL&D/RN · Sep 15, 2003

I agree 100% with the other posts. Maximum 2 pit inductions at one time, NRP required prior to coming off orientation (which by the way should be a minimum of 12 weeks) including intense training on EFM tracings.

Amber

CIVICgalz · Sep 17, 2003

Honey, where is this happening?? Third world hospital? Please don't say this is a North American standard!!

nrsnan_1 · Sep 17, 2003

2:1 patient nurse ratio in first stage of labor, 1:1 second stage is ideal. Sometimes, situations like yours will occur but that is the "full moon" days. I cannot imagine having only 6 weeks of orientation to labor and being cut loose! NRP is the minimum standard. It is best to actually have some hands on experience with depressed babies as an orientee with an experienced preceptor before actually having to deal with it alone. You and your patients are in a dangerous place.

I worked very briefly in a facility like that. It took me all of 3 months to ditch that place. I hated to quit because I am not a job jumper but it made my heart hurt. The patients were stuck in rooms on monitors and watched from a central system.

nekhismom · Sep 17, 2003

I'm not a L&D nurse yet, but all of my clinical sites had 2:1 in early stages of labor and 1:1 late stage/pushing. All of the positions I have inquired about and interviewed for also state these ratios. I have been told that NRP is required within 1 year of hire. That sounds like an insanely long time to me and I am praying I can get it before orientation ends. The timeframes for orientation that I have been told range from 4-8 months as a new grad. Not sure how long it would be if I had experience, but I would imagine 4-6 months would be a minimum since L&D is a specialty area. Good luck to you! I hope you find a better department.