L&D acuity

JaneyW · Jul 9, 2005

What are the acuity guidelines where you work ?
Have you ever felt unsafe with the acuity at any given time?
If so, what did you do about it?

California has state guidelines. 2:1 in labor and then 1:1 when pushing. But, we all know that there are also outpatients and pretermers and inductions. I believe we counted outpatients as 3:1 and the same for Cervidil and Cytotec inductions. This led to some interesting times when the outpatient turned into a PIH needing Mag turning them into a 1:1 instantly and when the Cervidil induction went active, SROMed and delivered in 6 hours.

What did we do??? What we could with what we had. Sometimes we had to call in our manager or assistant manager. I can say that I no longer work there. I guess that's what I did. :rolleyes:

Peaches N L&D · Jul 10, 2005

California has state guidelines. 2:1 in labor and then 1:1 when pushing. But, we all know that there are also outpatients and pretermers and inductions. I believe we counted outpatients as 3:1 and the same for Cervidil and Cytotec inductions. This led to some interesting times when the outpatient turned into a PIH needing Mag turning them into a 1:1 instantly and when the Cervidil induction went active, SROMed and delivered in 6 hours.
What did we do??? What we could with what we had. Sometimes we had to call in our manager or assistant manager. I can say that I no longer work there. I guess that's what I did.

Those look like the guidelines we follow here in South Florida except where I work it is not always like that.....When I am in charge I get 2 pts sometimes 3 like pp,labor & o/p I get soo angry at myself beacause this is unsafe, but all the other Rn's have their 2 pts too....I try to call people in but almost always unsuccessful, so then I call the Nurse manager who seems to think she could help me out over the phone/ the director of the unit is no better :angryfire So many of us have moaned and groaned about these unsafe practices, but we are all still there we try to help each other out and are always doing a route cause & analysis to help better our unit :uhoh21: Maybe some day we will achieve this hopefully before we get a sentinel event :stone

SmilingBluEyes · Jul 10, 2005

AWHONN has guidelines too, and if these are not adhered to, you can be in trouble.

SmilingBluEyes · Jul 10, 2005

I forgot to say, if staffing becomes unsafe, it is not only your right, but your RESPONSIBILITY to elevate that concern up the chain of command and do whatever it takes to achieve safer staffing levels. That would mean, talking to your charge nurse, house supervisor, and if need be, the Chief of OB or administration. You will have to have well-documented actions you took to try and alleviate the situation, if litigation ever were to be an issue, believe me.

Peaches N L&D · Jul 10, 2005

I forgot to say, if staffing becomes unsafe, it is not only your right, but your RESPONSIBILITY to elevate that concern up the chain of command and do whatever it takes to achieve safer staffing levels. That would mean, talking to your charge nurse, house supervisor, and if need be, the Chief of OB or administration. You will have to have well-documented actions you took to try and alleviate the situation, if litigation ever were to be an issue, believe me.

Been there done all the above, but it seems like things change for a little bit then our census decreases and we are back to where we started. :angryfire

BETSRN · Jul 10, 2005

Those look like the guidelines we follow here in South Florida except where I work it is not always like that.....When I am in charge I get 2 pts sometimes 3 like pp,labor & o/p I get soo angry at myself beacause this is unsafe, but all the other Rn's have their 2 pts too....I try to call people in but almost always unsuccessful, so then I call the Nurse manager who seems to think she could help me out over the phone/ the director of the unit is no better :angryfire So many of us have moaned and groaned about these unsafe practices, but we are all still there we try to help each other out and are always doing a route cause & analysis to help better our unit :uhoh21: Maybe some day we will achieve this hopefully before we get a sentinel event :stone

In our LDRP, the person in charge does all the outpatients and keeps any who become inpatients.

Each in charge elegates to others whenever possible. Those doing PP can always rise to the occasions to do NST's or early labors or cervidil/Miso's. We just do whatever has to be done.

We have a manager who is totally unhelpful and so there is no assistance there. On occasion, we have to call the supervisor up to help us.

SmilingBluEyes · Jul 10, 2005

I know. The problem is in ANY unit, census numbers go up and down----things wax and wane. It's hard to predict even from one shift to the next, what will happen. I have seen acuities (and census numbers) change in just an hour or two that make a "safe" situation suddenly very "unsafe".

It's hard to staff for "what if" also----and in this day and age of cutting costs to keep the higher-ups happy, it's hard to justify the numbers of nurses we DO have on the clock at times. They are always clamoring for us to do "more with less" .

It's forced us to be VERY creative with staffing, at times. Low census situations are just as tough and a hardship, as high-census ones can be. Who loses hours this time? Ugh, we have a book keeping track so it's fair.........

but I digress (again)

We are between a rock and hard place, between AWHONN standards, the law/lawyers and administration. It's a challege to keep up to standard and keep administration happy, isn't it?

It a big reason why where I work, nowadays, we have an "on call" nurse for each shift. We all have to take one "on call" shift per pay period. It's not a great way to solve the problem, (no one likes being on call)----but the only one that has worked so far to give us that "edge" for when the ole Labor Bus decides to drop off its occupants at our ED doors.

Peaches N L&D · Jul 10, 2005

I know. The problem is in ANY unit, census numbers go up and down----things wax and wane. It's hard to predict even from one shift to the next, what will happen. I have seen acuities (and census numbers) change in just an hour or two that make a "safe" situation suddenly very "unsafe".
It's hard to staff for "what if" also----and in this day and age of cutting costs to keep the higher-ups happy, it's hard to justify the numbers of nurses we DO have on the clock at times. They are always clamoring for us to do "more with less" .
It's forced us to be VERY creative with staffing, at times. Low census situations are just as tough and a hardship, as high-census ones can be. Who loses hours this time? Ugh, we have a book keeping track so it's fair.........
We are between a rock and hard place, between AWHONN standards, the law/lawyers and administration. It's a challege to keep up to standard and keep administration happy, isn't it?
It a big reason why where I work, nowadays, we have an "on call" nurse for each shift. We all have to take one "on call" shift per pay period. It's not a great way to solve the problem, (no one likes being on call)----but the only one that has worked so far to give us that "edge" for when the ole Labor Bus decides to drop off its occupants at our ED doors.

ITA with you, sometimes we have RN's on call too, but it seems we get on the right track then the ball is dropped :uhoh3:

but I digress (again)

SmilingBluEyes · Jul 10, 2005

Well maybe it's time to have a serious evaluation of what exactly is going wrong---- a meeting or something with the charge nurses and manager is in order. These are things that need to be ironed out by them. Also be sure to document when the ball IS dropped, how and by whom---using the occurence/incident reporting system. It still needs to be documented. I know how you feel, the frustrations you have are shared by many.

JenTheRN · Jul 11, 2005

Here's what I found in my handy-dandy AWHONN policy manual:

Intrapartum:

1:2 labor patients

1:1 pts in 2nd stage of labor

1: 1-2 pts with complications

1:2 Oxytocin induction/stimulation of labor

1:1 Epidural pts

1:1 Circulation for c-section

Ante-post partum:

1: 5-6 pts without complications

1:2 post op recovery

1:3 complications, but stable

1:4 recently born infants and those requiring close observation

Newborns:

1:5 Normal couplet care

1:5 Newborns requiring ongoing care

1:4-6 newborns requiring immediate care

1:1-3 nb requiring intensive care

1:1 nb requiring multisystem support

1:1 or greater : unstable nb requiring complex critical care

Hope this helps, sorry for any typos!