AWHONN Staffing Guidelines Please check this out:

[SmilingBluEyes]

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

[cmrrn]

My concern with the "recommended staffing ratios" is that they were written for large institutions. When you work in a small hospital like ours, it is very frustrating...

[KristiP, RN]

I started out in Labor and Delivery 8 months after obtaining my license and working " postpartum for experience" before switching to what I love... L&D. New nurses can do it; but it needs to be a facility where staffing is good and not a skeleton crew. What concerns me the most in regard to the nurse and patient ratio is that I worked in a HUGE hospital where nurses were " running over" -- 6 on day shift.. yes I said that correctly. Now I work in a TINY hospital with 2 RN's and THATS IT my friends... I have been an L&D nurse for almost 13 years and have never seen this type of ludacrisy going on. The MD's want to push the pitocin and it doesnt matter how many patients you already have; they keep sending them over from clinic !!!!!!! Enough is enough... No one should be made to take more that 2 patients on pitocin and I am one included.. I value my license too much and I go by the AWHONN standards. I like one on one patient care because the miracle of childbirth is just that -- a MIRACLE! and you cant enjoy it running from room to room to room... Lets stop the madness !!! :loveya:

[Dude,RN]

One of our docs now wants the Rt to come to every delivery and be in charge of the baby, after all they have taken NRP. I don't know what standard of practice is elsewhere but I don't think respiratory therapists are trained to assess, APGARs, ect. a newborn.

Makes me want to just quit OB........[/quote]

As a neonatal nurse and an NRP instructor- the guidelines put forth by NRP state that one person trained in NRP should be at each delivery whose total focus is the infant. Now, with that being said, I think that person should be an RN, but the guidelines arent that specific. Thats what gets me about the guidlines...we play with people's lives and in my opinion, the AWOHHN standards for staffing are too vague, management uses them as an excuse to "skeleton crew" the place, and then you end up in a hot mess if the crap hits the fan.

I took the issue to my management the other day about a staffing level being unsafe and was told "well, we didnt have a bad outcome." and "we just staff by the standards" and my favorite "what, do you want nurses to just sit around until something happens?"

Well, if it was my wife, my daughter, or my friend having the baby that could be a potentially dangerous outcome...you bet your rear I would want a nurse "just sitting" around until something happens.

Just my two cents worth. :nuke:

[bendnurse]

does anyone know what kind of things would qualify as a "complication" for a postpartum couplet? i'm stressed about having 6 pp couplets! i find no one ever gets quality care especially if there's more than one post-op c/s, or more than one mom who needs breast feeding help....

our unit has been dangerously short-staffed lately, and now management is threatening to take away our cnas. we only have 2 to begin with, usually only work with 1 (or none) per shift, on a 27-bed ldrp unit.

last week i had 2 labor-checks in triage, a laboring pt who delivered, a failed-homebirth walk-in at 8cm, and a antepartum with gallstones in ptl. help!

how can i get the attention of management to please hire more staff??? :angryfire

[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.

[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.

[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.

[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.

[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.

[NM_Nurse]

Any idea what the guidelines are for charge RN's on a L&D unit?

[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.

[LDRNMOMMY, BSN, RN]

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.