Is this legal for hospital to do this?

[ann915]

Hi everyone! It's been a while since I've been on here. A lot has changed since then, and I've been working as a nurse for almost 3 years now. But to make things short, I am now currently working in postpartum/nursery; and have been working there for about a year now.

Anyways, so here is the story. I apologize if this is long and redundent. I'll try to keep it simple and discreet, so I won't expose any potentially easily identifiable information. I am a nurse in California working in the maternity department of a hospital that gets many high-risk maternity patients. Our hospital has gone through some changes that has led to a significant increase in census in certain departments; OB being one of them. Since then, we've been very hectic and chaotic. They're currently working on making new floors for our department to keep up with the increasing census, but I don't think it will be complete for a while (about a year is what we've been told). As of now, whenever our beds fill up in our department, we open up a postpartum overflow unit (which is a floor on another side of the hospital), which is neighbored to an acute pediatric unit.

The original rules were that there would need to be at least 2 maternity RNs in the overflow unit, and that the patients sent there would be transfers of stable moms and babies who were going to be discharged the next day. We would also supposedly take turns on who would go to the unit next whenever it opened up.

A few weeks pass, and then all of a sudden they are only sending 1 maternity RN to open up the overflow floor with 3-4 couplets. The director feels that it is okay because the peds next door has at least 2 nurses to aid the nurse regardless of the issues with patients going on their floor: such as covering her breaks, answering her call lights, medicating her patients if she is too caught up with another patient, etc. She also says there was nothing to worry about because the couplets transferred to this floor were stable patients who were going home the next day, and that the lone nurse there would not get more than 4 couplets (as that is our ratio in California). If somehow the pediatric department were to close because there were no patients for them and if the overflow unit needed to be opened up, then she would allow sending 2 maternity RNs there.

Another few weeks pass, and now admits (fresh deliveries) from L&D are being brought to postpartum overflow. When confronting management that this was not supposed to happen, because the patients were supposed to be stable transfers, they say the rules have changed. So now new admits will go to that unit now - so no more transferring old OB patients that were going to be discharged next day. They tell us these admits were only "stable" lady partsl deliveries and that they would never send us c-section patients, or patients with maternal and/or newborn complications.

Well, few weeks pass again and now they send whatever couplet from L&D is ready to go to postpartum overflow, just as long as they weren't on magnesium or were "too sick". Many times when I was the nurse on postpartum overflow, they would give me moms on iv antibiotics; babies with temp, blood sugar, and feeding issues; moms with blood pressure issues who supposedly became stable in recovery; preterm newborns; newborns born from moms who were ruptured more than 20hrs or from moms with chorio; newborns who ended up being transferred to NICU later in my shift because they became too sick, etc. This is also along with rushing me to discharge patients before midnight (I work night shift), working on an admit I got an hour ago, having to weigh babies at nighttime, do hearing screens, teaching, etc. "Why are you making it a big deal? It's not that difficult. You have help from peds. So there is nothing to worry about." They'd say when we bring up our concerns. "Call OB if it's really urgent. Or call RRT." They'd also say.

And yes. They've ALMOST sent c-section patients there with only one OB RN present on the unit a few times (at least from what I've heard from my other coworkers). Luckily, it hasn't happened yet. But the fact they've considered it several times is scary to me.

Is this really legal? I thought by law, a unit/floor needs to have at least 2 RNs to open it up. Or maybe it differs per state? Or maybe I'm wrong? Regardless, I really don't feel this is very safe practice for a hospital to do. While the peds nurses I work with whenever I'm assigned to overflow are super great and helpful, especially when it comes to helping me with sick or potentially sick newborns (as they do encounter newborns in their pediatric population), I don't think it's really fair that they are expected to help us along with whatever issues and tasks they have going on in their unit. Not only that, if an OB emergency were to occur, they really wouldn't know what to do to help me stabilize the patient, as OB is not their specialty. Yes, they float to our department sometimes when needed; but they do not go to postpartum on daily basis and are usually not given very complicated postpartum patients. To me, and many others, this is just bad news waiting to happen. And it keeps getting worse with them constantly changing the rules. It's a huge safety issue for the patients and our licenses. It just doesn't sound right to me.

It's beyond frustrating. We've expressed concerns to management of this issue multiple times and they just keep brushing it off. We've also brought this issue to our union many times, who just tells us to keep filling out our ADOs and that they're working on it with management. This has been going on for almost a year and nothing has changed.

Has anyone here ever been in this kind of experience with the facility they work or worked at? Anyone's input and advice would be greatly appreciated. Thank you very much.

[klone, MSN, RN]

I would talk to your union rep. We aren't good resources to guide you on your state laws.

[KRVRN, BSN, RN]

It's certainly not smart or prudent. And really, who thought up the part about only putting couplets to be discharged the next day over there? That would mean they are making moms change rooms in the middle of their stay. That wouldn't bode well for the satisfaction survey would it?

[Buyer beware, BSN]

OP:

Not to worry. "The director feels it's Ok."

[ak3991]

The mother/baby unit that I work on does this too. Granted, I work in a state with no union so rules are way different. Our unit takes up 1.5 floors of the women's hospital and we share that half floor with a high risk ob unit. There have been plenty of times they have assigned 1 RN "upstairs" (1/2 unit) with 4 or 5 couplets to herself. It's been brought up countless times how dangerous that is, but it's all about the budget to management. Unfortunately, I think it's going to take a sentinel event to change things.