OB Dept Staffing

Cindy-OB RN/CCE · Oct 22, 2001

Our hospital does about 300 deliveries a year. We always have at least 1 RN in the unit even if it is closed or census is low. 2 RNs who can do L&D are scheduled but if it is really slow 1 will go and help med-surg. If it is busy we have an extra nurse for mother/baby care.

Solo36 · Oct 25, 2001

Doj,

It is great to hear from someone that has a unit a lot like mine. I am the supervisor of L & D and newborn nursery at a rural hospital that does about 125 deliveries/year. This is how my staffing is. I have 2 Rn's for L & D, they work 12 hour shifts, 7 am to 7 pm, They work 3 on, take call for those nights, then they work as Charge nurse on Med-Surg on Monday, then work the other 2 days for L & D, still taking call for nights.

In the nursery, I have a staff of 4, 2 Rn's and 2 Lvn's. It is totally inappropiate to have CNA's work nursery, your supervisor should check standards. My night nursery nurses are in training to L & D whenever we have a night pt., so this helps my L & D nurses not have to come in at night so much, plus our MD is pretty notorious for practicing daylight obstetrics. The nursery nurses work 3 on, take call on Sunday, then 3 on again, then 7 off.

If there is no baby and no laboring pt., they report to the med-surg charge nurse or to ER.

The call is a lot, and there have been times I have had a nurse up here for 22 hours or so, but not very often. The call for L & D averages about 220 hours per person a month. We pay 1.50 per hous for call and provide a beeper. The nursery nurses take care (except medications) for the postpartum pt. Med-Surg actually gets the revenue for these pt.'s, so they are their primary responsibility. I hope this helps, but again let me tell you CNA is a no-no big time for nursery, as a matter of fact, I have heard some talk about it going to Rn's for nursery as well as l & D.

Lisa

doj · Oct 25, 2001

THANKS FOR THE RESPONSE! It is nice to know that there are other facilities that have the same # of del and how they staff. Perhaps I didn't make the staffing situation clear or perhaps I did. The OB RN is responsible for all the areas, L&D, Nurs, and PP so they are responsible for the Nurs but the CNA is there so the baby is never left unattended, plus of course they do vitals, feedings, etc. Is this still a big no-no??? I have a copy of the current ACOG standards on the way so we can review them. Thanks again for the response!

Q. · Oct 25, 2001

We do about 180 deliveries a month; we staff according to AWHONN guidelines (or try to) which dictate the VERY LEAST 2 RNs who are labor trained to staff the floor - even if there is not a single labor patient. We will also staff 2-3 RNs to 12 mom-baby couplets, and 1 RN in the nursery. (We have a Level II nursery)

We don't float to any other floor and we don't accept floats. We have in-house pool staff and we use outside agencies. (as well as mandatory overtime)

Our GYN is a completely separate unit that is staffed independently.

moz · Oct 25, 2001

Our hospital does about 220 deliveries a year. If there are any patients in ob, then the RN stays there and the aide or 2nd nurse floats out. We don't get medsurg pts except during times of high census and then only if there are no beds on medsurg and the patients coming to ob are clean. We do 12hr shifts with 2 RNs on days and an RN and aide, or 2 RNs on nights. We are expected to float anywhere in the hospital if our census is low, but mainly medsurg. Administrations view is that all nurses received medsurg instruction in nursing school, so anyone can do it. We have some nurses who have only worked ob though, and have lost a couple good ob nurses over floating. My problem is often on nights, I am the only L&D nurse in the hospital and if I take a team on medsurg I feel like I'm abandoning that group of pts when an ob comes in...people do come in with ob emergencies or precip on night shift and often there is no time to give report to the nurse taking over my patients. The sad thing is the situation will not change, this has been an issue for a long time, and it would take a bad outcome for change. That probably didn't help you, but I feel better now..glad to know I am not alone. :)

rntmo95 · Oct 25, 2001

doj, isn't there infection control concerns? do they expect you take a team of pts with possible infections and take care of newborns? Even if you do have a cna in nursery, doesn't the nurse do a assessment on the newborn? And what if you had a delivery walk in the door? You would be again exposing a newborn to possible unecessary infections. I work in a small hospital also and only if our dept is without pts do we float to med-surg, and then we only pass meds and stay out "infection" rooms.

doj · Oct 26, 2001

mosleyrn,

These are some of the issues we are going to have to work out. They do not seem to be worried about cross-contamination as they say we will only take "clean" pts. My concern is that those "clean" patients are not always so clean. The real and right solution is to not take Med/Surg patients when we have OB pts!! However, I'm not sure we are going to be able to convince them of that. Yes, we would be doing assessments on the newborns plus helping Mom's with breastfeeding, teaching, etc. so we will be in contact with those newborns. Can anyone give me a source that I can go to to get facts that I can present to them on the cross-contamination issue. Is there something with CDC guidelines that addresses this?? I will try looking there for something but any suggestions are welcome and I appreciate the responses!

bbnurse · Oct 27, 2001

Have you looked in the American Academy of Pediatrics latest issue of "Guidelines for Perinatal Care"? It covers infection control and suggested staffing. Don't know whether it addresses actually not working elsewhere or not.

It is common practice to float OB nurses but my hospital had the rule that no infectious patients were to be taken by OB staff. Then when or if, OB returned to care for OB patients, they were to scrub and change clothes. That meant that House sups had to stay with patients or keep them in the ER till OB was changed. The floating and getting "dirty" patients stopped pretty quick after ER had to deliver one with the house sup...:)

Good luck with the problem. We just got ours converted to a closed unit which can mean lots of call. Most of the staff prefer it to jeopardizing patients with infections.

BB

**canoehead, BSN, RN** · Oct 28, 2001

I used to work on a pediatric infectious disease unit where we would have kids with chicken pox and kids with severe combined immune dificiency, both isolated of course. Even with the immune deficiencies we had the lowest nosocomial infection rate in the hospital, and the pediatric cardiology attendings argued for their most fragile patients to get special dispensation and be admitted to our unit.

So I think that all the hoopla about crosscontamination is a little much so long as you are all washing your hands and observing isolation precautions. Evidence based practise tells us that if precautions are observed no organisms will cross contaminate.

Of course if you are just looking for something to get in a twist about then it will do as well as any issue. Remember too that newborns are actually more resistant to infection than their 2-3 month old counterparts because of mum's antibodies. Don't know about your hospital, but at ours the 2-3 monthers get admitted to a regular, buggy floor. And on that floor good handwashing is considered adequate protection, for the babies and the immunocompromised adults.

You'll need to make sure that the hospital's own policies do not put patients that are even MORE fragile than the newborns on the floor you are trying to avoid. To have that fact brought up during a discussion of changing policy could be hard to rationalize.