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You expressed my concerns perfectly....

Thank you! This is exactly the type of information I was hoping to find. I do not know if we are a Critical Access Facility..but now I know to find out. Again, thanks! Bet

I work at a small rural hospital. Our census on the med-surg floor can fluctuate anywhere from 8 to 30 patients. Our OB department can go from zero to 4 mom/babies and a couple antepartums in nothing flat. Am I in favor of this patient law? Of course--as it all comes down to safe, quality care even on those days when it all hits the fan! BUT are there any links on how small hospitals have been able to meet these ratios and financially keep their doors open? For instance, do hospitals require mandatory on call to cover a unit with 8 patients but have beds for 30? Would really appreciate some creative suggestions/options to present to those (administration) who are suggesting if this law passes, it may threaten our facility's future. We are the only hospital in a 50 mile radius and in my opinion, patients receive very good care. I love to see the required ratios met but would hate to lose our hospital and the service it provides to our area. Thanks for any links or suggestions!! Bet

Thank you all for your great advice!! I think for our small unit, the policy of having anesthesia mixing/labeling it and writing the order is what will be best! Thanks again! Beth

I work in a small rural hospital where anesthesia can become unavailable due to unexpected situations. Although rare, there have been times when a mother experiences hypotension from a labor epidural and needs ephedrine but anesthesia has become tied up elsewhere. Does anyone know if it's okay for L&D nurses to push ephedrine IV if needed in a situation like this? Thanks much in advance! Beth

Thanks for the response! We have had GREAT control with subq....we have diabetic educators who have good intentions but are trying to make IV insulin our "standard" and insist we use is it all IDDM patients in labor--in good control or not. Thanks again for your response which supports my opinion completely!! Beth

How many automatically run IV insulin and dextrose on diabetics (on insulin) in labor? I have read the ACOG guidelines but after surveying hospitals in my area, it seems many still give insulin subq, check capillary glucose frequently and have dextrose for IV push if needed. Thanks! Beth

How many automatically run IV insulin and dextrose on diabetics (on insulin) in labor? I have read the ACOG guidelines but after surveying hospitals in my area, it seems many still give insulin subq, check capillary glucose frequently and have dextrose for IV push if needed. Thanks! Beth

If you are willing and able to keep up all the competencies required to work in the nursery, there shouldn't be a problem. We have nurses who work full-time for our hospital then work the minimum number of shifts at another hospital for the big bucks (registry wages.) Some love it, others find it too stressful. Good luck!

If you are willing and able to keep up all the competencies required to work in the nursery, there shouldn't be a problem. We have nurses who work full-time for our hospital then work the minimum number of shifts at another hospital for the big bucks (registry wages.) Some love it, others find it too stressful. Good luck!

We are fortunate to have a wonderful childbirth educator who tells her classes, "Childbirth is NOT a spectator sport." And, the oddest experience I have ever had with the "Baby Story" was the mom who insisted it be on while she was pushing. Of course, the lady on TV pushed her baby out first....

The 6:1 AWHONN guidelines pertains to well babies, only..I think? Couplets are 4:1.

I believe "Guidelines for Perinatal" states a ratio of 6:1 for well-baby:nurse. From the units that are completely "mother-baby" I have a question, please. What are your patient satisfaction comments? I do believe the key here is not only educating staff to the changed expectations, but educating the community and clients. Earlier, I referred to the unexpected, silent regurg of the infant. I agree parents should be taught appropriate use of the bulb syringe, but what if both are asleep? What is the liability regarding an infant aspirating in a mother's room when everyone is asleep? Granted, an infant can aspirate in an attended nursery, but which would be worse in the eyes of a jury who sees it as the hospital's number one responsiblity to keep infants safe?

I work in one of those "old-fashioned and outdated" facilities. Our moms are encouraged to keep their babies with them as much as possible but as a rule, most of them return to the nursery at night. Are your rooms arranged so nurses can be frequently checking the baby during the night without distrurbing the mother? I'm just wondering about those silent, unpredictable regurgs...Could you refer me to any articles with guidelines for this type of mom-baby care? Beth

Hang in there! I remember asking an OB-gyne about effacement. She told me what really matters is that you can tell the cervix is getting thinner or if it all of a sudden begins to swell somewhere. She was a very down-to-earth person but hearing that from her made me quit trying so hard! She suggested breaking it down into quaters (25%, 50%, 75% and 100%.) Practicing with the plastic board does help as everyone's fingers are different widths. See how your fingertip fits into the 2cm..3...I've seen nurses go right to the plastic board after an exam to finish their assessment. In time, you will learn your 4 is another person's 5 and yet another person's 3. It all can change with/without a contraction or if the patient has been up walking versus laying in bed. And if we are all honest, there are the patients we were SURE were complete....only later to realize we weren't near the cervix at all. :imbar