Need help...

  1. How many of you do pre-op C-sections on Postpartum?

    I need numbers to show my employer. These pre-ops take us up to two hours to complete all of the paperwork and shave and start IV and give pre-op medications.

    Had one today that was scheduled because of twins. We don't have twin monitoring capabilities on the Postpartum unit. The patient was supposed to have an NST.

    I called L&D for help. I told them I would complete the chart for them if they could do the NST and finish prepping her for surgery. They vehemently refused. We had 16 patients and the two scheduled C-sections that came in at 0530 and 0630. We were staffed with two RNs from Postpartum, one RN from Peds who didn't know a thing about OB, and one CNA. Oh, and one RN orienting. (She had a full load and took one of the scheduled C-sections). I was charge. I had 5 patients from 7P-11P. Gave one away to Peds RN (of course the assessment was already done).

    I was told from L&D if she came to them, she would be one-on-one. How is that possible for L&D and NOT for us?

    In the other 4 hospitals I have worked in the past (way back to 1989), ALL scheduled C-sections were pre-op in L&D.

    I had to do 2 20-minute NST's for each twin. I was told that this was done before there ever were twin monitors. Oh, please!

    Sorry this vent is so long...I really need some numbers to show my employer.

    My unit also staffs with 3 people for 12-17 patients (2 nurses and a CNA). The guidelines say 3 RNs but they put a CNA in place of the third RN.
  2. Visit webbiedebbie profile page

    About webbiedebbie

    Joined: Jan '03; Posts: 771; Likes: 77
    Remote Data Review Consultant
    Specialty: 22 year(s) of experience in OB, Telephone Triage, Chart Review/Code


  3. by   SmilingBluEyes

    Me thinks this stinks. THAT is what L and D is for. Being an LDRP, we do it all and I KNOW how much time it takes to work up a pre-op for a section. If you don't have the staffing for this and something is missed, esp. in monitoring the patient, well, you know....KEEP A RUNNING TAB on what it takes in personnel and time to do these pre-op's.

    Consequences can be disastrous. I would be fighting this one if I were you, too Debbie. The patients and YOU, the staff in PP are being done an injustice here.
  4. by   Jolie
    I agree that admitting these patients on PP seems ridiculous. Why introduce them to yet another nurse in yet another department when the section will obviously be done in L&D with L&D staff? I also agree that it throws your staffing off, while L&D can plan their staffing for scheduled admits. When I worked on an LDRP unit, we would have a day shift RN on call to come in early and do scheduled C-section admits if the unit was too busy for the existing night shift staff to take them.
  5. by   webbiedebbie
    So, how can we convince the manager this is not the way it should be done here? Ever since I have been here, all I have heard is "this is the way we have always done it". Or "you can't change things overnight". There are many problems on this unit. We are expected to meet the standards. Turnover on nights is tremendous because of this. Right now, we only have 3 fulltime RNs and 15 float pool for 12-hour nights. Float pool are only required to work in two areas, two nights a pay period.

    I was reprimanded by a coworker this morning because I didn't make sure days had enough staff to cover. Our guidelines say 3 RNs or 2 with RN or 2 with secretary. We had 3 admissions during the night. We are NEVER staffed to cover these admissions, even though they have delivered and usually come over right after change of shift.

    I am so tired of fighting this. My hands are tied. I need help with solutions. I already know how other hospitals separate L&D from postpartum. This is not good enough for this hospital.

    We also do saline ABs on our postpartum unit. Most times, we only have 2 RNs on nights. Our moms also have the option of "rooming in". Even though we don't physically take care of the infants, I think this increases our responsibilities. Fathers of babies may also stay through the night. Who is responsible for them if something happens? We also take female med/surg. We have had 3 patients with SBOs with NG tubes. I had a patient who had a hysterectomy 2 weeks prior and was admitted to our postpartum unit with infection and an open wound!

    HELP please. How do we change things at this hospital?!
  6. by   SmilingBluEyes
    DOCUMENT DOCUMENT DOCUMENT is the ONLY way to really convince minds. SHOW how much time it takes and make sure you have numbers/staffing issues to back you up. BE SPECIFIC. That is the only way I see it changing.
  7. by   packerfanrn
    Post partum is for just that. On my unit, the labor nurse does everything from admission, to pre-op, to the section, to the recovery, and then continues with that pt. one on one until the next labor pt. comes in. You are getting a raw deal.
  8. by   SmilingBluEyes
    Packer fan, where in WI are you? My dh is from Eau Claire but a VIKING fan (to the rest of his family's chagrin). I miss the "cheeseheads" sometimes........
  9. by   rdhdnrs
    Your manager needs to be shown AWHONN's staffing guidelines as well as standards of practice. I've never heard of Postpartum doing anything but Postpartum.