ejm RN

We have a system where we are required to sign up for 8 hrs of call every month - it is broken up into 4hr blocks, so there is some flexibility there. We're paid $8/hr just to be on call, and get paid time and 1/2 if we are called in. The system works well for us, but that's mainly because we have a large staff. Because of our call system, there's no need to float other RNs to us, but LDR nurses will sometimes be floated to PP or high-risk perinatal if our staffing allows.

stortstuff - we are usually very busy! The other night when we had all 22 rooms full, anesthesia was placing epidurals in triage and then we were doing vag deliveries in the ORs! mugwump - I definitely agree that the birthrate dropped in 2008 - 2010. Prior to '08 we would routinely have 11-12k deliveries/year. 2011 was definitely busier than the past few years, though we're still not quite up to par with how our volume used to be. We are at 1300 for 2012 so far (as of last night), so we're on track to have another 10k year I think. January and (part of) February have been pretty busy for our "slow season". So do most of you keep your patients postpartum or do you have a separate mother/baby unit? We only keep pp patients for 1-2 hours after delivery, unless they are on mag or had a pp hemorrhage. I think our family centered care unit has like 90ish beds? And we also have a separate high risk perinatal unit that has 36 beds, so unless they are full we don't typically have antepartum pts unless they require continuous monitoring, mag, or are especially unstable. I SO commend those of you who brave this job with only a few (or one!) others to back you up -- I can NOT imagine working by myself with no one else to help if crap started to hit the fan...you never know when someone might walk in with a cord prolapse, a bleeding previa, abruption, or complete breech multip! I'm guessing at many of these smaller facilities there is no OB in house in the case of an emergency? How do you handle that?? I'm realizing now that I'm probably extremely spoiled at my job with all the support we have in place...wow. We are a large teaching hospital, so we have at least 3 residents with us at night, a private 24-hr physician to cover the residents, and also a dedicated OB hospitalist in case everyone else is tied up and there is an emergency. Most of our attendings are good about coming in when they have patients in labor, but if they are unable to get there in time for a delivery, we have the 24 hr doc or hospitalist who can catch for them. What about anesthesia? Do you guys have an anesthesiologist there all the time for epidurals and to run your sections? Thanks again for the responses - and sorry for more questions!

Thanks for taking the time to reply! It's so interesting to hear how other units do things. :)

Hi all! New to this forum, and reading through some of the threads here has me curious about the size of your LDR unit. How many beds do you all have? ORs? How many nurses do you usually staff per shift? The unit I work on has 18 regular labor & delivery beds on our labor hall (and we have 4 more in an overflow wing that we open as needed), 9 triage beds, and 4 ORs dedicated to l&d. Our normal staffing on NIGHTS is around 14 or 15 nurses (we don't utilize tech's except in the OR). We always have a 2:1 ratio on the labor hall, with a DRP on each side to help during deliveries and with admissions, a designated circulator, and 2 or 3 in triage, depending on staffing. We also have a mentor who floats around and supports the DRPs when things get crazy. On day shift they run with 17-18 on the unit, not including a special C/S team that just does scheduled sections for the day. To keep things in perspective, we have a very high-volume facility with a pretty high risk patient population and did over 10,000 deliveries in 2011. It's just out of pure curiosity that I'm wondering how things are at work for other L&D nurses. Give me your stats!