Elective procedures and staffing.

[crysobrn]

At our hospital we do approx 400-450 deliveries a year. We seem to be doing more and more elective procedures. It's common for women to be induced at 38.5 weeks for no specific reason. As well as primary and repeat c-sections. Of course these are all scheduled during the weekdays and it's taxing on our staff and resources. We only have 3 labor rooms so obviously it's a problem to do 2 or 3 elective inductions on one day but we continue to do it because we have no back up from administration.

I'm wondering if anyone has a protocol for how many elective proceedures can be done on one day. How much staff is required etc. Does anyone use the consents that the dr must provide a reason? We've seen these and provided them to our director but they have yet to be utilized.

Unfortunately we are down to 2 OB's so they are constantly at battle for "getting (their) girl done" which seems rediculous to all of us. We can only do so much and believe me we do what we can but we are constantly put between the dr's and then they're mad at us and not eachother. Thanks

[GingerSue]

Nurses can only agree to do that which can safely be done.

Doctors and hospital staffing administrators also have responsibility for ensuring that safety can be maintained for these patients, and they also have responsibility for not putting their patients into unsafe situations.

The doctors should not be mad at you the nurses, nor at each other.

They should be working with the nurses and with the administrators to ensure safe conditions for their patients. Are the patients made aware of any unsafe conditions related to inadequate staffing in the facility?

What do you think would help here?

And if the hospital isn't going to provide staffing for safe nursing, then admissions can't be accepted. Who speaks for this?

[crysobrn]

I agree... we can only do what is safe. We can refuse to insert cervidil or start pitocin but the dr's are still sending the patients in with no regard for what we have to tell them. Then the patient is sitting there all night or all day with their sig other and family, they've arranged child care etc and pretty soon they're mad. I've told patients that we have to hold off on an induction because there is no labor room available... that's the safest thing I can think to tell them.

I guess I was hoping to find out if there are hospitals that actually have a protocol. That way we could have it in black and white that we cannot do more than a certain number on a certain day. That way we can refer to the protocol rather than it being the nursing staff arguing with the dr's. During the incident last week the nurse said to the dr who was trying to schedule the 5th elective procedure for that day that there was inadequate staff... and he responded "staffing is not my problem" We of course think that it is his problem because they are his patients too and we can only provide a certain amt of care if there are hundreds of things happening at once. Not to mention that anything could come in at any time... that is also conveniently overlooked.

[tntrn, ASN, RN]

We have at least one crybaby doc too, but it happens less and less. The charge nurse or manager marks how many procedures can be put on the schedule book each day, depending on what the staffing is. So if there's a short staffing day, maybe there's only 1 or 2 slots for scheduled procedures. Some days there are 4. Never more than 4. The docs are encouraged (yeah, right) to talk to the other guy if he wants to bump someone. Then the temper tantrums usually surface, with comments like "I guess it doesn't matter what the paitent wants." That's right. Maybe the patient should want good safe care!

[GingerSue]

it is the doctor's problem, just as much as it is the hospital problem of staffing.

the doctor has to consider the safety of the situation in which he/she is putting his/her patient.

and the doctor should be making this situation known to the patients.

obviously the patients aren't aware of what they're being admitted into.

and so it would seem that the nurses must refuse to contribute to any unsafe situations.

the nurses are doing their job, by trying to prevent problems related to unsafe staffing.

should the nurses then be using their time to explain to the patients about the lack of staffing in the hospital?

who should be explaining this to the patient?

the nurses aren't in a position to bring in more staff are they?

they can only work with the staff that they do have.

and the doctors have to realize this - maybe they can voice their concerns to the hospital admin re: improving staffing for their patients.

[SmilingBluEyes]

We do book and limit the number of elective procedures each day, based on core staffing. And the doctors know this.

If you are being pushed hard by the doctors you have to remember this is a doctor and management/administrative problem. IF elective procedures are being done and making staffing unsafe and you continue to do them, you have no defense in the case of a bad outcome. Admin needs to approve more staffing if they want to increase elective procedures or continue them when staffing is tight.

Bottom line: You have to refuse to do elective procedures if they are unsafe to do. Let the doctors work it out with administration and management. You need not fight this fight. But you must refuse to do what is unsafe whenever you have it in your control to do so. Often we put elective procedures like inductions and c/sections on hold until the unit calms down. Most of the time it is a matter of a few hours til we can get to them. Sometimes, it's the next day. Nobody is happy when we have to do this and no, it's not easy to tell the patients and doctors this I know. They all do rant, but let that roll off your back. This is not your battle.