AWHONN Staffing Guidelines Please check this out:

Specialties Ob/Gyn

Published

The question is posed a lot: "what is a good guideline/AWHONN recommendation for staffing on Labor and Delivery, Nurseries, and Mother-Baby units?" The purpose of this thread is to provide information/staffing guidelines, only, please.

Please, if anyone here gets updates/corrections, feel free to let me know via PM, or place your info and a link/AWHONN source referred (if you have it) in this thread. This information is courtesy of member, Mitchsmom (THANK YOU!!!). I hope you all find this useful and helpful if you are labor/delivery/postpartum or neonatal nurses:

*Quoting Mitchsmom*:

There is a chart from AWHONN's Perinatal Nursing: Co-Published with AWHONN: Books: Kathleen Rice Simpson,Patricia A Creehan

I have a photocopy of the chart, from p.42, it is labeled "Recommended nurse to pt ratios according to the Guidelines for Perinatal Care (AAP & ACOG 1997) and the Standards and Guidelines for Professional Nursing Practice in the Care of Women and Newborns (AWHONN, 1998).

"Intrapartum:

1:2 pts in labor

1:1 pts in 2nd stage

1:1 pts w/ med or ob complications

1:2 Pit induction or aug of labor

1:1 Coverage for initiating epidurals

1:1 circulation for c/s

Antepartum/postpartum:

1:6 antepartum or pp pts without complications

1:2 pts in postoperative recovery

1:3 antepartum or pp pts with complications but stable

1:4 recently born infants & those requiring close observation

Newborns:

1:6-8* newborns requiring only routine care

1:3-4 normal mother-newborn couplet care

1:3-4 Newborns requiring continuing care

1:2-3 Newborns requiring intermediate care

1:1-2 newborns requiring intensive care

1:1 newborns requiring multisystem support

1:1 or greater -unstable newborns requiring complex critical care

*This ratio reflects traditional newborn nursery care. If couplet care or rooming-in is used, a professional nurse who is responsible for the mother should coordinate and administer neonatal care. If direct assignment of the nurse is also made to the nursery to cover the newborn's care, there should be double assigning (ie, one nurse for the mother-baby couplet and one for just the neonate, if returned to the nursery). A nurse should be available at all times, but only one nurse may be necessary, because most neonates will not be physically present in the nursery. Direct care of neonates in the nursery may be provided by ancillary personnel under the nurses's direct supervision. An adequate number of staff members are needed to respond to acute and emergency situations

Soooo..........I have a real serious problem that I need some guidance on......it seems our labor and delivery unit has decided to leave the floor with one RN and one technician when we have no patients on the floor. The second RN is put on-call and to respond within 30 minutes. Isn't there a guidance that states the need for "two trained RN's staffed on unit at all times" for a labor and delivery unit? I thought I remembered reading this somewhere?

WOW do I fear the safety of the patients that show up in emergent situations!! Scary!!

What do you think? Can someone point me in the right direction for some AWHONN/ACOG/AAP guidelines or requirements?

Thank you!!

Oh my, I could have written this post. Graduated same time, went to L&D the same time. I have always dreamed of working OB, and it just THRILLED me to finally get there! Orientation was a nightmare and did a thorough job of ruining my selfconfidence. The term "positive reinforcement" must be a foreign concept to those nurses. Had only 3 deliveries under my belt before I was set loose on my own and expected to manage 2 pts. The nightshift nurses were awesome -- how I wish I had oriented with them, then I would have learned something without my selfconfidence being shattered. Dayshift staff were negative, catty, and punitive. I lasted about 18 months. I went back to school to become an RN in my 30s. Of all the jobs I have ever worked, this was the most destructive to me personally. I have learned first hand, "nurses eat their young...and they enjoy every bite!"

Specializes in Women Services.

Does anyone have a tool in which they look at the stability of the patient and rate their ratio from that? I understand the AWHONN guidelines but what happens when they aren't a "normal" couplet. I'm looking for a unit that looks at the patient and their medical issues and determines the ratio based on that instead of a blanket statement of 3 couplets per nurse or 4 couplets per nurse.

Dumb question: how do you say AWHONN? Thanks!

Specializes in Community, OB, Nursery.

Long-a - wahn. That's as close as I could get.:)

That's what I thought, thanks! Stress on the A?

Specializes in L&D.

"

Soooo..........I have a real serious problem that I need some guidance on......it seems our labor and delivery unit has decided to leave the floor with one RN and one technician when we have no patients on the floor. The second RN is put on-call and to respond within 30 minutes. Isn't there a guidance that states the need for "two trained RN's staffed on unit at all times" for a labor and delivery unit? I thought I remembered reading this somewhere?

WOW do I fear the safety of the patients that show up in emergent situations!! Scary!!

What do you think? Can someone point me in the right direction for some AWHONN/ACOG/AAP guidelines or requirements?"

**************************************************************************

Boy - do I feel your pain. We are a small unit and always go down to one nurse if we are empty - with no tech! I have worked L&D for several years in bigger hospitals, but never by myself until I came here. I have had several close calls in the 4 years I've been here, but by the grace of God, everything worked out each time. We can't even get our administration to let us keep a tech with us when we're empty. I too, hope that someone posts the answer to your question about guidelines mandating 2 RN's at all times. Good luck!

Specializes in NICU, Mother/Baby.

i work on a pp complications floor..so we get anything from pt's still on mag to pts with psych issues. we also take babies in our assignment. the awhhon guideline seem like heaven to me as my average assignment is about 5 moms and three babies. EVERY mom has a complication so it's not a breeze. my assignment could consist of a mag pt, a chorio mom and baby (both on antibiotics), HIV, and whatever else happens to come since we are steadily admitting new pts. we also take pp readmit wound infections, mastitis, or other post D/C complications....we rotate charge nurse but charge nurse gets an assignment!! staffing is always an issue unless we are slow which then we are forced to be canceled which is a whole other can of worms!! LOL

Specializes in OB - L&D, M/B & Nursery.

It's good (not really "good") to hear that other units have the same problems all over the country. What I don't understand, however, is why you have to take the post D/C patients on your floor. At our hospital they are considered med/surg patients once they are readmitted. How large is your unit? How many deliveries do you have and what are your staffing ratios?

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

stress on A yes.

A-won

Specializes in labor,motherbaby,surgical.

Our mother/baby unit also has antepartum and gyn surgeries. Any suggestions on staffing?

" It is unfair to ask someone to do something that you would not do yourself" Elananor Rosevelt

Specializes in Community, OB, Nursery.

Bear530, our unit also has gynies and antepartums. Our unit makes it so that we have 4-5 adults per nurse. This includes antepartums, gynies, or postpartum mothers w/ babies. If there is a particularly sick or heavy-duty patient, sometimes mgmt will allow that particular nurse to max out at 3-4. On one occasion (ruptured hematoma, mom transferred to SICU and back to us, got 8u PRBCs plus platelets) one nurse had 2 patients. But that's VERY rare. Generally we staff like I said previously.

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