Who staffs for C-Sections?

  1. In our OB unit we are discussing the OB staff circulating and scrubbing in for C-Sections. I would like to hear what other units are doing that do between 500-650 deliveries/year. What is your usual staffing like? RN, LPN, NA mix? Who cares for the baby- circulator or Nursery nurse? Do you have a call system and what time distance must you be from hospital? Level II nursery? Mom/Baby care or not? Cost effective? Call Pay? Entire staff participate? What is required to maintain competency? Who recovers patient? Closed unit or does your staff get pulled to other areas of hospital? One hospital manager told us that it was one of the biggest stress factors on their unit- how do others feel? A big thank you to anyone who can share some information.
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    About Jemma

    Joined: Nov '01; Posts: 22
    Clinical Nurse Manager- OB unit


  3. by   BugRN
    Jemma, I hate to be the bearer of bad news, but this is very difficult to do. I worked in a community hospital and I was instrumental in trying to set this up as a new nurse to this unit. I had done it before in a much larger hosp. where it worked great. But trying to do it here was a disaster. We also had about 600 del's/yr. We were already short staffed, but were now required to cover our sections as well. Ideally, we were to have one RN on the L/D floor w/ another on call. We then had someone sign up for c/s scrub call. That nurse had to be in the hosp. w/in 20-30 min. of being called. We then pulled the nursery nurse to catch the baby which meant she had to have the post part. nurse watch her babies! We also were expected to have another nurse circulate if she was available. That meant set up the OR as well as take it down and on off shifts, clean and restock the room too.( have you ever seen what an OR looks like after a section???) This also meant we had to have all nurses interested train for a 2 wk. stint in the main OR. This meant finding someone to cover them on the floor. Thankfully, the Recovery Rm. recovered them, not us. But I have worked where we did that too. It has a slight possibility of working if all the factors play out, but you know delivery, usually the S---t is hitting the fan when you're supposed to drop everything and cover a c/s. It is very stressful and hard to keep covered. We had the main OR take second call to back us up if we didn't have the staff to cover, but then we had to always "prove" why we didn't cover our own cases. It was very frustrating!! I would first take and train only those that really want to learn, we also trained our med. tech's and secretaries who wanted the experience and extra money. We got a small amount of money for being on call, ( I forget) and got time and 1/2 if we got called in for min. 2 hours. You will need to sit down w/ the OR and your unit manager and try to work out all the bugs, it ccan be done but only with a LOT of cooperation. I have since left and don't know what's happened now. Good Luck!! Let me know if I can help out in any way. I think other nurses also do this in smaller hospitals, you should get a lot of responses.
  4. by   HazeK
    technician or RN to scrub...
    RN to circulate...
    RN to receive & care for baby...
    when able, our CNAs come help with the paperwork & clean up.
  5. by   Nursz-R-Awsm
    We have 16 LDRP's. I work nights...we core-staff with no less than 3 RN's....two of which will circulate and scrub the c/s. Rarely have an aide, if we do it's only until 11pm. We have a nursery RN or LVN come to delivery. We prob avg around 50-70 births a month. Our unit floats, but night shift rarely has to since we're short-handed and are often the ones calling for help.
  6. by   valene
    Questions for BugRN: Did you have a level II nursery? how many nurses were staffing 7-3,3-11, and 11-7? did you have central fetal monitoring there? was an RN on call for all 3 shifts? who processed the instruments?
  7. by   BugRN
    only Level I nursery, but we had to stabilize these kids until the transport teams arrived. The most we did was IV meds, O2 and Bili lights, but only with one nurse who also took care of the well kids.Only 1 pp nurse with an LPN and 1 ld nurse and 1 on call for her. No central monitoring, Scrub call only eve's and nights, we just pulled off the floor on days, and instruments were washed by us then sent to sterile processing.
  8. by   mother/babyRN
    Hi there people,
    I am new here but relieved to know I am NOT the only ob nurse going nuts with regard to staffing ESPECIALLY when it comes to sections! We do about 600 births a year and have an allegedly level 1 nursery (we have many high risk patients and end up shipping many bad babies). The powers that be would ideally have us care for, scrub and circulate. (not sure why the OR isn't in to doing its job ) PACU doesn't like to come in to recover either, however if they do, they bring two of their nurses for one patient or expect a land d nurse to be freed up to help them if only one of their staff arrives. They (the OR and RECOVERY) are always ticked at having to be called in.
    There are not enough of us to do all of that, but we all circulated between nursery, pp and delivery so we can function in all areas. They did make an attempt to force us to scrub but we countered with the fact that wasn't safe until they sent us through an accredited scrub tech program. That would have cost 187.000 dollars, so of course, was put aside. Now, however, we do have to open the case carts for routing sections ( still not sure what the OR actually has to do in our hospital and they are prima donnas).
    Other night I came into a fresh section that I had to recover. No big deal, she had a spinal. The other patient was fully and pushing. THEN 2 active labor checks came in and I had the section plus them while the other nurse was tied up with the delivery. Ended up having to admit one of my patients ( who was 5 cms with bulging membranes) and discharge the other one. Can't say my recovery pt got deserved attention. And, of COURSE the pp people couldn't come over to help me get her over there. I called the supervisor and told her she had to send someone to PP to free up one of their two nurses (only one was an RN) and she said, sorry, deal with it. We are the float pool for the hospital, as the next night I had to go to the progressive cardiac care unit and take an assignment. WHO ever floats up to labor and delivery????
    Kind of ironic that our unit name is "First Impressions."
    Needed to vent. Feel like I am not alone after reading some of your posts.
    Some nights they leave us with 3 staff people and only 2 rns. I feel we don't get the prestige we deserve as the ER is always staffed for what may happen. So is ICU. Don't the powers that be consider an abruption or prolapsed cord an emergency????
    I just don't get it....
  9. by   layna
    We do about 400 deliveries a year. Our C-Sections are staffed by the OR crew. The labor nurse goes in to the C-Section suite to look after the baby only. Recovery is even done by OR staff right on our unit! It really works out well.
  10. by   ckalston
    We are looking at the OB nurses doing the after hours recovery of C-Sections. They don't scrub in for the surgery and there are criteria. The biggest criteria is if a patient recieves general anesthesia, then the Recovery room nurse will come in and recover the patient, otherwise, if it is only a spinal it is hoped that the OB nurses can start covering that part. Personally, my hands on knowledge of recovering C-sections is limited since we don't do that many of them and when they come into PACU right now, we take turns so it only makes sense for the person with the most experience to take care of the patient. Once again, this only applies to spinals. OB is all for it because they like to start breast feeding as soon as possible and our policy does not allow infants in the PACU.
  11. by   L&D_RN_OH
    Our CS OR is in the L&D unit. The main OR is 4 flights down. Very rarely do we do sections there unless the pt was extremely high risk to begin with (accreta, complete previa, etc.)

