Labor and delivery safe staffing and assignments

Specialties Ob/Gyn

Published

Specializes in Respiratory, Cardiac, ED, Maternity, Ped.

I work in a labor and delivery unit. We have 21 rooms and 2 triage rooms so we are a small unit. When we have a postpartum assignment we are assigned usually 4-5 couplets (mother-baby). We then have what is assignned as a delivery nurse...this nurse goes to all deliveries on her shift for the baby. So this nurse takes care of baby at delivery while the labor nurse focuses on mom. The delivery nurse then does the 2 hour recovery vital signs on baby then passes the baby on to the labor nurse. Yesterday at work I had 6 couplets! That is 12 patients! 6 moms, 6 babies! One couplet was a fresh c/s from the night before. I was upset as this is becoming more and more common. My manager was at work. She had triage. She did not even say anything to me or the other nurse who had 6 couplets the 1st half of the shift. I finally told her I was uncomfortable with my assignment and felt it was unsafe. She told me to call my nursing director at home if I had a concern! So I did that and the director of nursing told me "I am unavailable this weekend I am golfing in a golf tournament." I mean what if something happened and we have these unsafe assignments! What do other nurses out there think is an appropriate amount of couplets to be assigned to one nurse? Also the nurse assigned as the delivery nurse to go to the deliveries for baby is also supposed to be taking care of ONE couplet at most. The other night a nurse had 6 couplets and did 5 deliveries. UNSAFE right???? I do not know what to do! My managers do not seem to care and if we say anything about this to them they say they are working on getting more open positions for RN's approved from higher up but it is a long process. In the meantime we are all doing doubles constantly because at the end of our shifts we cant leave it is so busy! My managers also get ANGRY if you approach them about this! They seem nice to your face then they won't speak to you and avoid you. Any advice or opinions?

Up Vote Up Vote ×
Specializes in OB-L&D, Post partum, Nursery.

Does your facility use AWHONN Staffing Guidelines as a standard of care? I believe the standard is 3-4 stable mother/baby couplets and no more than 2 of these should be 1st day post op Cesareans. Standards and guidelines are for patient safety and if you facility says they go by these but don't staff accordingly, it can turn into a legal nightmare.

If you have to go up the chain of command (as you did when call the DON) and can't reach someone, keep going up the chain until you find help. I can only think that your manager is experiencing major frustration and a lack of support from administration, however that is no excuse for getting angry with staff for requesting help to maintain patient safety.

You can get a copy of the standards from AWHONN and find more info on www.awhonn.org

Up Vote Up Vote ×

I am assigned in obstetric ward here in saudi arabia and census here is very high with regards to deliveries. Every women here deliveries everyday. I am specifically assigned in postnatal ward and I am SN 2. I am assigned for babies and postnatal mothers. Sometimes my patients are 8 mothers the maximum. 2 fresh section. We are lack of staffs. They want to cut off our overtime but they dont think about the census we are having. Do catch babies during cesarean section? In my area we have Elective cesarean section, we nurses go inside the theater and we are the one catching the babies.

Up Vote Up Vote ×
Specializes in Respiratory, Cardiac, ED, Maternity, Ped.

I went to this website and could not find staffing standards. Where can I find them I think this could really help!

Up Vote Up Vote ×
Specializes in Community, OB, Nursery.
I went to this website and could not find staffing standards. Where can I find them I think this could really help!

It took a bit of navigating, but here is what the previous member was referring to:

http://www.awhonn.org/awhonn/store/productDetail.do?productCode=SG-910

For AWHONN members it is free; for nonmembers, you have to purchase.

Is risk management aware of this situation? I feel for you. Your staffing situation is totally unsafe and you are right to be concerned.

Up Vote Up Vote ×
Specializes in OB/GYN,PHN, Family Planning.

I have filled out the paperwork for assignment under protest (or somthing like that) when I worked in L&D. I had an unstable PIH, 2 active labor pts. it was a zoo night but it's my license and the form is just another CYA in documenting if something went bad that night (it didn't )

Up Vote Up Vote ×
+ Add a Comment