Staffing concerns

  1. I am a L&D nurse that works in a small rural hospital. We do about 35-45 deliveries a month and have a level II nursery. Our hospital and nurse manager is constantly putting pressure on us to work with the least amount of staff that is posible. L&D, PP, and nursery are very close to each other and we are normally staffed with one nurse per unit. I work nights and if we have a low census our nursing staff drops to 2 nurses. Not all of our staff is crosstrained to L&D, although we are trying to accomplish this time consuming task. Sometimes I am the only one working with labor and delivery experience. I have voiced my concern several times to our manager, whose response is, "that's why we have an on call nurse". However, some of our on call nurses live 45 minutes away and are also not l&d trained. Does anyone out there also work in a small rural facility and is willing to share info on their staffing? I would really like to hear how other people deal with this situation (if there is anyone else out there that is as crazy as me for working "all alone"). Also, because we are so small we do not have in house anesthsia or in house OB's.
    •  
  2. 11 Comments

  3. by   Doey
    I work nights in a community hospital and although I work critical care, we sometimes float to our birthing unit. We have a nine bed L&D/PP unit and a level II nursery. There is always without exception someone in the nursery, usually an RN but can be an LPN. Our LPNs for the birthing center are cross trained as OR techs exclusively for emergent/scheduled C-sections and everyone is trained in L&D and PP. All mothers give birth in their rooms. Our usual night staffing consists of 2 or 3 RNs, if two then an LPN is schuduled also, if 3 RNs then an LPN is on call for any sections or also may be on duty if real busy. There is always a secretary at the desk and always without exception an anesthsiologist on call or on the premises and everyone on call must be within 15 minutes of the hospital. If the census is low we can sometimes be staffed with 2 RNs and a secretary, but as I said everyone is trained in both L&D and PP. Hope that helps you.
  4. by   Pamela67
    I work in a facility that does around 500 to 600 deliveries a year. We have a level II nursery. You are not alone! They are wanting us to have only one RN and two LPN for a base staff and float the rest of the nurses, or nurse, out to somewhere else in the hospital. Sometimes we don't even get that nurse back. We don't have in-house anesthesia or OB doctor at night. We just have an in-house intern and the ER department. We also have several nurses who live 45 minutes or more from the hospital. All of our RN's do L & D, postpartum, antepartum and nursery. The LPN's do postpartum and nursery. We are going through several changes in our department and it has been very stressful. The most important issue I try to remember is the patient safty. Just recently I refused to start a pitocin induction on a patient while I was in the middle of a delivery. Believe it or not the physician was upset. I did start it about 1 1/2 hours after it was going to be started initially. I just did not feel it was safe to start an induction that I could not watch. There was no one else to do it. This induction was elective. She just lived one hour away and had a history of fast deliveries. Good luck with your situation! It is nice to know that I am not alone.
  5. by   gcrhodenrnc
    I know where you are, about 6 years ago when i came to work at the hospital i now work at, we only had 2 RN's on at night. I can't tell you how many times, we had near misses and God must have been looking out over us. One night when there was just the 2 of us, we admitted a lady 34 weeks ruptured, irreg ctxs, not laboring. Over the next several hours, this pt went to 9cm/and it was discovered she was breech, no doc in house. We immediately called the doc, and our call person who was about 55 min away. The doc came in demanding that both RN's come back to the OR for possible C/S if vag birth couldn't be performed. At the same time a triage pt came in bleeding, appeared stable, put her on the monitor, what few minutes she was there baby looked good. I ran back to the OR with the other RN, did the delivery, thank God went well, vaginal breech. left that delivery quickly, went back to triage to find my pt pushing, stopped her from pushing as her boyfriend said she was told last night that she would have to have a c/s due to herpes. My heart went to my feet. The other doc had already left. The other RN was transporting her fresh delivery back to her room, the call person was not there yet. It was God that got the doc there in time to do the c/s. However, the other nurse had left her deliverd pt and newborn (never recovered)to scrubb the c/s. All turned out ok, however, it could've been bad. When I discussed it with the L/D manager at that time, I was told....but see, it all works out in the wash... In the mean time, I was a nervous wreck. About a month after that, we had 1 lady pushing about to deliver, when a midwife & MD came from a local birthing center with a baby in fetal distress, The 1 RN was pushing with her pt, the other went to set up for the c/s. This left the midwife and MD to prepare the pt for surgery, the baby came out pretty bad at first, but later did ok. It was at that time, that MD went to the hospital administrator and complained and he demanded that we at least have 3 RN's (L/D) qualified, in house at all times. Sometimes it takes the MD's to talk to them to get things changed. We are still so thankful to this doc. For the few of us that are still there, we recall those days and refuse to ever go back there.
  6. by   BugRN
    Oh my God, it's just like de ja vu!! I thought my last L&D job was the only unsafe place to practice! Isn't it amazing we pull off nights like described above and survive!!That our patient's do ok??? Unfortunately it's because everything turns out ok that these horrible situations still occur. A suggestion is to have only nurses who live within 20 min. of hospital be allowed on call. It's ridiculous to get help from someone that far away. Esp. in L&D when you need help imed. I finally had it when they brought in the Hep. drips to post partum and took out the rn from the nursery and made the PP RN do both areas at once w/ only an aide or LPN if lucky. We were also a comm. hosp w/ 600 del. yr. also expected to do our own c/s as well. Why do we let our managers get away with it?? and why are there always the martyr nurses that put up with anything for fear of complaining??
    No good complaining anymore, I'm gone from a job I loved because I was too scared of going to work anymore. It should never get to that point.
  7. by   rdhdnrs
    These posts just infuriate me, especially when we read them along with the "how much do you make?" postings!!!! We're paid not much more than fast food workers yet put ourselves on the line everyday for people's lives.

