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[mamacat]

Hello to all. I have been working primarily as a L&D for the last two years at a level two hospital and for the last four months I have been working mother-baby part time. I am truly a L&D nurse first choice, but I am enjoying my work as well in mother baby. I recently went to a level one hospital in another town and was going to accept a job on a casual call position, but I am not sure that I feel safe. I am not sure what the staffing standards are compared to the level two hospital that I work at now. For example when I work L&D at the level two there are three nurses and a tech on duty regardless of the patient load. At the level one hospital it is the tech and the nurse with a nurse on call thirty minutes away. Also no anesthesia in house at level one. At the level one hospital there is no nursery and the nurse labors, delivers and recovers mom and baby. I am not used to doing all three areas and when I told the nurse manager at the level one hospital my concerns she said you have experience and you will do fine. When I asked questions or made comments about my concerns to some of the staff they attempted to say things like, "you'll get it or your just spoiled at that level two hospital- this coming from techs (no offense to techs I was a tech for twelve years) Does anyone see my point of view or am I being paranoid. I don't want anyone getting hurt because I am the only person on shift and I don't make the right decision. The nurse manager says she has approached management about wanting two nurses on at all times and their response is this is a level one hospital, my response is it may be a level one hospital, but a level two or three patient could land on my door. Sorry my first post is so long. I would really appreciate any input thanks.

[texas-rn-fnp]

You have to decide either one of two options. Either you can get trained up and get experience to become competent and confident in the new skills that you do not have or do not accept a position which you do not believe you can handle.

The admin's reassurances not to worry about it are not justificiations when you go to court. Don't ever do anything you are not comfortable doing. It is the patient's safety and your license, reputation, livelihood, etc.

Best of luck

[nicuRN2007]

:welcome:

[babyktchr, BSN, RN]

I work in a level 1 hospital, have for over 15 years and what I can say to you is that it is different from what you are used to and you will get used to it. I really just depends on what you want to do and what you want to learn. Laboring, delivering and recovering a patient is so second nature to me, that I can't imagine NOT doing it. Think of it as continuity of care, and the bond you have with your mom and baby (and family).

There will always be times when more staff would be great. Sometimes there just isn't enough staff when you have what you are supposed to. There will always be the what ifs and the always present fear of the train wreck patient. It is scary to be the one waiting for a care provider or anesthesia in the middle of the night...been there done that so many times. I don't understand the mechanism of administration. I suppose something has to go bad for change to occur.

In my facility, we always have 3 nurses on at all times. All nurses are cross trained to L&D, Mom/Baby, and nursery (we also have womens surgical). On the rare times there are 0 patients, we do go down to 2 nurses, but someone is on call (2 nurses actually). What you are describing is not uncommon, in fact, I would venture to say that many will say they operate just that way.

It does take some getting used to, I would imagine. I have always been at level 1 hospital (for L&D) and to be honest, I don't know if I would do anything else. As one of the previous posters said, you have to do what makes you comfortable. There is, however, a great opportunity for growth, education and autonomy. Its really up to you.

Good luck with your decision

[JaneyW]

I started out at a level one for two years and am now at a level three. Big difference! When my co-workers at the level three complain about bad staffing, I really have to bite my tongue. I loved the closeness with the patients at the level one. I also liked the autonomy and making decisions regarding when to call whom. We would always have two nurses, though. I would be a little nervous about the second one being 30 minutes away. It's funny how things would work out. I always said the unit had a guardian angel! We also had excellent nurses--it wouldn't work without them. In theory, level one is just for routine labor and delivery of term patients. In reality, you never know what will walk in at 3am. C/S with local? Yes. Nurse deliveries? You bet! You need to decide what you are comfortable with.

I moved on to the level three because I was tired of being frightened and was longing for NICU back-up and 24 hour services. I also wanted to learn about high risk situations as I am back in school to become faculty and teach others. Well, I have learned and am continuing to learn volumes. I LOVE being able to pick the phone up and call the NICU for a delivery. I LOVE having residents there to pass along the responsibility when those ugly strips happen. I don't love not having regular deliveries very often. I don't love being out of the loop with plan of care and not doing vag exams and sterile specs. Do they really need internals??? I miss the autonomy. I am thinking of going back to my old place as a registry a couple of times a month to get my 'fix'.

Yes, a level one is not as safe for those emergency and preterm situations. But, the level one is much better for regular deliveries and normal situations. I am glad I have experienced both.

[SmilingBluEyes]

Good advice.

Want to welcome you to our site!

[NurseNora, BSN, RN]

For nearly 30 years, I worked in Level 3 L&D units. I moved to the boonies and am now working OB in a Level 1 rural hospital. I understand your fears. I was lucky that my Director heard and understood my concerns. I'd done all kinds of knarly stuff with majorly high risk patients, but I'd never done a speculum exam (the med students and interns did them all).

The first time I put on a fetal monitor and got a FHR of 138 for 45 seconds followed by a 90 second deceleration to

It is a big adjustment to be working in a Level 1 facility. It's been a real learning experience for me and I'm glad I was forced into it. It's not something I would have chosen had I had a choice. My hospital is the only show in town. You have choices. Perhaps there is another Level 1 where the director and staff are more willing to listen to and be sympathetic to your very real concerns. Good luck whatever your decision.