patient ratios? - page 2

We recently had a meeting at work and one of the nurses brought up the fact that there are actual guidelines for patient/nurse ratios in mother/baby and that if our assignment is higher than set... Read More

  1. by   NurseNora
    Join your national organization, AWHONN, learn about the approved staffing ratios, report to your department director and house supervisor everytime you're over the staffing ratio. Send a copy to Risk Management also. Make enough noise and someone will listen after while. Be a part of the solution also, brain-storm about what can be done. Cross train some people to work as float nurses? Mandatory on call? (I know everyone hates this one, but sometimes it's necessary) Recruit more PRN staff to help cover shifts? Transfer to another hospital where appropriate staffing is more important to the management?
  2. by   SmilingBluEyes
    PRN is a definate solution. I have been a PRN'er for along time, filling in the holes.

    Also, yes,AWHONN has staffing standards you should be following. Joining AWHONN is something I encourage for EVERY OB or GYN/Newborn nurse.

    We have also had to institute mandatory 1 shift of call for all our regulars, when times have gotten tight and tough. Far from ideal but sometimes, necessary.
  3. by   MIA-RN1
    Quote from NurseNora
    Join your national organization, AWHONN, learn about the approved staffing ratios, report to your department director and house supervisor everytime you're over the staffing ratio. Send a copy to Risk Management also. Make enough noise and someone will listen after while. Be a part of the solution also, brain-storm about what can be done. Cross train some people to work as float nurses? Mandatory on call? (I know everyone hates this one, but sometimes it's necessary) Recruit more PRN staff to help cover shifts? Transfer to another hospital where appropriate staffing is more important to the management?
    oh we all have to take 12 - 16 hours of call a month, including our per diem nurses. They just won't hire any more.
    I turned in a suggeston tonight to cross train techs and secs so the secs can do basic bps and the techs can take off orders.
    I left in tears tonight. Five couplets, three with climbing blood pressures, one first time mom who needed help nursing and one whos teeny little baby had blood issues and that I had to transfer to our special care unit.
    Totally unsafe for a nurse less than six months out and yet everyone was busy. We closed down the nursery and still all had five couplets. Sick calls are increasing hmmm maybe from too heavy a load? :angryfire
    I am just thankful I am going to three 12's a week soon. I can't handle five days a week of this stress.
    Last edit by MIA-RN1 on Nov 12, '06
  4. by   SmilingBluEyes
    I would have a hard time working there after what you have said here.
  5. by   MIA-RN1
    Quote from SmilingBluEyes
    I would have a hard time working there after what you have said here.
    EDIT: I meant to say 12-16 hours of call time a MONTH.
    I am having a hard time. I am just at the end of my rope today, or at least need a break. I work three days on, one day off, all this month. THen I go to three days a week at least thru the first week and a half of December and I did it so I will have four days in a row off for the first four days of December. I was told my the NM that I can do 3 12's or 2 12's and 2 8's, and I opted for 3 12's. But the scheduler is like "Well, write it down and we'll see" (we self schedule but then she puts it all together after we hand in our schedule requests). She said that she has to 'do what's best for the unit' which I am sure means she will flip me to 2 12's and 2 8's.
    Since my orientation ended in August, I have dealt with four postpartum hemorrhages, at least four cases of PIH on mag, one readmit 2 weeks post Csect for hemorrhage/blood transfusion, numerous AP's, a fresh TAH/BSO, and even last night with three out of five mothers with blood pressure concerns. We typically get four to five couplets a night, and all those babies which is a HUGE responsiblity. Admissions either right as I get there or when I am just about done. And learning how to do the paperwork, to hone my nursing skills, to adjust at my age to working full time....
    I only just graduated in May and have only worked there since June. I feel like i am overwhelmed. Sometimes I feel like 'wow', I really did something tonight. I feel like a real nurse. Other times I wonder what the heck I am doing this to myself for. I ask my coworkers for help, and they help when they can, but that is not always the case because we are often swamped.
    Another nurse wrote me up a few weeks ago because I had a baby on Q4 vitals (r/o sepsis, no symptoms and stable) and I was two hours late because I had a hemorrhaging patient I was dealing with. I asked one of my supervisors what am I supposed to do. She said ask another nurse to do the checks. So I have been, and no one has been able to help me with the patient load we've had. Last night I had some help, but still, my eight o'clock patient assessment wasn't done til 10 and another patient who would have benefitted from help caring for her baby didn't get to see me much because of all the other pressing issues the others had.
    I meet with the nurse educator Monday. She is meeting with all of us newer nurses individually to go over paperwork etc. Our wonderful 6-8 week orientations never gave us a firm grip on paperwork. She said she might be able to get my 6 month review in as well but not sure. Then, after the paperwork meeting, mine (and the others) charting will be randomly checked by another nurse for errors. Its pretty brutal because its a very 'by the book' nurse.
    yet everyone says I am doing great, I am handling heavy loads really well. But what if I miss something in my inexperience? What if I don't realize a problem in a baby because I;ve got someone on mag needing hourly checks, and a fresh c-section patient to take care of?
    One newer nurse who was struggling to keep up got bumped back to 'resourcing' which is the last stage of orientation and had someone follow her every move and check her charting and it was bringing her to tears almost daily because of the stress. She was also given just a month to get up to par.
    I don't know. They want us to follow the Disney crap as well, so nurses are running around getting drinks, juice, pillows etc because we either don't have a tech at all, don't have a secretary, or both.
    I am sorry. I am feeling really bad about things today and I am so tired. barely slept last night.
  6. by   Buggs
    Coop, I feel your pain--I am your co-worker. Thank you for bringing our issues for input on a larger scale. We must take action together. Collecting data from others gives us support in our quest for improved conditions. Please don't give up yet. Some of us are trying to provide those in power with standards of care that are used nationally. The idea of involving "Risk Management" is also being considered. Besides the nurse-patient ratio, we are trying to provide written reasons for increasing ancillary staff. "Coop" briefly mentioned our lack of ancillary staff. What kind/number of ancillary staff do the rest of the OB units have? The majority of nights we "share" a secretary, and a tech between L&D and the 30 bed PP unit. Most, if not all, their time is spent in L&D, which is understandable. But one nurse in the nursery with 14+ newborns is a bit of a challenge. (We are talking about night shift). And yes, we take care of Mag patients, their baby, and three other couplets. We answer the phone, all call lights, do all bloodwork on moms/babies, do all our vitals, and of course tend to all the needs of the family unit--juice, pillows, snacks,make the bed for dad... Again, receive little to no help from any ancillary staff. Hard to believe a unit our size has noone at the desk. Any suggestions or support from our peers is greatly appreciated. Have any of you seen positive impact from "Magnet"?
  7. by   santhony44
    Any possibility of enlisting the docs whose patients you care for to help? If ACOG has a standard for safe staffing ratios your docs might be interested in knowing that those aren't being followed.

