OB hell...

I work on an OB unit with about 600 deliveries a year. We have no ward clerks, have to do all our own baby labs/IV and even are expected to empty the trash in patient rooms at night. My boss is afraid to do anything that makes her look bad to management. She likes to talk about safety but short staffs us every step of the way.

In the past few years I've worked 23 hour shifts on 3 occasions. We never get breaks as we have to answer the phone/unlock the door and while we aren't supposed to end up eating at the desk (which looks horrible). The second we aren't full of patients they start sending us home or pulling us to every corner of the hospital and if they feel the need they assign us patients on other units. A few weeks ago a new med surg nurse started complaining because we won't go in dirty rooms. Our boss immediately changed our policy to include taking and caring for infectious patients while we are on other floors. She said, "Well you can always take a shower and change your scrubs when you come back to OB."

I have on several occasions been pulled back to imminent deliveries where there was no time to make up a table let alone shower and change. My manager knows this but you know she's gotta be a, "team player."

I've watched so many wonderful, well trained, caring OB nurses leave because of our mess of a unit. I would go to another hospital in a heartbeat but I would have to drive an hour or more plus my partner is an OB/GYN and delivers here. It's in my best interest to see our unit become sane. We have a mix of mostly new nurses, some turning out really well and some just taking up space (you know what I mean). I also worry about how some of our new nurses are thrown to the wolves, if my manager needs someone on nights she will push them through orientation. A few years back there were enough of us with experience that the new girls had someone to rely on but that's changing fast, too many of our experienced nurses have left.

It's to the point that I am so stressed I can barely think of ways to fight this. I am a really good OB nurse and my patients love me and I love them what I do but the BS has become too much.

Any suggestions would be great. I know I need to go over my manger's head but fear it might do little to help as we are owned by a giant corporation that seems to have lost interest in our hospital (I keep hoping we get sold). I'm thinking of transferring out of the department at least part time.

Does anyone have idea where I can find guidelines to fight the dirty patient problem? I was thinking ACOG specified this but have been unable to find it. I'm also gathering staffing guidelines and would love to hear how other OB's of similar size manage to be closed units or positively deal with these problems.

I quit reading at the 23 hour line. As far as I know, 16 is the max allowable by federal law for safety's sake.

Run, leave, get out now before you lose your license.

Wow. Your unit sounds like a cluster! 23 hour shifts are totally unsafe, although I know stuff happens with weather, etc. but there's no excuse otherwise (and really, if poor weather is expected, somebody should be planning ahead and getting staff there ahead of time with a place to sleep).

Where I used to work the "postpartum" unit would sometimes take female med/surg patients, but they absolutely were NOT allowed to take anything infectious. Why on earth is your boss listening to a NEW med-surg nurse? Does that nurse know anything about the care of a newborn? Or how dangerous infectious diseases can be for them? I doubt it. I would look at ACOG or AWHONN to start with for guidelines on that; you could also see if your state licensing agency has any guidelines on it. Our unit handled about twice as many deliveries as yours but we were still a smaller hospital, smaller unit, etc. I would seriously consider getting out of there even if you have to drive because your boss doesn't have the backbone to stand up for the best interests of the babies and moms and THAT is never a good thing.

Best of luck.