Staffing question

palesarah · Oct 3, 2005

We never staff with fewer than 2 experienced/skilled nurses, and I think usually keep at least 3 nurses on. I can't recall a night where we didn't have any patients at all, but can thin kof at least 1 night with just 1 patient, and we staffed with 3 nurses (two experienced, and me, who was just off orientation). I agree with your coworkers who feel it's a big liability to only have 1 nurse on.

fourbirds4me · Oct 3, 2005

What do you do when an emergency walks through the door. How do you handle stat sections... prolapsed cord... abruptions... precipitous deliveries etc...

SmilingBluEyes · Oct 3, 2005

We MUST have two NRP-trained fully qualified L/D nurses in house 24/7. That is our policy and it has been sorely tested many times. We can go from "zero to 60" in short measure, meaning on the rare times we have no patients, we can have suddenly have 2 or 3 actively laboring patients or true emergencies be wheeled in at any given time.

I came from a rural setting where we did only 25-30 labor patients a month. The way they handled it was, we had to be in house 24/7, immediately available to L/D. We were obligated to "float" to help out on other floors, usually ICU/CCU, or the ED, just doing PM cares, starting IV's and passing meds we were familiar with. We were also their "gophers", if you will. We were not assigned a patient load, in the case we had to report to L/D immediately. But make no mistake, we were never out of the house, despite there being no patients on L/D. We were called on more than many occasions back to L/D to handle a case that suddenly presented. You do NOT want to be without properly-trained RN's in a place that does L/D at ANY TIME.

Where I am now is also a smaller-sized community hospital-----delivering only about 70 or 75 babes a month. As I said, there is the option of "floating", if they do not want you sitting around, doing nothing all night, but you BEST have two well-trained and fully qualified nurses in house at all times, (with a 3rd on call as backup) cause, as you know, you have no way of controlling or predicting what walks in or is wheeled in, next.

midwife2b · Oct 3, 2005

I once worked in a small hospital that did about 60 births/month. There were two fully credentialled RN's in house when there were no patients, with a third RN on call. All patients had to go through the ER, and the ER doc was NRP certified. One RN floated, the second stayed on the unit and did our neverending cleaning and paperwork.

Even if we were busy, there were times the OB docs were not in house. Going through the ER let the doc know who was in house because he was supposed to be called in the event of an emergency with no OB around. For the most part it worked for us, but our ER docs always let us deliver the babies :)

broncopooh · Oct 3, 2005

I guess I shouldn't have said I am okay with the only experienced L & D nurse in the unit, I'm comfortable with it, but would love to have another experienced OB nurse in house and can see the risks. I've worked at the same hospital for 15 years and we've always done it that way(no patients, one RN). The reason I posted the question is we are trying to get admin to allow more staff, because they usually won't allow 2 RN's to be there, either 1 RN alone or 1 RN and a CNA.

Jolie, BSN · Oct 3, 2005

The units where I have worked were staffed as Deb described. One RN on the unit at all times, regardless of whether or not there were patients. A second RN available in house to return to the unit immediately when a patient arrived (High -risk, or low-risk, it didn't matter.) That RN could not have a patient assignment on another floor since it wouldn't have been possible to dump her patients and run, so she did "tasks" to help out on another unit.

If your institution is not willing to keep 2 L&D RNs in house at all times, then I personally think they ought to notify all prospective patients of that fact. When patients trust us for care in labor, we are obligated to live up to that trust. Not having adequate staffing AT ALL TIMES is a blatant violation of that trust. I'm surprised that your OBs and their malpractice carriers will sit still for such staffing!

babyktchr, BSN, RN · Oct 3, 2005

Although the days (and nights) of no patients is few and far between, we always staff 2 RN's and one on IN HOUSE call. Period. We had been caught with our pants down because of hospital politics and well...the do do hit the fan. Now we have policy and I have no problem making that known to those who want to challenge it.

SuzieQ_Scrapper · Oct 4, 2005

I work in a small rural hospital where we have approx 50 deliveries a month. Ocassionally we have no patients. My question is about staffing when there are no patients as it has become a big debate in our department.
Some nurses don't mind sitting in the department alone, with an on call nurse anywhere from 5 to 25 minutes away. Other nurses think it's a big liability and if an emergency should walk in and you are the only one, it could jeopardize your nursing license.
I don't have a problem with being the only nurse on staff, because there is always a nursing supervisor on duty to call until your second RN arrives. We also have an in house ER physician who could also help.
What do other hospitals do in this situation?

I work in a rural hospital that delivers approx 30 babies a month. We always staff 2 RN's or 1 RN and 1 LPN (we have only one LPN and she has been there forever!). If there are no patients we try to catch up on stocking, or whatever else needs to be done. Then we do whatever we need to do to keep awake:rotfl: . We always have a 3rd RN on call as well. We do not float to other departments ever. We stay in our own world--ready for that unexpected labor (that hasn't had a chance to be induced yet:p ).

babynurse2001 · Oct 6, 2005

I work in a small facility that does 20-30 births per month. We have 2 RNs scheduled per shift but if the unit is empty or we have just one stable mom/babe we just have one RN with the second on call, meaning they have to be able to arrive within 30 minutes of the call. The rationalle from management is that the house supervisor and ER doc are immediately available should something walk in emergent and they can help until the second nurse arrives.

Now, I have thought for years that this isn't safe but I can't convince anyone of this, even many of my fellow nurses. "It's how we've always done it", "but I LIKE to be on call sometimes", are common responses from my coworkers. So do any of you have any suggestions as to how I can work to get this changed? No point telling me to look for another job - it's the only game in town and I like it there, not planning on moving to another city with my whole family.

Any suggestions?

RNnL&D · Oct 6, 2005

Now, I have thought for years that this isn't safe but I can't convince anyone of this, even many of my fellow nurses. "It's how we've always done it", "but I LIKE to be on call sometimes", are common responses from my coworkers. So do any of you have any suggestions as to how I can work to get this changed? No point telling me to look for another job - it's the only game in town and I like it there, not planning on moving to another city with my whole family.
Any suggestions?

Granted, I work in a larger facility, and we NEVER have no pts. But, on a rare weekend, we might only have two patients. We used to minimum staff with 3, with one on call. ALWAYS 3 in house. Until one night, when we had an emergent CS with 3 nurses on. 2 were in the OR, the other was in the station having a hypoglycemic episode and passing out when OR was calling for assistance. OK, so that's probably a very rare occurence. BUT, we now have minimum staffing of 4 RN's every shift, even if we only have 2 patients.

How did we get it to change? The docs insisted on it for pt safety.

SmilingBluEyes · Oct 6, 2005

You can only point to ACOG and AWHONN standards for your staffing decisions. Either management will comply or not. Then you have to make the decision whether to stay in an unsafely-staffed unit or not. Not much more anyone could do.