AWHONN Staffing Guidelines Please check this out: - page 5

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... Read More

  1. by   spring6723
    I don't know why, but somehow looking at these numbers/recommendations always gives me hope of what my work could be like!

    I'm a new-ish grad (started work in Feb.) and on our Postpartum Unit at night we rarely have less than 5 couples, regardless of complications. Basically 5 or 6 couples is a dream night that happens maybe a third of the time, but getting 7-8 couples is more of the reality most of the times. Now I'm definitely coming off of one of the worst nights ever, but I feel like I needed to just vent and get some reassurance that I'm not crazy. Last night was: 8 couples total, 2 moms on triple antibiotics, 2 fresh c-sections, baby under the lights, mom who had 2500 EBL and had been transfused before coming up, needy teen moms, needy breastfeeding moms, etc. It was out of control. Even with the ample help of my charge and fellow nurses, I still came no where close to doing everything that these patients needed. Last night wasn't a rare occurrence, just last week my fellow new grad was stuck with 9 couples. 9! 18 patients to chart on! We also never have a nurse in the nursery, only a nursery tech, so even if your babies are in the nursery, you're still fully responsible for the care excluding bottles and diaper changes.

    I feel like management is aware of the issues here and we're definitely a very busy hospital (average 24 births in 24 hours, 68 bed postpartum unit that is full at least half the time), but I feel like this is just plain unsafe. Does anyone have ideas about how to approach this? I have my 6 month evaluation coming up soon, and I definitely want to talk to my manager about some of my concerns - I was thinking of trying to keep a record of how many patients I have each night, and how the night goes in general to get a nice objective view of things. I think our main problem is that we don't really have a float pool - it's crazy, if two people call out sick, the only thing the charge nurses can do is beg the regular nurses to take overtime, which people aren't really that fond of doing. There needs to be an emergency back-up plan. Or just better staffing in general.

    Thanks for letting me vent! Here's hoping for a much better night on Monday.
  2. by   RN0202
    What you are dealing with is UNSAFE. I did find out that we can not refuse to take our team but we can state that we feel unsafe with the assignment and it needs to be changed. After all who will be in court with you or pay your bills etc if there is a major occurance? Nobody. It is unfortunate that nursing is no different than being a cashier at a grocery store. The patients are our customers and that is it. It is ashame you being a new nurse has to deal with this so early in your career. I want to continue to take care of my patients like I was taught many many years ago. I keep that with me everyday. If it ends up my hours are over budget so be it. At least I know I gave the best care possible and if it was a horrible day my manager and house supervisor are aware of that too. I am seriously considering home health. For the one on one. So we will see. Keep your chin up, voice your concerns by email at least then you have a copy if something does happen. And keep with you the good that you have done for your patiients.
  3. by   SmilingBluEyes
    And we wonder at people who seek homebirth at almost any cost. They know getting decent and safe care in a hospital is increasingly less likely. All this at a time when nosocomial infections will not be compensated. You can bet these numbers won't help.

    Seeing ratios like this makes me cringe and I would want to either quit and find a new job or turn in my license. It's beyond dangerous and all it will take is one bad outcome for the hospital to lose $millions. Sadly the nurse who is involved and her patient stand to lose a lot more. I would not work in a unit like that. Not a chance. 7-8 couplets is 14-16 patients. 9 couplets? That is a new one, even for me. Beyond insane. Even on med-surg, they are not doing 16-18 patients! Crazy does not begin to describe it. If I were you, I would do all I could to get out fast. That place is a factory, not a birthing unit.
  4. by   SmilingBluEyes
    I might add; just because a person feels she is efficient and "can handle it" or would be "bored" with staffing according to recommendations, does not mean she is operating SAFELY. Nor giving decent care; there is always plenty we can do for our PP couplets, such as teaching them things like how to bathe their babies, etc. This is so often being neglected now that staff are overworked. If I found myself bored, that is basic; spend that time on my patients. There's a concept.

    Anyhow: let just one of your 6 or 7 couplets have major issues and you miss it. Let your day come in court; you sing a new tune and fight for the right ratios more often after that.
    Last edit by SmilingBluEyes on Aug 11, '09
  5. by   ebby79
    On our unit, which is 19 ldrps/level 2 nursery(crosstrained staff), our minimum staffing is 4 nurses. This can be either all RN's or 3 and 1 LPN. This is if our level 2 nursery is closed. If it is open, even with one kid, staffing needs to be at 5. This in theory gives us enough people to do a stat section if one were to walk in. (one for the floor, one for the baby, one to scrub and one to circulate-hopefully we have a resident to assist!) Our unit never closes- we are self sustained so we cant be floated out elsewhere.
  6. by   NM_Nurse
    Any idea what the guidelines are for charge RN's on a L&D unit?
  7. by   bevans56
    where I work,managment expects 1:4 couplets,mixed w/gyn surgery or medical 1:6-7.With the paper work we have to do and lactation personell only on 5 days a week 8-5.This poses a problem of mothers who have problems nursing and we do not have time to assist them.Complications as a baby spitting up green and going to xray creates a problem and one nurse has to leave the floor for 1 1/2 hrs.The ratios need to be lowered to 1:6 postpartum.New younger nurses are not going to stay in these areas .Young nurses on on floor are fed up.
  8. by   LDRNMOMMY
    New staffing guidelines released today! AWHONN members can download for free! I haven't completely finished reading them, but I am liking what I have read so far.
  9. by   debsgreys
    I work on a m/b unit. 29 yrs. OB, We generally start with 4 couplets, maybe you will have a high risk ante. We also have post op gyn. I work days, having discharges and admits, ongoing, sometimes not even counting how many pts. you actually have. We assign by acuity, of course thats in the beginning of the shift. We also take into consideration continuity of care.
    Lets face it our floor is 90% education. We have lactation 6 days a week, about 5 hours a day. I agree with earlier mention, you can be in one room for 2 hours assist with brstfdg. Oh do not let me forget all the documentation and serving hot tea with lemon on time!
    Add that to administration saying we are always over budget, compared to other floors in the hosp. A wise administrator, who no longer works here, said" please" the moms they are the ones who make the choice which hospital a family member will go to.
    I could go on and on
  10. by   mitchsmom
    I didn't look through all the posts to see if someone wrote it already, but if not, be aware that the staffing guidelines were updated last year (2010) --> *to our advantage* --> for example, pitocin patients are now supposed to be 1:1.

    I will try to post the new guidelines when I can.
  11. by   mitchsmom
    Article regarding the release

    Guidelines can be purchased here, but as I said before I'll try to post sometime:
  12. by   ElvishDNP
    You are right, mitchsmom. Thanks for the links!!
  13. by   LDRNMOMMY
    If you are an AWHONN member you can download the guidelines for free.

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