Safe nurse to patient ratio? How do they do it at your hospital?

  1. I saw a similar thread addressing this a few days ago - I'm just curious how other hospitals staff their labor and delivery unit. I work 3-11 shift and there are usually two RN's staffed, sometimes three. We have a "call" person from the 7-3 shift that may have to stay until 7 and, depending on how busy we are, the night shift "call" person may have to come in to meet the day shift person. We base our staffing on the census - you can come in and have two patient's in labor, both on pitocin. You may come in and have a laboring patient and a PIH observation patient. You may come in have a c-section to circulate and while you're recovering that patient, you can get a patient in labor. We usually don't have a secretary to put charts together, or answer the constant phone calls. We dont have techs to help us clean up after a delivery. We circulate our c-sections. Most days, I don't get a meal break because we are just too busy. Some days (very, very few) we actually sit down and eat in the break room...while we're answering the phone. I've actually had times where I sit down to eat my dinner (that I just heated up) and a doctor or sometimes even a patient! will come into our break room to get me to assist them with something! Is this about how it is everywhere?
  2. Visit SierraN profile page

    About SierraN

    Joined: Apr '05; Posts: 45; Likes: 4
    Labor and Delivery, staff nurse; from AL
    Specialty: 10 year(s) of experience

    11 Comments

  3. by   mollyaqua
    You day sounds very familiar. We do about 200 deliveries per month. Minimum staffing is five RNs, a unit secretary and a tech, but we are often missing the secretary or the tech. Staffing ratio should be 2:1 unless it's a preterm patient on magnesium sulfate or other very high acuity patient. Our hospital pays us the equivalent of 1.5 hours of time if we get no lunch, which is very often. That comes out to 30 minutes for the time I worked and a 1 hour "penalty" to the hospital for No Rest Period. I'd rather have lunch! If I do manage to get away for lunch while my patient is "covered" by another nurse, you can be certain that no charting was done in my absence--the other nurse answers call lights and responds to emergencies only. I don't call that a "break", if I have to come back and catch up on what I missed.
  4. by   Suebee6
    We always do 1:1 with all active labor or section patients. We circulate and recover our section patients, but they are our only patient at the time. We have 2 or 3 at the most "watcher " patients in L and D..PTL or Mag..etc. No PCAs in L and D. Usually one secretary for the unit. We do about 300 deliveries a month, core staff is 3 RNs and 1 scrub tech at all times.

    On our perinatal floor, we have 4 patients each at the very most, some days we also have 1 PCA to the floor (12 patients) and 1 secretary..but not always. We can get pulled up to perinatal for staffing if they have over 4 patients each. (that is the only floor where we get pulled)
  5. by   SierraN
    Molly: I'd rather have lunch also - they don't pay us extra for missing it though! It's exactly the same with having someone watch our patient - you end up having to "catch up" so, it's not really a break. It's just wearing me down to run my butt off for 8 to 12 hours straight almost every day - go from one delivery, right to the next (with no tech help, no secretary...) and no breaks. I love my job. I love my patients. But I'm getting so burned out.
  6. by   SierraN
    SueBee - it sounds like they run your unit the right way. It sounds like it's safe. I think my patients deserve the safest environment possible and a good experience. After all, your labor and delivery is a memory that will last forever.
    Last edit by SierraN on Sep 16, '06
  7. by   LDRNMOMMY
    Quote from Suebee6
    We always do 1:1 with all active labor or section patients. We circulate and recover our section patients, but they are our only patient at the time. We have 2 or 3 at the most "watcher " patients in L and D..PTL or Mag..etc. No PCAs in L and D. Usually one secretary for the unit. We do about 300 deliveries a month, core staff is 3 RNs and 1 scrub tech at all times.

    On our perinatal floor, we have 4 patients each at the very most, some days we also have 1 PCA to the floor (12 patients) and 1 secretary..but not always. We can get pulled up to perinatal for staffing if they have over 4 patients each. (that is the only floor where we get pulled)
    I wanna work where you work!!!! The only time we are 1:1 is if the floor isn't busy! We do about 400 deliveries a month, in the daytime there is a dedicated circulator, and recovery room nurse. On nights your circulate and recover your own c-section pts, usually then you are 1:1 but not always. If another c-section is called and the unit is hopping whoever is already recovering will recover the next patient. We have sometimes have even been 3:1 (I HATE when that happens), and usually one of those pt's is in active labor.

    We don't float in or out of our unit. We have to take one 12 hour call each schedule period with assigned weekend call once every 3-4 months. It helps, but when you have several callouts you are screwed. Our manager has hired several nurses most with prior L&D experience so they do not require as much orientation but they are all still in oreintation.
  8. by   crosfam
    Where do you work? National Standard is 2:1 labor, but how do you watch a patient on the monitor and circulate at the same time. Sounds a dangerous to me.
  9. by   crosfam
    Amen to that! If we miss we are to busy for lunch we clock out no lunch and are not deducted the 30 min.s we should of had.
    We usually have 5-6 RN's, 2 tech.'s, and a HUC. Our ratio is usually 1 labor with outpatient triage or an antepartum.
  10. by   SuperFlyRN
    In our hospital it is L&D is ALWAYS 1:1, even if that patient is long, thick and closed and intact and basically sleeping. PP our guidelines are four couplets per RN but, if necessary, we CAN go to five couplets per RN. My last shift I worked we were extemely short staffed and had 25 couplets to 4 RN's and we had to do some creative scheduling and use NICU to help with a 10 baby assignment and and the PP RN takes 10 moms. Yuck
  11. by   kastas
    Holy cow! I can't imagine 3:1 !! We (almost) always get 1:1, 2:1 if overnight induction or slow moving prime. We do have separate areas for antenatals, but staff that also. The ante side we have anywhere from 4 to 8 patients (rarely any pp mom's/babies over there). We staff with 5 minimum RN's. One has to be with the antes if any are PTL or "time bombs" and one has to be in triage (separate area also). That leaves us 3 for L&D on most nights and we do 200+ deliveries/mo.
  12. by   SmilingBluEyes
    We staff much like SueB. If in the event, we go back for section, the staff on the unit watch the remaining labor patients, usually about an hour to hour and half til the section is complete and patient done w/PACU recovery (which is done in her room, immediately after the surgery----the labor nurse does the recovery of the newborn and mom in that hour, unless the baby is sick).

    We have to wear lots of hats, cause we are an LDRP and GYN unit, so we have to help each other a lot--and be willing to change assignments sometimes, as the day changes.

    There are very few uninterupted meal breaks, really. That is just how it works in OB.
  13. by   LDRNMOMMY
    Yes, 3:1 sucks bad, thankfully it is the exception, not the rule. That usually happens when you have multiple call outs, no call person, no one wants to come in to work overtime, and a full moon! Most of the time we are 2:1.

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