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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

Your concerns are completely valid. I work in a small rural hospital (300 births per year) so we wear many hats, too. We worked very hard to convince our administration 2 OB RNs (we do labor,delivery, pp, and nb with our C-sections being done in surgery) at all times even when the unit is closed. All it took to reinforce this staffing was a 34 week gest. breech complete with history of previous classical C-section when the unit was CLOSED to realize what happens in OB. We can go from 1 to 100mph in the time it takes to inhale. I surveyed hospitals my size and the staffing is varied to dangerously creative. And, I'm not convinced adminstration will let ours alone. The only advice I have would be to keep a log of true OB emergencies and start to explain how they could happen at any time and one RN inhouse isn't enough. Two weeks ago, we had a 24 week gest breech, complete who delivered in 13 minutes from the time she arrived! Thanks goodness it was shift change. The 500gm boy was doing great but in that instant, if there were only one OB RN inhouse, the outcome could have been completely different. Good luck and don't give up. Beth from Illinois

Do your L&D nurses have other responsibilities (postpartum, nursery.) Do you do C-sections in your unit?

it's my understanding Watchchild isn't FDA approved for some reason. All monitoring systems have Sa02, b/p capabilities. You can also get them with maternal ecg. Truly, I'm not a sales rep for either company! I've just been looking into updating our system, too! Phillips has a new cableless toco and cardiotransducer that IS jacuzzi safe. They look just like the regular equipment with cables. You can program in which monitor that unit is for so the patient can walk all over. Also, they don't wear the little antenna thing...just the two round pieces..As years go by, I think our unit will be replacing our corometric monitors with Phillips--and probably the cableless system. All system have a pp/nb documentation program, too. Of course, each phase costs $$. Phillips appears to have a better program for keeping your hardware updated. We have GE Medical surveillance only at this time. If you buy the entire documentation program, when thechart is to be closed, all the areas that are JACHO required pop-up and tell you what needs to be finished. Can you believe that?? Also, all the mom's info templates over to the baby. AND, Phillips has a program that will replace your handwritten delivery logbook. Both programs can start prenatally and go through pp discharge. Both companies have ways you can start with surveillance only and build up. Good luck! Beth from Illinois

I recently sat through vendor presentations from Phillips Medical and GE Medical (who was corometrics.) Go with who will provide best service. There were 5 hospitals at this presentation and the consensus was Phillips product was less busy and more user friendly. The COOLEST thing was during labor, the Phillips product entered all the assessment findings. The nurse reviewed them and clicks either "agrees" or "disagrees" or can simply change the finding or two she doesn't agree with. Like any other product, the nurse must be careful not to depend completely on the electronic assessment. Both products automatically enter VS and anything entered via keyboard. Both products allow you to view another patient's strip at another patient's bedside if necessary. My hospital is associated with a very large, level III facility and their preference is Phillips. My hospital is a small rural hospital, too. Good luck! Beth from Illinois