Staffing Problem; Need suggestions!!

1. This issue has been driving me crazy for weeks. It's a BIG issue, and I'd apperciate your suggestions. I am resposible for staffing in a small rural hospital. I am a supervisor and also in charge of OB. We do about 100 deliveries a year...And yes I think we give GREAT care..The problem I am having, on many levels, is that I have an RN who usually just works acute. But because of our fluctuating census most of us are "cross-trained". We do our best to make sure anyone doing OB has had as much training as possible before they are left on their own, and we "try" to always have back-up available. Anyway...this, very good, nurse doesn't feel confident doing OB even though I have tried to convince her, and the MD's agree, that she is competent. On many occasions she has reluctantly taken over care at the begining of her shift and just recently she told me that she doesn't think that she should be forced to do OB. Can I, should I, "force" her? We tried to give her options including 1. Doing OB when absolutely needed. 2. Trading shifts(she currently works 3p-3a) and replacing her with someone willing to do OB. or 3. Orienting to ER so the supervisor can be relieved. or4. ??
   I am rambling, venting, and let me tell you I have worked here 12 years and we have never, not been short RN's,( does anyone want a job?) and those of us that do like OB work a lot of overtime. What do you all think??

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   About RMH

   Joined: Dec '02; Posts: 46; Likes: 1
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   9 Comments

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3. 
   Feb 8, '03

   I would not just force her. I would ask her what she thinks she needs to feel competent there or which of your other options appeal to her cause she has to pick one or help you come up with a solution. Give and take seems to be the best idea and she'll have to figure out how to do that in one way or another.
4. 
   Feb 9, '03

   Could you arrange, and I know this is difficult with already short staffing, for her to spend a period of time, perhaps a week or two, precepting with someone at a larger, busier OB unit? Perhaps at the tertiary care center where you refer high risk from your hospital. It may be that since you don't do OB procedures often, she simply needs a chance to see/do more to feel comfortable. It would be worth the investment if she is someone you see working in your facility long term.
5. 
   Feb 9, '03

   It maybe that she will never be comfortable doing OB. Some folks just don't like it at all! Maybe she will take one of the other options. Or maybe she will just move on...to somewhere that doesn't present the need to cross train. I realize that most positions now days require some degree of cross training...but some people will never feel comfortable doing this.
   
   Maybe finding a new nurse is a better option to losing a good one..
6. 
   Feb 9, '03

   No you shouldn't force any RN into cross training for any specialty they don't feel qualified or comfortable in doing. Was this need to cross train made abundantly clear prior to their agreeing to work for that facility?
   A fully trained L&D RN is just part of the cost of doing business, if your facility doesn't want to incur this cost 24/7it shouldn't be in the business. Our facility does, we do about 200 deliveries a year,
   the liability that your facility is taking, and the RN who agree to do that job is enormous.
   Find someone that is either fully trained or willing to be. But then don't expect them to have responsibilities for patient care in other areas of the hospital.
   It will take a change in capital/expense priorties but that is what should be done.

   Last edit by OC_An Khe on Feb 9, '03
7. 
   Feb 9, '03

   What some supervisors don't seem to really understand, and no disrespect intended, is that OB and delivery in particular, is a critical care area...There is supposed to be more than one nurse and ALWAYS a backup...If you mean Post partum with relation to this nurse, so many things can occur.She should not be forced, and actually cannot be forced, to do an area she is uncomfortable with, just as an OB nurse should not be expected to take an assignment elsewhere in the house if she or he is floated...The ER is never left short on purpose. Neither is ICU...Maternity is usually but never SHOULD be the area to take away from...It isn't like in the movies with one cramp and push leads to baby...Many OB nurses are leaving for the similar reasons I have described. If a nurse does not feel comfortable in an area, she has a right to say so. It is her license. And, unless she takes and passes the specific tutorials of the area involved, whether it be OB or any other area, any number of lawsuits could be pending....
8. 
   Feb 9, '03

   Here is a little bit more info. When someone is assigned to L and D, they do not have any other patient assignment. In fact we rarely do more than 1:1 with any type of labor patient. This nurse willingly oriented to OB and has been involved with more deliveries than our policy reccommends. I don't know if her original hire agreement said anything about cross-training, but we hired her as a new grad about 6 years ago and she has worked with all kinds of patients..Including ortho, general surg, pediatrics, r/o Mi's, pp, etc. We all do it.
   I feel this nurse is competent, but how do I get her confident? I like the suggestion of sending her to a larger hosp, we've done that before, so maybe...
   As for the supervisor comment..At our hospital the supervisors work on the floor when needed, and all 4 FT supervisors, do OB when needed.
   Maybe the solution is to keep precepting her, and slowly letting her make more decisions on her own, and not just tell her we're "there if you needs us".
9. 
   Feb 10, '03

   I also work in a small hospital, we do about 250 births per year, so I understand the difficulty with staffing and cross training. The short answer is no, you can't force her to be comfortable in OB. Probably the answer is to keep on encouraging her and try to send her off to a bigger place for a while (we routinely do this with new grads). The question is does she want to do this? If her heart isn't in it then she's probably never going to be comfortable with labor patients. Even if she has met your competencies, if she's not comfortable being there then you can't expect her to like it. Is there any way she can work other areas and not OB? What is the staffing like in the rest of the hospital?
10. 
    Feb 10, '03

    Thanks AlaskaKat..You sound like you know what we are going through. Sometimes when there is a labor patient at change of shift we have to get extra staff or stay overtime to care for them..that isn't the problem. I've told her that. When we don't need the scheduled # of RN's in the rest of the hopital, when the census is low, then we would like and need her to take the assignment. We have already given her the options that I mentioned in my first posting, but she still hasn't replyed..I think she is going toward the not doing OB..So now what? I think we are going to have to decide..I really wanted her to be a part of the solution. but I will try to see if I can get her more experience before she makes a final decision..
11. 
    Feb 11, '03

    It takes more than a year for a nurse to feel even remotely "comfortable" in labor and delivery as a first, assuming her second is at least as well or more trained...Delivery is a whole other area than post partum, which shouldn't require as much intense experience, but requires quite a bit non the less...I just came from a lecture outlining the new thinking in PIH, pre eclampsia and HELLP syndromes and how much more agressively treated they should be. A small hospital population doesn't remove the risk factors of the patients who present there....Also, it has been my experience that if someone ever feels "comfortable" in delivery, or isn't nervous, however long they have oriented, they shouldn't be there...All good nurses are nervous...Forcing, or making your staff feel as though they are forced to do something in such a high risk area will only either cause them to leave or attract less well intentioned or skilled people. I have worked for years when management has and does consider OB at the bottom of the food chain, hardly ever realizing or caring that it isn't just about having babies and it isn't an easy job...Our patients can be as sick or sicker than an ICU pt. That nurse is right to be concerned. I hope you are able to solve your problem, but making her feel badly for taking the correct approach is probably not going to fix it...Good luck, however.

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