Critical Access: OB/MedSurg

[OBRN91]

I work at a small 23 bed critical access hospital that includes ED, labor and delivery, special care nursery, adult special care unit, medsurg and full OR services. Currently we have 1 inpatient nursing supervisor that oversees all L&D and medsurg staff. Whenever L&D is slow and medsurg is short, they always pull an OB nurse to the floor, lately it has been expected that an OB nurse be utilized on the floor, and it has put OB short. We staff L&D according to AWHONN staffing guidelines. I am looking to see how other small hospital with an L&D unit staff their units as well as floating policies. We are too small to be extremely specialized, but not just any nurse can float to L&D and take patients like L&D can float to medsurg.

[MC RNC]

Your situation sounds exactly like ours. And.. it's frustrating to float out to a department where you are not familiar with routines, meds, procedures etc in the ED and M/S areas, and in return you don't get help from them when your are in need of help. We have attempted to implement cross-training between all departments in the past and are again trying to do that but get push back when it comes to them learning OB, so leaving the OB nurses being called in extra when busy, and not able to get caught up stocking etc in our down times. One thing we have done is for the OB nurses to not have to carry a patient load and be task only, so we are free (kind of) to return to our department when a patient arrives. We do have house supervisors that also can be called to the area of highest need and coordinate the hospital with one persons overall view of the situations of the facility. Its a catch 22, budget vs patient safety/liability vs staff satisfaction.