nurse/active labor pt. ratios

Published

Could anyone inform me of AWHONN nurse/pt. ratios recommendations? I attempted to find results on the web but was unable. Have been told that one nurse can care for two active pts. up until the time that one is complete. I hope this isnt the case.....please inform. I have always cared for only one active labor pt. and hope to continue to do so.

Up Vote Up Vote ×
Could anyone inform me of AWHONN nurse/pt. ratios recommendations? I attempted to find results on the web but was unable. Have been told that one nurse can care for two active pts. up until the time that one is complete. I hope this isnt the case.....please inform. I have always cared for only one active labor pt. and hope to continue to do so.

From AAP/ACOG Guidelines for Perinatal Care, 2002, p. 24:

RN/Patient Ratio

Intrapartum:

1:2 Patients in labor

1:1 Patients in second stage of labor

1:1 Patients with medical or obstetric complications

1:2 Oxytocin induction/augmentation of labor

1:1 Coverage for initiating epidural anesthesia

1:1 Circulate for Cesarean delivery

1:2 Patients in postop recovery

Note these guides don't talk about stable,arrested preterm labor (on mag or terb) or patients who are being monitored who really are not in labor. It is those patients who give staffing the greatest difficulties.

If I start the day with 2 patients, someone must assume responsibility for one of them if I am doing an epidural or when I begin second stage. For the most part we adhere to these guidelines... although as we all know there are days when the patient population outnumbers the nurses by 3 or 4 times!

Up Vote Up Vote ×
From AAP/ACOG Guidelines for Perinatal Care, 2002, p. 24:

RN/Patient Ratio

Intrapartum:

1:2 Patients in labor

1:1 Patients in second stage of labor

1:1 Patients with medical or obstetric complications

1:2 Oxytocin induction/augmentation of labor

1:1 Coverage for initiating epidural anesthesia

1:1 Circulate for Cesarean delivery

1:2 Patients in postop recovery

Note these guides don't talk about stable,arrested preterm labor (on mag or terb) or patients who are being monitored who really are not in labor. It is those patients who give staffing the greatest difficulties.

If I start the day with 2 patients, someone must assume responsibility for one of them if I am doing an epidural or when I begin second stage. For the most part we adhere to these guidelines... although as we all know there are days when the patient population outnumbers the nurses by 3 or 4 times!

Thank you very much for the information. Speaking from 18 years of experience in NICU and Labor nursing I feel that assigning one nurse to more than one ACTIVE laboring pt. is unsafe and a disservice to both the unborn child and mother and to the RN.

How do other RNs feel about this? I have worked on 4 units and have done agency in 2 units and have not experienced this yet. How prevalent is this practice and how do RNs feel about this issue from a nurse perspective or from a mothers perspective?

Up Vote Up Vote ×

I never had more than one active laboring patient when I was in Canada, but did take two almost routinely when I worked in Washington state. It does do a diservice to the patient IMO. How are we supposed to provide real support when we have to keep leaving the room to see our other patient?

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I never had more than one active laboring patient when I was in Canada, but did take two almost routinely when I worked in Washington state. It does do a diservice to the patient IMO. How are we supposed to provide real support when we have to keep leaving the room to see our other patient?
agreed 100%
Up Vote Up Vote ×
Specializes in L & D; Postpartum.

I agree that having more than 1 active labor patient is unsafe. I think they rationalize that by saying the availability of central monitoring makes it all possible, but while you can monitor two patients at a time on the monitor screen, that's a privacy violation. We do 1:1 labor nursing and have to continue to fight for it tooth and nail all the time. Plus we have so many inductions, another reason for it to be 1:1 from beginning to end.

Up Vote Up Vote ×
I agree that having more than 1 active labor patient is unsafe. I think they rationalize that by saying the availability of central monitoring makes it all possible, but while you can monitor two patients at a time on the monitor screen, that's a privacy violation. We do 1:1 labor nursing and have to continue to fight for it tooth and nail all the time. Plus we have so many inductions, another reason for it to be 1:1 from beginning to end.

So what is the next step? Can we pull together and petition ACOG? Are there any RNs out there who actually think it is a good idea for one RN to care for two ACTIVELY laboring patients? (RNs that have actually done this or do it on a regular basis) And who recommended this...a physician? What are AWHONN guidlines if any? Thank you.

Up Vote Up Vote ×
Specializes in Case Mgmt; Mat/Child, Critical Care.

I have routinely been assigned 2 actively laboring pts. Do I like it, no, of course not, but if you complain, all you're gonna get is "that is the standard of care". That's amazing that you have worked for 18 yrs in this field and have never had to care for more than one active labor pt! That's great! Where are you, anyway? I'm currently in Ca, we have staffing ratios and I still get 2 pts.... :rolleyes:

So what is the next step? Can we pull together and petition ACOG? Are there any RNs out there who actually think it is a good idea for one RN to care for two ACTIVELY laboring patients? (RNs that have actually done this or do it on a regular basis) And who recommended this...a physician? What are AWHONN guidlines if any? Thank you.
Up Vote Up Vote ×
I have routinely been assigned 2 actively laboring pts. Do I like it, no, of course not, but if you complain, all you're gonna get is "that is the standard of care". That's amazing that you have worked for 18 yrs in this field and have never had to care for more than one active labor pt! That's great! Where are you, anyway? I'm currently in Ca, we have staffing ratios and I still get 2 pts.... :rolleyes:

10 of my years were in NICU, last 8 in Labor. In labor and delivery capacity I have worked in CA, IL, and Oregon. Ive worked in a small town hospital, one comminity hospital, one small city hospital and one large inner city teaching hospital. I have worked in both agency and staff capacity. I had heard that one of the units was considering changing the nurse pt ratio but as of yet am not sure if they have. Guess I have been lucky. I am really not sure how prevalent this practice is.

Key word here.....active labor.... I am fine with two early labors if all is well and not an induction but to take care of two actives at same time is unreasonable.

Up Vote Up Vote ×
Could anyone inform me of AWHONN nurse/pt. ratios recommendations? I attempted to find results on the web but was unable. Have been told that one nurse can care for two active pts. up until the time that one is complete. I hope this isnt the case.....please inform. I have always cared for only one active labor pt. and hope to continue to do so.

1:1 at my place.

Up Vote Up Vote ×
Specializes in OB, Telephone Triage, Chart Review/Code.

I worked in one hospital back in the 90's where I was the only L&D nurse with 2 birthing rooms. If I had a patient that was being pitted and my other patient was delivering, I was told to stop the pit on my other patient and do the delivery. I always hated that! I didn't think it was fair to the other patient on Pit. I quickly lost my desire to stay in L&D at that point after working for 2 years in another hospital in another state and being certified!

Up Vote Up Vote ×
+ Join the Discussion