    Sometimes when doctors speak up management listens, since they are seen as bringing money into the facility while nurses are "expenses." Threatening to send their patients to another facility can be very effective leverage.

    I'm not OB and have witnessed one postpartum hemorrhage. I've never seen anyone bleed so much so fast ever and that includes some significant saw cuts in industry. Very, very scary prospect.

    (And no, I don't agree that nurses are "expenses" but that's still a common management perception).

    If all else fails, a nice media expose might work wonders!!

    Good luck to both of you. It sounds like a horrible situation to be in.
  8. by   MamaMadge
    I wish you the best of luck in rectifying your situation. It sounds like you work in a very dangerous place! Keep notifying your lead/manager when you feel you are out of compliance with ratios....keep good notes about who and when you talked to people. Cover your butt, and maybe start looking around for another job?
  9. by   SmilingBluEyes
    The Disney stuff would be OUT THE WINDOW for me. Nope, no time. I would be telling families where the kitchen is and how to get their own juice, etc. You don't have time for that. You are dangerously understaffed and especially for your inexperience, this spells trouble.

    Also, write up any variance from standard of care, no matter how small. Talk to the risk management department about all of this.

    Meant to ask, do you have a union? I can't remember if you said so or not. If so, I would be talking to my rep. You are trying to handle too much with too few staff, and too little experience. This is a dangerous formula for disaster. I am so sorry for all of this. I feel for you.
  10. by   MIA-RN1
    Quote from SmilingBluEyes
    The Disney stuff would be OUT THE WINDOW for me. Nope, no time. I would be telling families where the kitchen is and how to get their own juice, etc. You don't have time for that. You are dangerously understaffed and especially for your inexperience, this spells trouble.

    Also, write up any variance from standard of care, no matter how small. Talk to the risk management department about all of this.

    Meant to ask, do you have a union? I can't remember if you said so or not. If so, I would be talking to my rep. You are trying to handle too much with too few staff, and too little experience. This is a dangerous formula for disaster. I am so sorry for all of this. I feel for you.
    we can and do tell them where the kitchen is but then sometimes they complain the nurses arent' helpful enough, our press gainey scores or whatever go down and we are the bad guys. disney model says to make them feel at home or something but also to anticipate their needs. Fine, I am there for all my patients to the absolute best of my ability. But to the rest of their families too? I haven't been able to finish the disney book yet, but I think that would say to bring everyone juice and pillows. And its not that I mind, its just that I am more often SO FREAKING BUSY. We need more ancillary staff.
    I have to say its been better lately, but that is just the luck of a low census and not on purpose.
    We are not union and I don't think that will fly becuase now there was that new ruling (read about it in RN today) that charge nurses are considered supervisors and therefore not covered by union and since many/most of our nurses seem to share the charge nurse role, I can't see unionizing being accepted.

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