Number of procedures scheduled per day?

Elvish, BSN, DNP, RN, NP · Aug 22, 2008

We have a fairly large unit - so it's not uncommon to see c/s scheduled at 0800, 0830, 1000, 1100 plus a couple inductions. Those are just examples. If the Pregnant Bus :) rolls up, the inductions get bumped. I personally would rather the scheduled sections bumped if there's not an urgent reason to do them. (Which, being that they're scheduled, is not generally the case.) It's a pretty rare occasion, at least when I'm working, that we don't have the staff for the procedure. I guess we are lucky in that sense.

RNmama05 · Aug 22, 2008

Where I work (a relatively small unit) the number of procedures per day is limited by the amount the anesthesiologists feel like doing, not whether there is enough nursing staff. We frequently have two scheduled sections per day along with varying combinations of versions, cerclages, laser procedures, tubal ligations, D&Cs, unscheduled sections, inductions, and fertility treatments. On top of antepartum and labor patients who roll in the door.

Yes, it's a madhouse.

LizzyL&DRN · Aug 23, 2008

We are a fairly busy unit (about 300 deliveries/month) and we allow 5 procedures per day. We usually have a 0730, 1230 and 1730 c sections and then two inductions per day. We have a schedule book at the desk and charge nurses are responsible for consulting the book and scheduling procedures. If we don't have a bed, inductions get bumped based on the reason for induction. Obviously an indication for induction like post dates, oligo or something like that gets a bed before an elective induction. Your unit does sound unsafe if they aren't scheduling based on staffing. Docs probably won't like being told no, but they've gotten used to it where I work.

mom2michael, MSN, RN, NP · Aug 23, 2008

We can have 3 plus a carry over on our books and we schedule according to that. Like next week we know we have scheduled twins coming it so we've scheduled accordingly.

An example might be a: 0500, 0600 induction and a 0730 C-section. We then can have the occasional Cytotec or Cervadil induction that comes in anywhere from 1700-2000 and is a carry over to the next day. We don't have many elective inductions anymore after our unit manager told the doctors no more and they WILL get bumped so don't even bother trying to schedule them.

We always schedule at least 2 RN's in the unit and then at least 1 in the nursery even if we are totally empty. We adjust according to what is going on that week though and if our schedule book is full, then we add another person to the schedule. We always have at least 1 person on call 24/7 and if we anticipate a busy day - we schedule 2 on call.

We are a small unit, 5 LDR rooms and 5 PP rooms with an average deliveries of less than 100 per month

lisamct · Aug 25, 2008

Im in the UK so lots of variables are different here but for comparison; in my unit (@300 deliveries/month) we only have 2 days a week where we do schedules C Sections (mon and thurs) and on those days we do 5, 3 in the morning and 2 in the afternoon (we never do scheduled CS's after 5.30pm) Mon-Fri we also have up to 4 scheduled inductions each day.

L&Doldtimer · Aug 25, 2008

Thanks for all the responses-wow, quite a diversity! Our hospital only does 50-70 dels. per month, so we are not staffed quite as well as most of you are-only have 21 nurses that work our unit, so 4 procedures before noon puts quite a strain on us. We all work all the areas, so L&D is not a separate entity, either (means that after 4:00pm the nurses are the ones answering all the call lights, the phones (our security system is set up to be answered by the phone also), etc. (no clerks or CNAs).

Anyways, it was interesting hearing how other units work.

Connie

LaborLovinRN · Sep 2, 2008

I work in a medium sized community hospital, we have about 275 deliveries a month. We can schedule up to 3 c/s per day (sometimes 4 if the docs push hard enough) 2-3 AM inductions, and 1-2 PM inductions per day. We also usually have between 8-10 NST's or other antepartum tests (amnio's, versions, rhogams, etc) per day.

If we are busy, the inductions get postponed, which happens all the time! It is very rare that any C/S gets postponed, only if an urgent case bumps them. The docs have a fit if their sections don't go on time!

Baby1nurse · Sep 2, 2008

Hello all-I would like to know what other L&D units out there do as far as the number of procedures (inductions and c/sections) they allow the docs to schedule per day... I have worked in one hospital where there was a schedule book that was kept and no more than 2 procedures were allowed to be scheduled per day shift and two per night shift-the docs would call from the office and the book was consulted as far as when and what and why. If we were busy, the inductions got postponed. The hospital I now work in, the docs schedule as many procedures as they want-never consulting the nurses as far as if the staffing is such that we can handle what they want to do. We had 2 c/sections, 1 version (that was pretty much guaranteed to be a section) and 1 induction scheduled the other day. Our usual staffing numbers can't handle that load and so they beg everyone to work extra, but I believe the situation is still unsafe for everyone. I think the procedures should be limited and we have discussed this at staff mtgs. and agreed that 2 per day should be our limit, but no one around there says "no" to any of the docs when it comes down to it. I think we should band together and not come in when they do things like that, but there are always those that come in anyway and so they get away with it.
How do other units handle this problem? Any discussion on this issue?
Connie

We have a small Level II hospital. We have 22 beds, 11 of which are labor. We have 6 or 7 nurses scheduled per shift, which includes M/B & L&D. Our doctors are allowed to schedule 6 procedures per day. 3 C/S and 3 Pitocins or Cervidils. We never have scheduled procedures on nights because none of our doctors want to work nights. It is manageable but if someone calls out we drown. The doctors really don't care whether we have enough staff to accommodate them. Their standard comment is "get more nurses". If we have 6 procedures scheduled, we go through the book and cancel the ones that are elective. We time and date the book when a procedure is scheduled and the reason for the procedure. When I get a doctor who already has 3 procedures on and wants to put on another my standard reply is "Fine, which one of your other three do you want to postpone?"

HappyNurse2005, RN · Sep 5, 2008

WE have a schedule book for inductions-2 scheduled inductions a day, 2 on call (in case of low census/high staffing or if a scheduled one delivers ahead of time). 1 of each on sat/sun, 1 sched. on holidays. 2 or 3 c/s a day scheduled. 1 sched c/s at at time, though we do have 2 OR's, so a stat can be done while a sched is being done if necessary. Of course, we only have 1 anesthesiologist dedicated to OB each day, so we'd have to call one up from main OR. amnio to induction/amnio to section included in those #s. Versions scheduled-but they go to triage to have it done.

Of course-if the office sends someone over for medical induction, they get done even if 2 sched. inductions are in progress. Occasionally, the morning induction has shown up to find all beds are full and seh has to wait in antepartum bed or in pre-op (both still on our unit) until pt is moved. That isn't too common.

Its normal that a sched c/s can be bumped for a stat. 2 or 3 weeks ago, the 1030 section didn't get done until 2000. SHe got bumped twice.

300-350 deliveries/month

jenrninmi, MSN, RN · Sep 5, 2008

2 c/s and 2 inductions can be scheduled each day.