BELCJ

What is your average census? How many RRT calls do you average? When not responding to a call, what other job duties does the ICU nurse do?

What is your average census? The RT (supervisor) that responds, I assume that they are the one to respond due to no patient load?

Quick question: The 1-2 patients for the orientee, is that 1-2 in addition to the 4-5 that you have, or is it 1-2 of your personal patient load?

We are trying to improve our preceptor program and are seeking advice from the general nursing population for help. 1. How long does your facility preceptor new grads? 2. How long does your facility preceptor experienced nurses who are just new to your facility? 3. How long do you preceptor LVNs who have worked at your facility, but who are new RN grads? 4. During the preceptor period, do your new staff have their own patient load? if so, does the preceptor have their own patient load also? If yes, what is their nurse to patient ratio? 5. What is the average nurse to patient ratio for the new nurse? 6. Does the preceptor have only 1 new nurse, or can they work with multiple new nurses at a time? Thank you for taking the time to answer.

It's only been about the last 6-9 months were this has become the "norm". The previous director submitted an FTE budget for the new year of about 36 I think, and said she wasn't adding any nurses, just trying to keep what they already had. With an ADC of about 6, I'm still trying to figure out what her thinking was. Well, the budget process isn't finished yet, so of course I immediately lowered the number, but with all the griping I'm hearing, and being new in the position, I thought I should ask others. You all have been a fabulous resource. Thank you so much for all the support and information. I'm sure I'll be back with more questions as time goes on.

Our postpartum are on the same floor, but on the other side, (seperated by a walk-thru storage area) and it is staffed separately. The entire area has three actual departments, L&D, Nursery, Post Partum, but it's one unit, Women's Services, all under me. The L&D also staff the c-sections, do the Labor Evals, and NSTs. The problem is that the staff want a patient load of 1-2 for all antepartum patients whether they are in active labor or not. The guidelines state 1-3 or 1-4 depending on their acuity. You've given me a lot of help, and I think once the staff realizes that they aren't going to be paid for sitting around, they'll either get with the program, or we'll weed out the ones we probably don't want anyway.

Yes, those guidelines do help. That is how I'm trying to staff, but that means letting all these travelers go because we don't need them, and the nurses are saying it's not right and they can't do it without the added staff. Obviously administration is all for getting rid of all the travelers, but I want to be reasonable too.

Active labor is 3 nurses, but for how many patients? The antepartum is 4 nurses, but again, how many patients is that?

I am a new L&D Nurse Manager, and I'm still having trouble trying to staff appropriately. We average about 2000-2100 deliveries a year, which is about 6 a day. When I look at the guidelines on AWHONN, it says the staffing is 1-2 for active labor, and 1-3 or 1-4 for antepartum. A couple of years ago, the manager staffed like this, but the recent managers have been bringing in traveling nurses and we have nurses just sitting around. I'm trying to staff based on patient needs, but the staff is having fits because now they don't have time to just sit around. How do you all schedule your L&D staff?

You have 1 nurse per couplet? So if you have 10 postpartum couplets, you have 10 RNs? Your hospital must have very deep pockets. That would never fly here, but I wouldn't want it to either. That seems too exessive.

Emtala deals with patient care associated with their ability to pay. If the ER doc had said "we have a self pay patient needing surgery", and the OC doc had refused to come in and treat, then YES he would be in violation of EMTALA. The OC not responding to the first ER is just a matter of the OC being a jerk. If the patient is Medicare, the first ER will be rolled into the second bill anyway, so basically, no harm, no foul. There should definitely be an incident report however since the patient had to be transferred and there could have been risk. Medical Staff needs to be made aware.

I'm looking for information on what the standard is regarding discharges home from ICU. It's been quite a few years since I worked there, and it used to be that if the patient was well enough to go home, then they didn't need to be in ICU. We were required to transfer to the Med/Surg unit prior to discharging home. It seems like things may have changed, but not sure if it is the physicians, or something else. Does anyone know if there is a guideline somewhere? What happens at your facilities? We're a 10 bed ICU/CCU unit.

There isn't a program per se, since each facility may define hours differently. At our facility we use only "productive" hours. We total all productive hours for the unit, (this includes the director) and divide by the number of patient days. This gives us hours worked per unit of service, or "Nursing Hours Per Patient Day".

It depends on the state. Most states however, require you to take their exam for certification in that state.

We don't use nurses for cleanup and restocking. We use the techs. Whether in OB or OR, the tech's job is with the patient is done once the procedure is done. They're not saying it will be an hour before they get the job done, they are telling me it takes an hour to do the actual job of cleaning and restocking. That is why I am concerned. I don't understand why it would take 3 times as long for the same job.