Floating

[JenRN99]

OK....I have to vent and would LOVE some opinions...

I work on a small low risk L/D, M/B, Pediatric and GYN unit. We are occasionally faced with the dilemma of no patients or one couplet and such at a time (not too often however it does happen). With the low census on our unit and the high census on Med/Surg, they are wanting one nurse to float while the other nurse stays on the floor alone. We are a locked unit on a different floor then any other unit in the hospital. Last night, we had one freshly delivered couplet with a heavier blood loss then average but not quite a hemorrhage (worth watching). They made the other nurse float. My issue is I think it is a huge safety concern and NOT in the best interest of the patient for there to only be one nurse on the unit. If we have a mom up to the bathroom and she passes out...how are we going to get help quickly? Tell the mom that is passed out on the toilet...."Hey hang on a sec....I have to go all the way to the desk to get the number to call up stairs to get the other nurse back on the unit"?!?!?!? Then ten minutes later help arrives!?!? I don't know....I am just very leery about this newer procedure with floating. AWHONN guidelines do not support this. What do you all think?

Jen

[netglow, ASN, RN]

Wow, L&D is usually where a facility wants to market hi-end care. If I was a mom on that floor, I'd be scared if I knew all of this.

[Lissa,RN]

Yeah, but correct me if I'm wrong. You're complaining about a 1:2 nurse/patient ratio here?

[nurse2033, MSN, RN]

Sounds bad. Does your boss know that this goes against AWHONN guidelines? They might not have thought it all the way through, or not realized this is happening. Bring it their attention and make sure your insurance in paid up.

[helper T cell]

Rapid response? House supe? They should leave you with a CNA. At our hospital there must be at least staff of two on each unit which is safer. I agree for safety this is appropriate.

[Elvish, BSN, DNP, RN, NP]

No one's complaining about a 1:2 nurse ratio; the complaint is that there is no help in case of an emergency. And while CNAs are fantastic, there are some things a CNA can't do in an urgent situation.

No matter how low census gets, there need to always be at least two RNs. I'd be leery too. Does risk management know about this?

[tablefor9, RN]

Very unsafe. If your backup is floating, that doesn't mean she can come back via startrek teleport, right?

I work in a similar unit, and the lowest we went in the "bad old days" was 2. Now it's 3 minimum to keep the unit open. Print the AWHONN guidelines and ask for an audience with risk mgmt.

For risk mgmt's sake, you may have to get to the nitty gritty about what happens if there is an abruption or cord prolapse or precip delivery or 28 weeker complete over BBOW that steps off the elevator...what happens then? Esp while you have a bleed going on? Who is paying the lawsuit $$$$? We actually lost nurses from our facility over this issue and took a letter to the CNO, CFO, CEO and risk mgmt with the brand new unit mgr going to bat for us to get this changed.

Good luck to you!

[roser13, ASN, RN]

Yeah, but correct me if I'm wrong. You're complaining about a 1:2 nurse/patient ratio here?

Yes, you are wrong. OP is worried about a basic safety issue, not ratios. In my facility, there are never fewer than 2 RN's on the floor at a time. If one leaves even briefly to discharge a patient, there must be another body on the floor for back-up.

[rn undisclosed name]

I completely agree with you. It is not a ratio issue. It is that you are left alone with NO help and that is the issue. I am not an ob-gyn/l&d nurse and it does not matter what field you are in you should never be left alone. A patient can code at any time no matter the age or be a rapid response. The patient is obviously in the hospital because she requires care.

At one position I had I was left alone on the floor (without my knowledge). There were usually 3 nurses on our small unit. I knew one had to go to IR so a patient could have a procedure done so that left 2 of us. This other nurse knew and just went off the floor so she could eat. Totally unacceptable. As soon as I realized it I called the house supervisor who came and stayed on my unit until this nurse got back. I went to management, she got in trouble, and it NEVER happened again. A little different situation, but, also totally unacceptable. Thankful nothing critical happened on the floor.

[JenRN99]

I have definitely approached management...several times. For a while the issue stopped and now we are back to the same dilemmas. I do like the idea of approaching this with risk management involved. I talked to my director again today and she says she will make it so that we "only float if there are no patients" which is slightly more acceptable to me then when there is even one patient on the unit. The biggest problem is the director has never been an OB RN nor even worked on a unit like this so she does not understand. Risk management here I come! Great idea!!

[NurseNora, BSN, RN]

I always advise people to go to risk management with these kind of problems and tell them what AWHONN standards are and how your are deviating from these standards. Remind them that OB malpractice cases have some of the largest awards to patients. Tell them about the patient arriving abrupting or crowning or with a cord down,etc. And how much damage can be done while a second nurse is found to assist. Sometimes the reality of the size of malpractice awards can sway management.

If not, you must at least have a second person there to call for help if a patient has a problem. The nurse who is floated must not be given patient assignments because if she is called back, there probably won't be time for her to give report to whoever takes over her patient load. She has to be able to return immediatly.

How do your nurses feel about taking call time? Since I live more than 30 min away, when I'm on call I have to sleep at the hospital. With no patients, perhaps someone could go on call and sleep in an empty room (I work nights, so I assume anyone would want to sleep). I'm lucky that my hospital accepts that sometimes even when there are no patients in labor, 2 RNs have to be in the department.

,

What kind of things do you do when you have no patients? Clean equipment, audit charts, stock rooms, prepare posters for inservice. What kind of things need to be done in your unit?

[JBNEAL]

I find that it is the same at all hospitals in the USA when it comes to OB and the pompus attitudes of nurses from med surg and any other nurse that that has never worked OB. They think the reason we want to have two nurses on OB at all times is because we are "primadonna's and " oh we can take 7 med surg. patient and you whine because you dont want to take care of one patient by yourself. These are the same nurses that would not ever step foot in OB to take care of a labor patient, but think because we went to nursing school we should be able to take care of any type of med surg patient on OB when they are full and we have overflow. We actually had an patient from ER to OB with DX of unstable atrial fib and was on telemetry. The consensus from the med surg unit director and the CCO is you went to nursing school, you are all ACLS Certified so you should be able to take care of these types of patients.BS. We wouldnt expect a med surg nurse to come to OB and take a newly delivered patient or a preterm labor patient. I would never say to them " you had oB rotation in nursing school didnt you?" I wouldnt expect a med surg nurse to come to OB and take care of this because we were having an overflow of OB patients. I am sick and tired of the predudice against OB nurses. Any one else out there feel the same.