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.

I know you said no joking, but come on. 2 hrs versus 30 minutes? Sounds to me like either the L&D staff are taking their time so they don't have to go back to the floor, or some serious inservicing needs to be done. You do however present a valid point, that we may be encountering, in that OR staff can clean and stock the OR suite in an average of 20 minutes. They schedule 30 minutes between cases, but rarely need that much time. Our c-sections are actually done in OR suites located in the OB department. I have someone telling me they need an hour to clean and restock. I guess I'm going to have to go watch to see what is taking so long.:)

I'm posting this in both the OB and OR forums, since different facilities may do their c-sections in one or the other. Sorry for the duplication. I am interested in knowing if anyone has done any time studies to determine the OR time for c-sections. this would include turn-around time for cleanup and restocking. Thank you.

Has anyone done any time studies at their facility to determine average time of c-sections? This would include turn-around time for cleaning and restocking the room.

Your RN or LPN that 'assists' the OB.... Obviously they're not RNFA since you use LPNs too. You provide an assistant and a surgery tech? Just want to make sure I understand. Our docs want us to provide the assistant, but we are fighting it. Thank you for taking the time to answer.

Does your staff do C-sections, or is that done by Surgical Services?

Our current budget is based on 4.5 hours for each Labor Eval we do, 3 hours for each NST we do, and 8 hours for each delivery we do. Based on our budgeted projections, and staff, we have a budget hours worked per unit of service. Then the total actual hours worked is divided by the actual units of service. What I am looking for is how other facilities calculate their units of service in this department. At our facility, each department is held accountable for staying within their budget. Everything is based on units of service. What I have been unsuccessful in doing however, is finding other facilities that are willing to share how they calculate units of service (PD) in their L&D area. I can't believe we are the only hospital that has a budgetary accountability by department.

I am trying to see what other facilities use to calculate a "patient day" for their L&D department. I have been on the OB forum, and I have searched the Manager's forum clear back to 2003 and it appears that either managers have no clue, or are afraid to respond. I cannot find a single person who has provided this information, for any unit. Finding nurse to patient ratio standards is easy, but determining what criteria is used to determine a "patient" is another. Midnight census works (somewhat) for most units. Acuity based is another method, though I've yet to see how that is being utilized effectively. L&D is another scenario however, since during a 12 hour shift, a nurse may have 1 laboring patient, or 8 laboring patients, (not all at the same time) depending on how quickly they deliver. I know different facilities have different ways to measure. I just would like to see what is being utilized at facilities other than ours, for a comparison, and to create some sort of benchmark for us. Thank you for taking the time to respond.

Does anyone have their HPPD for L&D? Also, what formula do you use to calculate a patient day in L&D? At our facility, HPPD is hours "worked" only (productive hours). This means if staff is paid, but not working on the unit, their hours are non productive and not included. Staff attending an education class, are non productive. They do however include ALL staff.

Our staff are trained RNFAs. Currently I believe only 1 is actually certified. Reimbursement is a whole other issue that we haven't even started tackling yet. My biggest concern was whether this person was even necessary, which I have gotten mixed reviews on, and if necessary, isn't the physicians obligation to provide, not the hospital's.

Yes, that helps. Thank you for the info.