Unsafe staffing in OB dept

Specialties Ob/Gyn

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I've been a long time lurker on this site for nearly 4 years now and this is my 1st post!

I changed from cardiac nursing to OB nursing back in June and have loved every minute of working with these types of patients. I work in a smaller hospital (50 beds) in a rural community (15,000 population). I work the night shift from 7pm - 7am. We are staffed with 2 RN's each shift with an occasional CNA if things are really busy. We are a locked down unit and it's nice to have someone do the extra little things when things are chaotic

Anyways, the last couple weeks have been challenging. We are short staffed (isn't every place these days?) and we are down to 2 RN's and 1 LPN who work nights. There are 6 full-time RN's on days. The position has been open for almost a year, with no applicants in sight yet. We've had travel nurses, but we were told they are trying to do w/o as long as PRN staff is willing to pickup the extra shifts. I've also been picking up extra shifts and taking call, which is helping pay off the tremendous student loans!

It's our unit policy (so it's said, I haven't found the actual hard copy of the policy yet) to have 2 nurses on the floor when we have an active labor patient.

Last Wednesday our unit was closed (no patients) so myself and my co-worker floated up to Med/Surg for the night. At 9:30pm I got a phone call that I had a patient coming in with possible ruptured membranes. I called the House Supervisor (HS) that I would be leaving the floor to return to OB. I also told her that I would notify her if the patient was in fact ruptured and would be admitted.

After the patient arrived it was determined that she would be admitted. She was contracting every 2-3 minutes, water was in fact ruptured and she was 3-4cm. After I called the Dr for orders for admission I called the HS to notify her I would need my co-worker back to help.

I was told "no, she can't come until delivery is imminent"

Ok....so I have to labor this patient, BY MYSELF, for the next 9 hours?? Are you freaking kidding? Heaven help me if the baby crashes or the mom has a complication. I had some words with the HS but I didn't get anywhere.

The next several hours went by, the patient progressed to an 8cm and was comfortable with her epidural. At 3am I called the HS again to let her know I needed help at 5am. We had a repeat c-section coming in that needed prepped (IV, foley, meds, monitoring, assessment, consent, etc) and it would not be possible for me to admit this new patient and continue to monitor my current labor patient. I got crap for asking for help. She told me I was "crazy to be asking for help when we have 19 patients upstairs for 3 nurses and 1 aide." I told her that if my backup nurse wasn't available then I suggested that she come and admit the patient for me. She wasn't happy about it, but she agreed to do it. She showed up at 5am to admit the section patient.

I wasn't happy at ALL when I learned that my backup nurse left the hospital to go home at 6am, leaving me the ONLY OB trained person in the hospital. If they were so busy upstairs, how was it possible she could leave?? I don't get it.

So. Yesterday I spoke with my unit director about that night. She told me "I'm afraid you won't like my answer". She agreed with the HS decision to leave my co-worker upstairs and not have her come back to OB to help out. She stated that "if the floor is that busy upstairs and they are needed an extra person to help out, that's where that person needs to be at that time". As long as she was "in house" it was just peachy that I was laboring this patient solo. She then thought it was silly for her to be "just sitting around" in OB when I was managing the labor patient just fine. There had been no complications with the patient, so my co-worker wouldn't have been all that effective.

Okay...but what happens when the babies heartrate drops? How am I supposed to do all the interventions AND call all the right people for help? Doesn't it make more sense to have that 2nd person on the floor? And I can't possible answer the phone and enter the code for the door (we're a locked down unit) for people coming and going.

I talked with her for an hour about this and she wasn't budging on her stance. And either was I. I told her it was a huge amount of liability on my part, and also on the hospital. I told her I wasn't comfortable with working alone with an active labor patient and I never would be. It's not right. I told her that nobody else in our dept stated that they would work alone with a labor patient, so don't expect me to do it. I've had 7 months of OB experience for heavens sake!! Is she crazy??

So, since I wasn't happy with yesterday's meeting I made an appointment with the VP of Nursing for this morning.

She, thankfully, understands where I'm coming from and agrees that this is not approapriate, nor is it safe practice. She is appalled that my boss is "okay" with this and told me that she would be discussing this situation with her today. She told me if it happens again in the next week, that I'm to call my boss at home, and if I don't get anywhere with my boss, I can call her at home to interven.

I'm documenting everything that has taken place. I'm not going to leave this situation alone until things change. I will not be put in situation where I could risk losing my license. If things don't change, I will not continue to work there. I hate to leave because I really do like it there, but it's too much liability for me. Or for anyone. I've talked to my other co-workers and not one of them said they would be comfortable in this situation.

