I've been working as a Mother/Baby postpartum RN for almost 3 years at a community hospital. My hospital is rated one of the best in the state, and our marketing department is top-notch at letting the area know we deliver 6,000-7,000 babies a year. We have two Mother/Baby Units with a total of 60 beds.
I was in :redbeathe with postpartum since nursing school and thought I'd hit the jackpot when I was offered the chance to transfer after completing one year of Med-Surg nursing. Now, as a 2nd career nurse, I am fully aware that change is constant and customer service/physician loyalty is important.
Our division has undergone a lot of changes since I've been there. On what used to be the postpartum unit, we are now required to care for antepartum's. The c-section rate is through the roof. Our ratio is 5 couplets:1 RN. On a normal day shift, a nurse discharges 2-3 couplets and admits at least two more. Assignments are not based on acuity, but simply rotated between nurses. All patients are to be discharged by noon (on their scheduled d/c day) regardless of what time the baby was born or the fact that the insurance company pays for up to 48-hours for vag deliveries and up to 96 for c-sections. All patients are to be assessed by 1000/2200. Due to budget control, they are blocking off rooms and calling off staff when in-patient census is low-but the policy does not consider how many patients are in L&D, so it's possible for one RN to have 3-4 admissions on a shift. Now, the newest thing is revving up for the Joint Commission's exclusive breastmilk initiave and again the Marketing dept is hard at work to advertise us a 100% breastfeeding hospital.
So, while I (and most of my co-workers) are very good nurses, I do not see how it's possible to admit and discharge this many couplets, assess, intervene, educate, assist with breastfeeding, perform newborn screenings (hearing, pulse ox, daily baths, HBV vaccines, etc) effectively-not to mention the PP hemorrhage, antepartum that goes into labor, jaundiced newborn, freshly circumcised babies-I could go on and on.
We have voiced our concerns to administration only to be told we don't have to do it-we can simply find somewhere else to work. Since we are the only Magnet hospital in the area (gasp), they try to pacify us by making us form commitee's to...well, I'm still not sure what the committee is supposed to do.
Most of the perinatal techs are lazy and useless-for lack of a better term. Nurses have gone to our manager for years and being the non-confrontational people-pleaser she is, she simply asks you what could you have done in order facilitate help or difuse a bad situation from a co-worker, so most people don't report things to her anymore.
The hospital's administration is focused on Patient perception scores more so than actual patient care, because as I was told "patient's expect that you will give them the correct meds, so just providing good nursing care isn't enough". For example: some patient(s) complained about the staff not knocking on doors before entering the room. Management told us we are to knock on the door and wait to be invited into the room-even at night. So that's what we do-every two hour nurse check. Then patients complained we were keeping them up all night checking on them. So we were told to do it quietly . This is just a small example, but hopefully you can get an idea.
Now, I know it's not only me, but most of my co-workers have the same complaints. I have decided that although I still enjoy taking care of mom's and love the babies it's time for me to leave OB. I feel like my hospital is setting me up for failure as I can't provide the type of care my patients deserve not to mention I think it's totally unsafe. I like to know that all patients I am responsible for have received 110% from me but unfortunately, I am unable to give it to them under these conditions. I am planning to attempt a transfer from in-patient to out-patient over the next few months. I'm just afraid that I will miss my patient population and end up regretting my decision, but I also don't feel I should hate my current working conditions either.
I know I'm rambling and for anyone that's still reading, thank you! I try not to complain to my co-workers too much because gossip amongst those women spreads like the flu and my manager will know of it and may block my not too distant future request for transfer. My family is very supportive, but none work in the healthcare field, so they don't quite get it. I just felt the need to get some things off my chest. Of course, any advice/support is much appreciated!
. This is just a small example, but hopefully you can get an idea.