Just wondering -

shortstuff31117 · Feb 9, 2012

Wow you guys are busy! 18 labor bed doesn't even seem like enough LOL.

I work at a small community hospital. Last year we did just under 700 deliveries, which was a slight decrease for us.

We have 9 LDRPs, as well as 7 "surgical" rooms, which we use if we need to move people after delivery, for readmitted babies, and GYN surgeries.

We have 1 OR that is dedicated for OB, and another that is used for GYN surgeries (we can use it the rest of the time).

I work nights and our core staffing is 3 RNs and an OR tech, who also acts as our unit secretary. Day shift staffs 4 RNs (except Sat and Sun) and an OR tech.

We limit our scheduled events to 2 per weekday.

We have a group of 5 OBs who do the majority of our deliveries, and 1 other OB, who does

2-3 deliveries a month with us.

We use our LDRP rooms as triage rooms, and take turns doing triages. We just rearrange assignments if we get an admit. We are 1:1 for labor.

We circulate our own c-sections. We have a level 1 nursery as well, but that is staffed among us, no special dedicated nursery staff.

Anyone who is not at least 35 + 4 gets shipped to a higher level facility if they're determined to be in labor, pprom, etc.

melmarie23, MSN, RN · Feb 9, 2012

we have 20 LDRPs, 1 OR, 3 triage beds. We typically staff 8-9 RNs on days, 7-8 RNs on nights and have (one being a resource person-our charge, and one being a core RN-meaning they are also the designated special care nursery staff. If we have a couple feeders and growers or a NAS baby or two, we will usually have at least 2 special care nursery RNs scheduled). All RNs are trained to circulate and will do so if their patient is a section. We have 2-3 LNAs scheduled on days, and 2 on nights (one being the designated scrub tech if there is a section) and 1-2 care partners (who clean the unit, turn over the rooms etc). 1-2 unit secretaries on days, 1 on nights. 1 lactation consultant on days and are trialing a night LC at present time.

we have about 1200 births a year.

bagladyrn, RN · Feb 9, 2012

I'm currently on a contract at the opposite end of the spectrum. I'm at a rural critical access hospital that does usually 20-some deliveries a month. They have 2 LDR's, 4 pp beds and staff with 1 RN and 1 CNA on nights, 1-2 RNs (with the manager as second most days) and a CNA on days.

MomBabyUnitRN · Feb 10, 2012

New to this forum, and reading through some of the threads here has me curious about the size of your LDR unit. How many beds do you all have? ORs? How many nurses do you usually staff per shift?

We have 9 LDR beds. 3 triage rooms, 2 OR suites. Staffing on nights is usually 3-4 nurses vs. 4 nurses on day shift. We are a 1:1 staffing and our charge nurse does all the triage and catching babies, plus putting out the other fires that may arise. It really works out well. We don't do our own surgeries.

ejm RN · Feb 16, 2012

Thanks for taking the time to reply! It's so interesting to hear how other units do things. :)

mugwump · Feb 16, 2012

well, technically we have 24 LDR's, 4 OR suites, however we typically only use 3 (one of those being for cerclages mostly. we deliver about 450 a month, although a couple of years ago when I started (before the birthrate dropped yes I think it it did) we were delivering over 700 a month

ejm RN · Feb 17, 2012

stortstuff - we are usually very busy! The other night when we had all 22 rooms full, anesthesia was placing epidurals in triage and then we were doing vag deliveries in the ORs!

mugwump - I definitely agree that the birthrate dropped in 2008 - 2010. Prior to '08 we would routinely have 11-12k deliveries/year. 2011 was definitely busier than the past few years, though we're still not quite up to par with how our volume used to be. We are at 1300 for 2012 so far (as of last night), so we're on track to have another 10k year I think. January and (part of) February have been pretty busy for our "slow season".

So do most of you keep your patients postpartum or do you have a separate mother/baby unit? We only keep pp patients for 1-2 hours after delivery, unless they are on mag or had a pp hemorrhage. I think our family centered care unit has like 90ish beds? And we also have a separate high risk perinatal unit that has 36 beds, so unless they are full we don't typically have antepartum pts unless they require continuous monitoring, mag, or are especially unstable.

I SO commend those of you who brave this job with only a few (or one!) others to back you up -- I can NOT imagine working by myself with no one else to help if crap started to hit the fan...you never know when someone might walk in with a cord prolapse, a bleeding previa, abruption, or complete breech multip! I'm guessing at many of these smaller facilities there is no OB in house in the case of an emergency? How do you handle that?? I'm realizing now that I'm probably extremely spoiled at my job with all the support we have in place...wow. We are a large teaching hospital, so we have at least 3 residents with us at night, a private 24-hr physician to cover the residents, and also a dedicated OB hospitalist in case everyone else is tied up and there is an emergency. Most of our attendings are good about coming in when they have patients in labor, but if they are unable to get there in time for a delivery, we have the 24 hr doc or hospitalist who can catch for them.

What about anesthesia? Do you guys have an anesthesiologist there all the time for epidurals and to run your sections?

Thanks again for the responses - and sorry for more questions!