Question for OB nurses in small hospitals

**canoehead, BSN, RN** · Mar 9, 2006

If you go to the unit and they try to give you report when you think the assignment is unsafe you can decline it. Your manager DOES have an option, she can come in and help out herself.

rn/writer, RN · Mar 9, 2006

I was just wondering what kind of practices are in place for those of you who work in small hospitals when you get into a "bind".
I work in a small hospital and have posted threads in the past (mostly when I first graduated) about the woes of working in a small hospital with limited staffing.
Tonight I will be going into work, alone, in the L&D unit because the nurse I usually work with suddenly quit with minimal notice. I called the unit a few minutes ago to ask my nurse manager a question and was told that there had just been two deliveries with three more to go. I told my manager to get me some help for tonight if there would be three laboring patients because you never know what will walk in. I was told that she would "try", but that she didn't have a lot of choices ...
There are a lot of nights that I may only see 1 or 2 triages the entire night, then others when I have admission after admission. More often than not I wind up delivering the day shift inductions.
I know that my manager's job isn't easy. I constantly hear that our numbers just don't support the kind of staffing we ask for. I was told a while back that outpatient triages don't even count towards our numbers as far as hiring "full time employees" is concerned. We do 700 - 800 deliveries a year and a lot of shifts are covered by only one nurse. In this case there isn't a question that I need help, only the fact that there isn't any! Any advice on how other hospitals handle situations like this?

Who attends a delivery? If it's just you and a doc, that is extremely unsafe. And what happens to your other patients in the meantime?

You probably ship out any high risk moms before they deliver but you can't always predict problems.

Seems like you need a large on-call/pool staff available for the wild nights. As far as justifying the expense, compare the cost to that of just one lawsuit.

Jolie, BSN · Mar 9, 2006

Small rural hospital or not, your manager still has the professional and ethical obligation to provide patients with care that meets nationally accepted standards. Please consult AWHONN for staffing ratios, and review NRP guidelines for attendance at deliveries. To do less puts every staff member at legal risk, and every patient in potential jeopardy.

rn/writer is right on in comparing the cost of prn staff vs a single legal action.

SmilingBluEyes · Mar 9, 2006

If you are understaffed you are in jeopardy of harming patients and losing licensure. I recommend EVERY ob/gyn/newborn nurse be a member of AWHONN to know current issues and recommended staffing patterns for their respective units.

Not having two NRP-qualified personnel available at all times for any delivery is dangerous, to say the least. You are in a very precarious position, to say the very least.

SmilingBluEyes · Mar 9, 2006

http://www.awhonn.org

tryingtomakeit, RN · Mar 9, 2006

I just wanted to clarify that we do have both an L&D nurse and a nursery nurse attend each delivery and we are all certified in NRP. I didn't mean to lead you to believe that I am the only nurse in the entire women's unit. Only in L&D, and most of the time I am not alone.

We all work together very well together and I only have to yell loudly to get both the nursery nurse and the post partum nurse at my side and we are all cross trained. Also we are very close to each other physically in the unit. So it isn't like I am totally alone should I need help fast.

Nights like last night are few and far between - so much so that this is the cause of inadequate staffing in such an instance. I was just wondering how other small hospitals cope with the rare occasions when they are overwhelmed. I didn't mean to imply that I am totally isolated in a true emergency situation.

SmilingBluEyes · Mar 9, 2006

Well these certainly are issues that loom large for rural hospitals. I know this first-hand, having worked in a rural situation in Oklahoma in the past. Ebb and flow. Such is OB anyplace.

Hopefully you have a "working manager" like I did. That helped us immeasurably. She knew OB well and would definately help on the floor when it was nuts.

Also....

Are you an open unit, meaning do you float nurses in and out? We had to do that in OK in order to survive. Rural nurses have to pull together to get it done, no doubt about it. Floats can be lifesavers, even if not OB experts. They CAN do mom/baby couplet care while you attend to more acute cases....

It's also a situation where you HOPE you have good and reliable PRN staff.

Also, do you do 8s or 12s?

SmilingBluEyes · Mar 9, 2006

One thing we had to institute at my current hospital, (which no one likes) was signing up for one mandatory on -call shift per pay period (every two weeks). It was really the only insurance we had for the times when the "labor bus" hit our ED doors......

imenid37 · Mar 12, 2006

We have an on-call system for PACU and for short shifts. We do 650-680 deliveries annually. We have 6 LDRP's and 12 postpartum/C.Section/GYN rooms. We have 6 nurses on days and 5 on eves and nights. If swamped, our manager , assistant manager, and educator can help out, esp. on days. They will come in on the off hours if push comes to shove.