Questions about L&D staffing and scheduling

  1. I am a new L&D Nurse Manager, and I'm still having trouble trying to staff appropriately. We average about 2000-2100 deliveries a year, which is about 6 a day. When I look at the guidelines on AWHONN, it says the staffing is 1-2 for active labor, and 1-3 or 1-4 for antepartum. A couple of years ago, the manager staffed like this, but the recent managers have been bringing in traveling nurses and we have nurses just sitting around. I'm trying to staff based on patient needs, but the staff is having fits because now they don't have time to just sit around. How do you all schedule your L&D staff?
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    About BELCJ

    Joined: Dec '05; Posts: 32


  3. by   SmilingBluEyes
    Hello there and welcome to the forum.

    I would say,they are not being paid to sit around, are they? If you are following AWHONN guidelines, they will be busy, but it's usually manageable, especially if they work as a team and help each other out. You always have to take into account acuity as well as the numbers, of course. But I as a manager would not worry about them being upset about being busy. If we are slow enough to sit around, low census/cutbacks are made and quickly, where I work. Sitting around doing nothing does not fly where I am-----the manager keeps a close eye on this and once stocking/cleaning and the like are done, people start getting sent home if it's excessively slow. Our admins have shallow pockets and keep staffing as lean as possible.
    Last edit by SmilingBluEyes on May 24, '07
  4. by   rgroyer1RNBSN
    My fiance is the nurse manager of our L&D unit at my hospital heres how she staffs it-

    Active labor 3- 2 Rn's and 1 Lpn

    Antepartum-4- 2 Rn's and 2 Lpn's

    If you use the Lpns or not depends on where you live but thats what I would use is the 3 for active and the 4 for antepartum.

    Now Im the nurse manager of our ER which I have 3 places to staff-

    Main er w/ Trauma- About 30 beds if you count the 5 trauma rooms. I staff it with a 3-1 or 2-1 ratio I also use about 3 Emt's, 2 pcts, and 5 Lpn's per shift because we get quite busy over here.

    Then I have the Emergency Chest pain Center to staff which is about 10 Beds- I staff it with a 2-1 ratio ( 2 pts. to 1 Rn) I also have about 3 Emt-p's over here and 2 Lpn's per shift.

    Then I have the Urgent Care-
    Which is about 8 Exam rooms- Which I staff with 2 Rn's, 2 Lpns, and 1 Medical Assistant per shift.

    I also staff triage which is 2 teams one team is an RN and an Lpn, the other Team is an RN and a PCT.

    Hope this helps!
  5. by   BELCJ
    Active labor is 3 nurses, but for how many patients? The antepartum is 4 nurses, but again, how many patients is that?
  6. by   SmilingBluEyes
    Do AWHONN guidelines posted above in the sticky help you at all?
  7. by   SmilingBluEyes
    Generally we try to stay 1: 1 or 1: 2 for active labor. 1:1 for pts getting epidural, undergoing c/section or pushing/fresh delivery.

    Antepartum, well, we do LDRP, so our matrix may be different. The nurse with the lightest load takes the ante's and rule-outs as they come.

    Does that help?
  8. by   BELCJ
    Yes, those guidelines do help. That is how I'm trying to staff, but that means letting all these travelers go because we don't need them, and the nurses are saying it's not right and they can't do it without the added staff. Obviously administration is all for getting rid of all the travelers, but I want to be reasonable too.
  9. by   BELCJ
    Our postpartum are on the same floor, but on the other side, (seperated by a walk-thru storage area) and it is staffed separately. The entire area has three actual departments, L&D, Nursery, Post Partum, but it's one unit, Women's Services, all under me. The L&D also staff the c-sections, do the Labor Evals, and NSTs. The problem is that the staff want a patient load of 1-2 for all antepartum patients whether they are in active labor or not. The guidelines state 1-3 or 1-4 depending on their acuity. You've given me a lot of help, and I think once the staff realizes that they aren't going to be paid for sitting around, they'll either get with the program, or we'll weed out the ones we probably don't want anyway.
  10. by   SmilingBluEyes
    I am in awe of the fact, that until your taking over, staff felt they had the right to sit around and get paid to do nothing. Where I am, it's like "chop-chop". If we d/c a lot of people and there are no labors coming in, the manager is wondering who the charge will be sending home on call and SOON. Not much time for sitting around really, anyhow. Usually way too much to do for that. Good luck making your changes!
    Last edit by SmilingBluEyes on May 30, '07
  11. by   BirthingBabies
    I totally agree with the above post, we work minimal staff at night almost always, now we only deliver about 1200 a year but if we ever have an extra person, the first time it calms down, they are sent home right away on low census call... dayshift the same way...
  12. by   BELCJ
    It's only been about the last 6-9 months were this has become the "norm". The previous director submitted an FTE budget for the new year of about 36 I think, and said she wasn't adding any nurses, just trying to keep what they already had. With an ADC of about 6, I'm still trying to figure out what her thinking was. Well, the budget process isn't finished yet, so of course I immediately lowered the number, but with all the griping I'm hearing, and being new in the position, I thought I should ask others. You all have been a fabulous resource. Thank you so much for all the support and information. I'm sure I'll be back with more questions as time goes on.