Am I just being a baby?

[nicki23]

I don't normally post but have enjoyed reading this forum for several years. I have come to a point in my career that I'm at a crossroads and would like to ask for opinions on my situation. I have been an RN working in mother baby for five years. I started working my current job four years ago. Initially everything was great. We had great staffing, good leadership and I loved my job. Over the last year though, things have taken a turn for the worst.

We are pretty busy, delivering about 250 babies per month. We take care of high risk antepartum and postpartum on our floor. When I first started, the nurse/patient ratio was about 1:6 which was very doable. We do total care on our floor, no techs or CNA's, no secretary past 3pm. Everything falls on the nurse to do. Assessments, vitals, blood draws, PKU's, serum bilis on all babies, hearing screens, heart defects screening on all babies, nutrition care (making sure patients ordered their meals, passing out/picking up trays), security for the floor, cleaning, setting up rooms, in addition to all the teaching that comes with working this specialty. If we are working with an LPN, the RN must still chart all assessments (our facility does not allow LPNs to chart a full assessment), but the duties can be split which makes things much easier.

The thing I'm most concerned about is that we have become severely understaffed with no plans to hire new nurses in the near future. I have started to feel that my license is in jeopardy nearly every day I work. Most days we start with 7-8 patients. I have had as many as 9 at one time by myself. We rotate charge nurse duties so I take charge at least once a week, sometimes twice. Charge is expected to take a full patient load (up to 8 patients) in addition to the extra charge duties. We have the chores that don't take too much time like stocking supplies and checking the crash cart. But it takes up time to coordinate admissions with L&D, work on staffing for next shift, make all baby appts before they can be discharged, and be a resource person for other staff. There are days when I am charge with eight patients, discharge a couple, have several admissions, and have had a new grad preceptee to train. And no it's not just me, all of my coworkers feel like this is dangerous and that something bad is bound to happen. Everyone with experience is leaving to find other jobs. At times I go to work and I will be the most senior nurse on the floor working with four other nurses that all have less than a year experience. Does that sound unsafe to anyone else?

I guess I want to ask if you all have similar work environments? I don't want to leave here to find that it's the same everywhere. Maybe I'm just being a baby and need to suck it up. But I just feel so stressed and unhappy every day. I want to at least like my job most days. Any insight would be helpful. Thanks.

[BSNbeauty, BSN, RN]

This is crazy ! I would leave ASAP. No techs??? How is one nurse supposed to do all of this. Our tecs do V/S, serum bilis, and PKU/Hearing screens.

[BSNtraumaqueenRN]

The situation you describe sounds unsafe! If you feel so stressed and and are worried about your license it sounds like time to move on!

[LibraSunCNM, BSN, MSN, CNM]

When you say 1:6 do you mean you have 6 couplets? Or just 6 moms? We do couplet care and try to stay within AWHONN staffing guidelines, which recommend 1 nurse to 3 couplets. If we have several sick calls and end up short, sometimes we're "grouped" with a patient care tech, and given 6 couplets, with the PCT doing all baby vitals, hearing screenings, PKUs, weights, etc. Our PCTs are generally pretty awful so luckily this doesn't happen too often, only when unexpectedly short. We rotate via a logbook whose turn it is to be in a group when the need arises. I also worked temporarily at a hospital that didn't do couplet care, so you were either in the nursery responsible for 6-7 babies, or on postpartum with 6-7 moms. Workload-wise, that wasn't bad at all, as the techs there were much more helpful but I still certainly prefer couplet care. Your situation sounds bad! Is there any possibility of looking elsewhere?

[debsgreys]

Sounds unsafe. We do postpartum / nursery at present. Usually 4-5 moms, no techs. We are working on becoming baby friendly so we are suppose to go to couplet care, praying for 1-3 not 3-4. Especially on day shift with so much teaching to be done and discharges that can consume so much time.

I really don't know what to tell you to do, but it certainly is not fair to the pt

[catfac]

Do you have a union at your hospital? Do you have a staffing committee at your hospital? Work for a staffing guideline. Such as the AWHONN recommendations. With the rise in healthcare costs we are all being faced with increased work load. You can file unsafe staffing reorts with your state board of nursing. Have you talked with your manager? You have Four years invested, work for changes. Encourage using national standards of care.

[nicki23]

Thanks for your replies. Just to clarify, we do couplet care. So 6 patients is 3 couplets, or any mix of antepartums, couplets, and postpartum readmits. But because we are so short staffed there is really no accounting for acuity level when the assignments are made. A nurse could end up with a complicated antepartum, and 3 or more brand new couplets.

We do have staffing guidelines that were put in place a while ago. According to the guidelines, an RN is supposed to be able to take 8 patients. But we don't have the power to stop taking admissions from L&D so if they are busy and need to send patients over we have no choice but to take them even if every nurse is already maxed out. Our head nurse is very aware of the situation and has tried to be empathetic but says her hands are basically tied. She does try to pitch in and work the floor sometimes but is usually busy with meetings. The leadership above her is aware as well. Letters have been written, the issues have been raised during committee meetings. The problem is that according to the acuity/staffing computer program that we use we have adequate staffing to handle the workload. We have told them over and over that the acuity program does not accurately reflect the amount of nursing care hours (especially teaching) that we provide but they don't seem to care.

I really feel for our patients. We just don't have the times most days to provide the best care and teaching that they need. I just don't want to see anything bad happen to one of our moms or babies because we were too busy to care for them properly.

[Elvish, BSN, DNP, RN, NP]

Does risk management know about this? It has been my experience that kicking something to them gets results faster than just about anything else.