So, hopefully after today, things will change.

What is your opinion on this matter. Have you been in similar situations? I'm hoping things will change, but if they don't, I'm prepared to find another job. I'm not willing to risk my license for this place.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I disagree. The 2nd person needs to be a qualified nurse, not an aide.

The 2nd person needs to be a qualified nurse, not an aide.

Absolutely! I also work at a small hospital (about 550 babies/year) Fortunately, our P/P state that we must have 2 OB RNs in house at all times, and if we get floated to another dept we cannot be assigned pts or take care of any infectious pts. Our OB manager is also very staff-friendly, but some of our house supervisors are very pushy about trying to pull us from OB.

To the original poster, STAND YOUR GROUND! I'm not saying be hateful when you are discussing it with your superiors, but be firm. Don't let them push you to do something unsafe. It's not only your license on the line, but the safety of the future patients of your unit. Fortunately, it sounds like the VP will be there for you. Best of luck!

Specializes in ER.

I used to work at a small hospital OB dept, and often was the only nurse in house with NALS, and the only nurse in OB, no one else within shouting distance. We were told to hit the code blue button in the room, or have the SO hit it if we needed assistance. We also had a panic button in our pocket that rang at the sherriff's office. The panic button was useless cause the dispatcher would call the ER and tell them to go check on the OB nurse, and the ER would call us on the phone (can't get to a phone, that's why I hit the button, getit?).

Anyway with OB emergencies I got very good at delegating non OB staff. They say I got bossy, lol. But my advice is to hit that code blue button with emergencies. They will either show up and help every time, or they will get peer pressure to admin that this is NOT a safe practice.

All of these situations sound horrible, one of our docs who no longer practices used to demand that an L & D nurse and a nursery nurse be on the floor for that occasion when a mom gets off the elevator. Anyone who has been on OB for any length of time can tell of Moms getting off the elevator. I have literally pulled the pants down of one and her pants were the only thing holding the baby back. ( Funny tho, the ER doc I had summoned was hollering for me to start an IV ! ) Ok, and which set of hands should I use ?? Also have seen a Mom get off the elevator with blood-saturated bath towel between her legs. Everyone has tales of how things can turn sour quickly. We don't have a code button either, just phones which are not easy to reach. The bottom line with these places is money but like one poster said, millions are gone in a flash in a lawsuit.

Specializes in L&D.
I disagree. The 2nd person needs to be a qualified nurse, not an aide.

I agree that the second person SHOULD be a qualified nurse. However, you were alone, you were told you could not have another nurse and you did not get another nurse. I believe that in that particular situation, you would have been better off with a warm body sitting by the phone.

It's good that your VP is on your side. With her, lobby for what you SHOULD have. In the midst of a bad situation, try for whatever you can get at that time and then go thru channels (as you are now doing) so that that situation cannot repeat itself.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

But there *was* another nurse available in her situation. The house supe made a bad call, keeping that nurse away in another unit, (that apparently did not need her that badly) when there was an actively laboring patient---and then sending her home at 0600. This is wrong on every level. It was so beyond silly---the supe ended up admitting patient #2 when the other nurse assigned to the unit could/should have been doing that. Stupid use of resources, really, if you think about it.

And if an OB emergency happens, a warm body is not enough; I want an NRP-qualified nurse there with me, readily available to help out.

I disagree. The 2nd person needs to be a qualified nurse, not an aide.

I think so too!

She told me I was "crazy to be asking for help when we have 19 patients upstairs for 3 nurses and 1 aide."

Good grief.

I work NICU now, but in a previous life was on a (very busy) colorectal surgery floor.

We were lucky to have 4 RNs on at night - for 31 beds! And that was only on busy post-op days. Most nights were 3 RNs for 31 beds. And that's total staff - no LPNs, no CNAs, just us.

Now I know that's a bit excessive as far as workloads go, but surely they could have managed 19 patients with 3 staff.

That's what I reckon anyway, and that's coming from a med/surg point of view.

Primm

So I have question about documentation. Is it right to document in the patient's chart about the unsafe staffing and that the HS was notified, along with their response?? I wanted to include that in my labor notes, but didn't know if I'd get in huge trouble for doing so. I've never been faced with situation, so this is the 1st time this has come up.

I haven't filed a report with Risk Mgt, but I will now. At least then, maybe they'll realize just how serious I am on the matter.

I'm glad to know I'm not alone in my thoughts on this subject. Thanks for your reply!

incident report

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