AWHONN guidlines??

[KellNY, RN]

Reading another thread got me to thinking--where can I find AWHONN guidlines (specifically r/t antepartum)?

I've searched this forum, and I've seen anywhere from 1:6 to 1:4 to

Antepartum/postpartum:

1:6 antepartum or pp pts without complications

1:2 pts in postoperative recovery

1:3 antepartum or pp pts with complications but stable

My facility is a 1:6 ratio--we have 12 beds and no more than 2 RNs at night (if we have 3 RNs on, except from 7p-11p, where eves and 12h nights mix, one RN will almost certainly be floated). Nights never has a clerk, and sometimes has a 4hr aid (a CNA doing ot-she'll come at 2330 and leaves at 0300).

Now granted, we can only have 1 pt who requires constant observation (ie fetal monitoring), but it would not be unusual to have one Pt on con't monitoring (cervidil) who has GDM and needs a FS q4h, plus a pt on Mag with q1h vitals, plus a PTL/Previa in t'berg with a foley on strict I&O (or worse-on a bedpan), plus 2 pre-eclamptics on q4 BPs and I&Os, then to get an admit of a PPROM on q4hr Amp and q4hr temps and q6h Procardia PO.

Then God forbid your cervidil decels, or a previa bleeds, or your pre eclamptic spikes BPs or flares up, or the PPROM prolapses, you need to leave your 5pts with the other RN (who'll take care of all 11 while you're gone-from 5-20 min!) so you can wheel your Pt down to L&D which is 5 floors down.....Then an hour later, that bed gets filled with a s/p trauma Pt who needs con't fetal monitoring x6hrs.

This doesn't seem like safe practice to me. Even an aid, who can do Pt transport, call admitting to transfer pt to L&D (yeah, we have to do that too), get the chart together, etc....Nurse Manager says no need-no reason we can't do that.

To top it off, day shift (who have 3 RNs, plus an aid, plus a clerk) will chew you out if you don't empty the linen basket, or forget to total an I&O sheet. L&D will chew you out if you bring a Pt down without her stupid Education sheet (because you had to rush because her baby was decel'ing into the 50s...sorry, I didn't realize that you need to verify that I explained TV rental policy before you do the stat section:uhoh3: ).

It just doesn't seem right. And don't get me wrong, I love my job. And there are nights when I might have 3 Pts-one just on "therapeutic rest" before her pit in the am, and 2 stable shortened Cx's....but our clinicians and NM use this against us-- "Well, last night you had 3 pts and probably played cards all night--nothing wrong with doing a little work":madface:

Thanks for letting me vent....any advice (besides "get outa there")?

kellny

[crissrn27, RN]

In ALL of the situations you described, I mean EVERY SINGLE ONE, we send to L and D, where they have 5 nurses on every single shift.......and usually 1-2 pts per night (days usually have more).......now I'm not saying they shouldn't have 5, they get emergencies that need that many........so does the nursery where 3 nurses are the norm and usually have 6-8 babies. The only antepartum that stays on the floor are very stable moms that probably will go home soon.........or maybe a hyperemesis. Now it sounds like you work in just an antepartum floor, but you still need to have SAFE ratios. You have to fight to get safe ratios instituted if you are going to stay there. Sooner or later something very bad will happen and guess who will get the blame? Maybe just being this blunt with the NM or whoever, tell them someone is going to die, or get hurt and then you guys are going to get sued........flat out tell them this, maybe it will open their eyes.

NO ONE on mag, with an active previa, or a trauma, needs to have a nurse with 5 other pts..........regardless of how many she/he had the night before! These, by there very definition, are example of unstable pts! Who decides, at your hospital, who is unstable? Doesn't sound like that is being handled correctly. I would not take more than 2 pts with the above conditions, it just isn't safe. And those 2 better be in side by side rooms with someone available to take 1 if the other goes down hill. You are not superwoman, and can't be in 6 rooms at once. Someone is going to end up with a dead baby or mom. I am so glad you realize something needs to be done, and are willing to do it!

[Elvish, BSN, DNP, RN, NP]

I do not have any words of wisdom for you, KellNY. Just saying that I think you're right to be concerned. For the life of me, I can't imagine why anyone would think the combination of patients you describe would be safe. Where I am we do AP/PP together but they really try to give just 1 AP to each nurse. When APs break, it takes up SOOOO much time. Is your NM aware of the AWHONN guidelines? If not she should be. Your license is on the line should something go south. You may end up having to vote with your feet, as they say. Keep us posted please. Hang in there!!!