all alone

Here are the Amerrican Acamdemy of Pediactrics and ACOG guidelines. Hope this helps. nurse/patient ratio care provided Intrapartum 1:2 pt. in labor 1:1 pt. in 2nd stage of labor 1:1 pt. with medical or obstectrical complication 1:2 pt on pitocin 1:1 coverage for initating epidural 1:1 circulation for cs antepartum\postpartum 1:6 ante&post pt.without complication 1:2 pt. in recovery 1:3 ante$post pt. with complication but stable 1:4 recently born infant & those requiring close care newborns 1:6-8* newborn with routine care only 1:3-4 normal couplet care 1:3-4 newborn req. contin- uing care 1:2-3 intermed. care 1:1 multisystem care 1:1 or greater unstable critcal care

I am a L&D nurse that works in a small rural hospital. We do about 35-45 deliveries a month and have a level II nursery. Our hospital and nurse manager is constantly putting pressure on us to work with the least amount of staff that is posible. L&D, PP, and nursery are very close to each other and we are normally staffed with one nurse per unit. I work nights and if we have a low census our nursing staff drops to 2 nurses. Not all of our staff is crosstrained to L&D, although we are trying to accomplish this time consuming task. Sometimes I am the only one working with labor and delivery experience. I have voiced my concern several times to our manager, whose response is, "that's why we have an on call nurse". However, some of our on call nurses live 45 minutes away and are also not l&d trained. Does anyone out there also work in a small rural facility and is willing to share info on their staffing? I would really like to hear how other people deal with this situation (if there is anyone else out there that is as crazy as me for working "all alone"). Also, because we are so small we do not have in house anesthsia or in house OB's.