Ratios Mom Baby Northern California

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Specializes in Mother/Baby; Postpartum, Newborn Nursery.

Hi. I am doing some research and hoping my fellow Nor Cal Postpartum RNs can help me by answering some questions.

What is the ratio on Mom Baby (3:1 or 4:1)?

Does your unit take Bakri, high risk pts who require more monitoring, and/or Mag pts? If so what is that ratio?

Do you take care of 35 -37 weekers? What is that ratio?

Do you care for NASS babies, babies on phototherapy, or babies with sugar/temp issues in MB?

What is your blood sugar protocol: SGA and late preterms for 12 hours and LGA, GDM for 24 hours or is it more involved? Do you use glucose gel?

How often do you take vital signs on well babies - q8 or q4?

When your unit makes assignments do they staff based on acuity or ratio? Do they take into account any social issues, if mom requires lots of breast feeding help, or if it's a first time mom or high risk of PPH?

Also if you work for a Kaiser hospital or non-KP facility and the location.

Thank you!!!

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Specializes in Critical care, tele, Medical-Surgical.

I am a retired California nurse who was NOT a maternal-Child nurse.

But maybe some information may help you. First from Title 22 regulations hospitals must follow as a condition of licensure:

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Requirements of registered nurses in all California acute care hospitals:

https://govt.westlaw.com/calregs/Document/IFD69DB90621311E2998CBB33624929B8?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

Staffing requirements for California hospitals:

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Hospitals shall provide staffing by licensed nurses, within the scope of their licensure in accordance with the following nurse-to-patient ratios. Licensed nurse means a registered nurse, licensed vocational nurse and, in psychiatric units only, a psychiatric technician. Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system.

No hospital shall assign a licensed nurse to a nursing unit or clinical area unless that hospital determines that the licensed nurse has demonstrated current competence in providing care in that area, and has also received orientation to that hospital's clinical area sufficient to provide competent care to patients in that area. The policies and procedures of the hospital shall contain the hospital's criteria for making this determination.

Licensed nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse at any one time. “Assigned” means the licensed nurse has responsibility for the provision of care to a particular patient within his/her scope of practice. There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. Only licensed nurses providing direct patient care shall be included in the ratios...

... (3) The licensed nurse-to-patient ratio in a labor and delivery suite of the perinatal service shall be 1:2 or fewer active labor patients at all times. When a licensed nurse is caring for antepartum patients who are not in active labor, the licensed nurse-to-patient ratio shall be 1:4 or fewer at all times.

(4) The licensed nurse-to-patient ratio in a postpartum area of the perinatal service shall be 1:4 mother-baby couplets or fewer at all times. In the event of multiple births, the total number of mothers plus infants assigned to a single licensed nurse shall never exceed eight. For postpartum areas in which the licensed nurse's assignment consists of mothers only, the licensed nurse-to-patient ratio shall be 1:6 or fewer at all times.

(5) The licensed nurse-to-patient ratio in a combined Labor/Delivery/Postpartum area of the perinatal service shall be 1:3 or fewer at all times the licensed nurse is caring for a patient combination of one woman in active labor and a postpartum mother and infant The licensed nurse-to-patient ratio for nurses caring for women in active labor only, antepartum patients who are not in active labor only, postpartum women only, or mother-baby couplets only, shall be the same ratios as stated in subsections (3) and (4) above for those categories of patients...

... (b) In addition to the requirements of subsection (a), the hospital shall implement a patient classification system as defined in Section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements. The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, psychiatric technicians, who shall be assigned to direct patient care. Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements:

(1) Individual patient care requirements.

(2) The patient care delivery system.

(3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population...

https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

At my hospital the Maternal/Child nurses negotiated with their nurse manager and medical director that the ACOG and AWHONN guidelines would be used to add staff when needed. That is how they comply with the requirement to implement a patient classification system.

The attached ACOG guidelines may still be in place OR may have been updated.

ACOG Staffing Guidelines as of 2012_large print.pdf

AWHONN has excellent guidelines too. I hope your unit has a copy. If not a hospital nursing, or medical library should.

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Specializes in Mother/Baby; Postpartum, Newborn Nursery.

Thanks for your reply. I have all this information but I am researching to find out what local hospitals are actually doing b/c the hospital I work for most definitely does not follow any of those guidelines. They are staffing based on California State ratio not by acuity and they most definitely are not using AWHONN Guidelines, that is what we are trying to get them to follow.

They max us out with 4:1 assignments that include C/S less than 12 hours, 2 late preterm babies on blood sugar protocol with breastfeeding issues, and a pt on triple ABX for chorio or unstable BPs. We get pts on mag (q1hour assessments) with 2 other couplets who are far from stable. It's ridiculous.

I was hoping to find out if other hospitals use AWHONN or do they all staff to the max ratio to save money.

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Specializes in OB.

You will probably get more answers if you move this to the OB/GYN forum.

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Specializes in Nurse Leader specializing in Labor & Delivery.

Not in California, but when I was the manager of an OB unit in Oregon, and now, in the upper Rocky Mountain region, we DO staff to AWHONN guidelines. It's something I feel very strongly about.

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Specializes in Mother/Baby; Postpartum, Newborn Nursery.

Any chance you would like to become our director??? ?

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Specializes in Nurse Leader specializing in Labor & Delivery.

Are you in Santa Rosa, by chance? I keep getting emails from recruiters for a manager position at that hospital - it seems they can’t keep a manager there!

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Specializes in Mother/Baby; Postpartum, Newborn Nursery.

No I'm in Northern California. We have an amazing manager who tried to let us staff by AWHONN guidelines but the finance people make sure to not let that happen.

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Specializes in Nurse Leader specializing in Labor & Delivery.

Yeah, it’s a constant battle (literally - every four hours, night and day, I’m justifying why we have a certain number of nurses on the unit).

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Specializes in Mother/Baby; Postpartum, Newborn Nursery.

It’s very frustrating that people who are not nurses nor understand the workflow are the ones deciding how many nurses should be working a unit. ? Isn’t that why we have a nurse manager?!??

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Hi, I’m going to send you a message! 

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