Postpartum maladjustment...moral support, anyone?

[L&Dhopeful]

I started working in postpartum a few months ago as a new grad. I'm floored by the volume of pt.'s we have and I am told by nurses who have experience elsewhere that this is not the situation in every facility. We frequently have 10 patients (5 couplets, or 4 couplets and a surgical/hysterectomy patient or two). The night shift frequently has 12 and rarely has a nurse tech. Recently we did not have assistance from a nurse tech, I had 11 patients including a couple on antibiotics, several who needed discharge teachings, a fresh surgical patient, 2 sections among other things. I'm afraid I'm letting things slip, missing important things. I'm not able to learn good habits in this environment and I'm afraid I"m not going to be able to learn to be a good nurse.

Am I being a total wimp? Do I need to suck it up? I really want to get at least a year in somewhere. The reason I went into nursing was to get into L&D but I couldn't get a job in that unit. I'm not sure I"m gonna last a year. I cried for the first time yesterday (managed to keep it in until I got into my car at 10:00...yes 3 hours late). I haven't left work earlier than 8:30. Any tips? Words of encouragement? My goal was to get a year of experience and leave the state.

[klone, MSN, RN]

That is an insane patient load. Where I've worked, we only have 3 couplets, and at only one facility I've had 4 couplets. 4 couplets keeps you running the entire time. I cannot imagine 5 couplets, or sometimes 6 couplets, and no tech. That's nuts, and unsafe. How on earth are you supposed to help with breastfeeding?

I honestly don't have any good advice for you, other than to tell you you're not a wimp or incompetent for not being able to keep up with that patient load.

[mombabyRN96]

Holy crap! That is crazy!!!! You should have 3 couplets at the very most 4! NO TECH? Thats like 10-12 pts! We have to chart, weigh babies, do pku's, get c-sections up, meds, teaching, breastfeeding assistance, more charting, call md's, not to mention if a baby goes downhill, call lights constantly going off, postpartum hemorrhage, triaging phone calls, etc..... You are not a wimp, you r OVERWHELMED!

[rn/writer, RN]

You're not crazy. You're a sane person trying to function in a crazy situation. You can't possibly give good care to your patients with that kind of workload. Once in a great while, sure, things get out of control and staffing is stretched beyond a reasonable limit, but that shouldn't be an every day occurrence.

AWHONN would have a fit about your ratios. Google their website and look at their guidelines for proper staffing.

How do your co-workers feel about this?

[serenity1]

That is totally unsafe. You are putting your license on the line every shift. Try to find something else as soon as you can. You are not a wimp. That is just nuts. Good luck!

[carrie_c]

This is crazy! The max we have is 4 couplets. You shouldn't ever have more than 8 patients. You should get out.

[Traveldee]

At my facility we are supposed to have no more than 3 stable couplets...and I believe they were going by AWHONN nurse to patient ratio recommendations when they wrote that policy. If we have more it is the exception and not the rule (as in the house supervisor will be calling looking for another nurse to come in and at the very least staffing up the next shift). You are not incompetent. You are being forced to work in an unreasonable, far from ideal and safe situation. Have you spoken to your manager/unit director about this? If the hospital is unwilling to make a change in staffing ratios I recommend you start looking for another job asap.

[L&Dhopeful]

Thank you everyone for the tips. There has been a change in the administration at my facility so I'm gonna try to stick it out so I can get that year under my belt.