    We staff with 3 core RN's with one on call. The day shift RN's scrub and circulate. Most nights, we have an OB tech who scrubs, but the RN still circulates and recovers. We are all ACLS certified for this reason. We have RT's at every delivery, who only staff L&D. They are responsible for baby, and hand carry baby across the hall to the SCN/transition NSY. We are level II. No LPN's or CNA's. No one floats to L&D, but we do occasionally float to PP or GYN. That is all.
  12. by   SmilingBluEyes
    Originally posted by Nursz-R-Awsm
    We have 16 LDRP's. I work nights...we core-staff with no less than 3 RN's....two of which will circulate and scrub the c/s. Rarely have an aide, if we do it's only until 11pm. We have a nursery RN or LVN come to delivery. We prob avg around 50-70 births a month. Our unit floats, but night shift rarely has to since we're short-handed and are often the ones calling for help.
    Sounds like us, except we do more like 75-80 deliveries a mo.
    We staff our OWN csections......

    but getting EVERYONE on board would be a nightmarish task. It does NOT happen over night.

  13. by   fourbirds4me
    We do 1100-1200 deliveries per year. We staff 3-4 at night. We scrub/circulate/recover our own sections. Nursery come to accept the baby with the circulator helping if needed.
  14. by   MishlB
    We have 3 nurseries, newborn, special care, and NICU, doing approximately 250-300 deliveries a month. Newborn goes to our sections, and keeps the baby until Mom is recovered. We always have two nurses in the newborn nursery, and more based on numbers. We also have a transitional nurse that catches the babies in the LDRP's, and transitions with the Mom.