Do you have an OB in the hospital 24/7?

APL&D · Feb 4, 2015

I am sure there are still backwards hospitals out there in the country, but I think it is going towards having an in-house OB 24/7. I used to work in a small community hospital a couple of years ago, and last year they started requiring an OB present in-house 24/7. Not only do they have to be present, but they had to see all triage patients within 1 hour of arrival to the hospital. I think it is a law in some states and a standard of care. Sorry you feel so discouraged. Next time you interview for a job, make sure to ask questions like these. Good luck.

adpiRN · Feb 4, 2015

What drives me crazy is that the nurse manager and other nurses don't see this as a problem.

I guess if it's all you know....

They act like there's something wrong with me that this stresses me out. Like I'm less of a nurse. The nurse manager even called me "sheltered".

Not sure I want to ever work L&D again but if I do I will definitely ask these questions.

Live and learn....

Calinurse4 · Feb 4, 2015

That would be so scary! We have at least one resident and one attending 24 hours a day, usually several of each. It's all I've known but I would be terrified of not being able to act fast when things go bad.

adpiRN · Feb 5, 2015

Oh AND they actually had a stat for an abruption last week. Luckily on day shift and the OB was there. The baby did not do well and was transferred to a level IV NICU. If that had been night shift and we'd had to wait 20-30 min for an OB he likely would have died.

And even that didn't rattle the nurses and make them second guess the policy.

adpiRN · Feb 10, 2015

Still interested in getting more input on this! Curious if any other hopsitals out there function like this one. And how the nurses feel about it and where these hopsitals are located.

**LibraSunCNM, BSN, MSN, CNM** · Feb 11, 2015

I'm a midwife in NYC, no hospitals that I've worked in function like this! Ours is a pretty small public hospital, with no private practices. Everyone is an employee of the hospital. We have one OB on at all times (they do 24 hour shifts generally), and 2 midwives (we do 12s). No residency program. 24/7 anesthesia and peds coverage. It's not a perfect system but it works pretty well.

A new midwife I work with was a longtime L&D nurse at a hospital about an hour north. What she describes is pretty similar to what you describe---RNs do EVERYTHING, and call the docs when the patient is close to delivery. She is going to be a damn good midwife because of her experience, but it definitely doesn't sound like my cup of tea! And honestly, it's not even fair! If the nurse is doing that much independently, he/she is doing a lot of the work that the OB is billing insurance for.

pattywatty · Feb 17, 2015

Yes I started nursing 34 yrs ago and it was like this. Small hospitals had no dr,the nurses did everything. I worked nights newborn nursery, small community hosp. I lasted 1 year. Very unsafe. I was the only nurse with 2 aides in nursery on nights.

imenid37 · Feb 17, 2015

I worked at a hospital like you describe for 16 years. Drs did have to come in for epidurals. We were to call for a multip once she was 6 or a primip once she was fully. As a nurse, I learned a lot from doing a lot. It was a huge responsibility. In some ways, I miss it. Always something exciting. I think there is a happy medium. My daughter still works at that facility and they often have a CNM in house. The CNM's are a lot better about taking calls and looking at bad strips during the nite. Back in the day, we did not do our own C/S. I became their educator and we did do a practice drill and have a plan for starting a C/S under local. We also went in the ambulance on transports to higher level hospitals which were 20-60 miles away. Your whole team has to work together well to be safe. The team isn't just OB, but can include your supervisors, ED personnel, and other units. It is important to drill and to talk about the what if's... on those slow nights. When you have an adverse event, you need to carefully dissect it and plan what you will do "next time." If you really only feel comfortable with 24/7 providers, it isn't the place for you. There are things you can do to make it safer, but no matter what you will always have to be more independent than in a teaching facility. You do need to have protocols to which physicians are required to adhere. You need a gutsy manager and cooperative risk management and quality departments.

shortstuff31117 · Feb 18, 2015

Yes where I work is like this. Small community hospital, doing around 50-60 births a month. Mainly 1 group of OBs. It varies as to when they come in, or when they might actually stay in house. They don't come in for epidurals. This hasn't been an issue in the time I've worked there (8years). Not to say there haven't been emergencies, but somehow they seem to happen when the OB is there, or at change of shift when there is extra staff around.

Maybe it's "backwards" but it is what it is. I don't see it changing, at least not around here. I'm in WA by the way...

RNmom7 · Feb 19, 2015

I am from the Midwest and the facility I work at is just as you have described. It is scary, but also has made me a stronger nurse, IMHO. As previously mentioned, when a crisis occurs all hospital staff have to be a part of the team. I'm not sure however, if this is backwards. Rural community hospitals do not have the luxury of endless resources as do larger facilities. Our facility provides a service to women that can't afford to travel for prenatal care or birthing services, as many of our patients do not own reliable transportation. We also have patients who choose to deliver with us due to the holistic approach our midwives offer.

MotherToPeanut · Feb 23, 2015

I work in one of these hospitals. Our entire facility, not just the OB department, has 25 beds. We do about 180 deliveries per year. (No, that was not a typo.) We have three OB physicians to cover this hospital 24/7. This hospital could not afford to have an OB in-house 24/7. When we are fully staffed, we have 12 nurses to cover our department with two nurses per shift. Is it scary? Yes. As someone else already mentioned, this is the reality of living in a rural area. No, we are not backwards. This isn't all we know. Some of us previously worked at other hospitals, myself included. I took the job at this hospital to be closer to home. To get my foot in the door for OB nursing, I took a job that was 60 miles away and slept in an on-call room between shifts. That hospital did about 350 deliveries per year. They also had three OB docs and did not have an OB in-house 24/7. When a position opened up at a hospital closer to home (still 35 miles from home), I seized the opportunity. Yes, they do things differently here. Yes, sometimes it feels unsafe. We only recently convinced management (who do not really understand the realities of OB) that we NEED to have two nurses scheduled for every shift. For years prior to my arrival, it was a fairly common occurrence for a nurse to be here alone. Now, that's scary!

We do the best we can with the resources we have available. Communication and trust between the nursing staff the the OB docs is critical. The second one of the nurses feels something isn't right, they're calling the doc. The OB's usually don't come in for epidurals unless anesthesia has a concern. For multips, the docs usually come in when they're around 5-6cm depending on their progression and previous labors. For primips, they usually come in when they're 8-9cm. In this environment, everything is a case-by-case basis.

Working in a hospital like this isn't for everyone. We have to be a jack-of-all-trades. We have to know antepartum, L&D, postpartum, nursery, and GYN surgery. We try to be as prepared as we can. We are the only hospital in this county. Some neighboring counties have no hospital at all so some of our patients drive 30+ minutes to get here because we're the closest. These patients deserve the best care we can offer. It would be nice to have an OB in-house 24/7. It would be nice to have anesthesia in-house 24/7. When you work in a facility that routinely has stretches of several days without an OB patient, with only 3 OB's to share the responsibility of coverage, it just isn't feasible to have someone here 24/7.