    What can we do to change this? Get MDs on our side? Mass walkouts or demonstrations? Any ideas?
  8. by   Jemma
    here's our rule: (50 deliveries per month give or take)
    bottom line rule is that we must have 2 nurses in the department at all times trained in l&d. if there are 4 on days and we flex down to 3, that nurse can be 40 min away, if there are 3 on off shifts and we flex down to 2, that third nurse must be within 20 min of the hospital or take her call time in house sleeping in spare room. occasionally we staff the pp area with a orientee, float, or nursing instructor not trained in l&d, in this case she is always on call first if she is on with only 2 other nurses. we recently closed our unit, we take turns taking 24 hours of voluntary unpaid call every month where we will come in extra when all heck breaks loose, in exchange for not be pulled to med surg, we don't have floats on pp anymore either. this vol. on call time for times of increased need has an obligation to be here in 40 min. as the dept already has base staffing.
    valene (val@svol.net) i am using my friend's computer (another member)
  9. by   Jolie
    Dear All Alone,

    How do you handle emergency C/S's on your shift? I mean the true emergencies, like cord prolapses that can't wait for the on-call nurse?

    I've worked in some very small hospitals (less than 100 beds), but have never experienced this type of staffing before. It scares me!
  10. by   wlnbrg
    Small community hospitals are sometimes scary places for L&D nurses to work. At the one where I FORMERLY worked, 1 OB nurse was required to be in-house at all times. If OB was closed, she was required to work med-surg or ER. A 2nd OB nurse was on-call and had to respond within 30 minutes. No in-house OB doc and the 1 CRNA on staff lives 45 minutes away. If there was a laboring pt. at night or on a week-end, 1 nurse was there - nobody else in the unit! Talk about scary and unsafe! Of course day shift during the week had the dept. manager and other ancillary staff available. At night the nurses also cleaned the room after delivery - no housekeeping staff available at night! And they wonder why they can't keep nurses?!?! Placing a mom and baby's life at risk all in the name of the almighty dollar.........
  11. by   RNKitty
    Last June I left a CNY hospital for the poor staffing. Same scene: Level II nursery, 40-50 del a month. The manager posted the schedule with me as the only nurse for eve shift two Fri's in a row. I brought it to her attention twice. When I came on that Fri, I was left on eve shift with 2 labor pts, 2 PTL pts, full pp floor, a float who had never been to our unit before and a per diem ped nurse. They had to run the pp floor by themselves (I was in charge, of course, since I was the regular staff member - and I had only been there 3 months). The pp floor and L&D are geographically isolated. I called the supervisor before day shift left, and told him in front of everyone that I needed another L&D nurse. He shrugs. Days leaves.

    After 4 hours, I have sent the PTL's home, assisted and recovered the labors, and started cleaning up the mess (no housekeeping of course. Then the multip walks in, delivers precip in the tub (mec of course), and hemorrhages 1800 cc after I get her back to bed. No-one died, but if she had come in 2 hours earlier... Not even the supervisor was qualified to do neonatal resus.

    The next day my manager had my resignation. Her comment about my concerns about staffing and pt safety? "Well, we ARE in a nursing shortage." That's right, so by the laws of supply and demand, I can go elsewhere to work. And I did.
  12. by   jananurse
    WOW! Although it doesn't make things any better, it's comforting to know others are in the same situation as I am and trying to cope for the patient's sake as I do. I am a Level II Nursery nurse and have been for over 18 years. I've only worked in 2 hospitals, was the nurse manager for 11 years in the first one. When we moved and I became a staff nurse again I couldn't believe the sense of freedom I had. Now we have >850 deliveries in a county hospital with 3 nurses regularly scheduled for night shift (which is what I work-7P-7A). I work with nurses who have been out of school 2-3 years and for the most part am impressed by their abilities and coping skills. The last night I worked I started the shift with 8 babies (no help in Nursery), one of which had a uvc, was receiving blood, under oxygen but stable. Had a new baby to admit and two on the way. At 11PM I got an "old" Nursery LPN to help (God bless the "old" LPNs) and the rest of the night went fine, even with two more admissions. The RN on the floor had 2 Rehab LPNs to help her and I worried about her all night, but she is such a trooper, a wonderful young nurse. My Manager knows, but choses to put her head in the sand and not face up to the risk we are taking. God bless the nurses!
  13. by   RNKitty
    And God Bless the NICU nurses! I'll take care of them in utero, but I really LOVE to see a good NICU nurse at a delivery gone bad. You just can't trade a body for a nurse with specialized skill and experience.

close