Re: staffing...please explain

[webbiedebbie]

I am not really interested in nurse-to-patient ratios right now. I can read many threads regarding this.

My question is, do any hospitals staff according to acuities anymore?

Case in point: I have worked two shifts now 7P-7A where the acuities of patients (not that this hospital cares about how much care the patient needs) exceeds the number of staff working. I am especially worried because we work 12-hour shifts now and anything can happen! On paper, 2 nurses for 10 patients sounds easy. (No CNA by the way or secretary). The nurses station is left unmanned. Call lights go unanswered. Phone calls go unanswered. 6 admissions between 3 p.m. to 6 p.m. Visitors all over the place. Toilet leaking in one bathroom. Pt transferred to another room. Heavy lady partsl bleeding with one pt. New admission right at change of shift. (Requires hourly checks x 4). Patients in pain...need to assess and medicate.

I was expected to call people at home who were off to come in! Who has time for that. Supervisor would not make calls.

This is probably typical for most of you. Why do we put up with this?!

Just once, I would like to have an administrator for a patient and have them "wait" for someone to help them.

How do I get the hospital to rethink acuities? This worked great in the 80's. Each shift was responsible for the next shift's staffing.

We have an extensive float pool. Why aren't they utilized?

Oh...I was told by my manager that we staff according to ACOG standards. What?!

[Jenny P]

ACOG= ? American College of Gynecology?

If so, no, your hospital is NOT following their guidelines (try checking their website and see if they can tell you their guidelines).

[webbiedebbie]

I was just quoting my manager who stated that the hospital follows ACOG guidelines. I didn't believe her either. I looked up ACOG and couldn't find anything there.

I also checked AWHONN's site and couldn't find anything there either.

Money talks, I guess. Hospital administration and billing decide on staffing. No wonder there is a nursing shortage!

[Mimi2RN, ASN, RN]

Originally posted by webbiedebbie

Thanks, rdhdnrs....I sent you a pm.

I work a Postpartum unit...granted, there are many times we are not busy. But when we are, that is when we are short-staffed.

I am a professional and I feel I know an unsafe situation when I see one. (So far, I have worked 2 of these nights in this hospital).

Our system currently only allows for 3 nurses total for 11 patients and higher (up to 23 beds). That may be fine in some instances, but the majority of the times, we only have 2 nurses and may or may not have a CNA (and they only work up to 11 p.m.).

How do I get the hospital to start staffing by acuities??????

Debbie, are you including the babies in your numbers? or does that mean 11 couplets and higher? So many place don't seem to count the babies, but they can take a lot of work. Even if you have babes with a nursery nurse, they won't be there for every feeding.

I do know how fast pp patients can go bad.....having babies is not always an easy, joyful time.

[pickledpepperRN]

You can buy the book "Guilelines for Perinatal Care" on line. It is from the American Academy of Pediatrics, the American College of Obstrticians and Gynecologists, and the March of Dimes.

I'm an adult nurse who hand wrote page 19 when taking a relative for a prenatal visit. I do serve on a practice committee of nurses at my hospital.

Table 2-1 :

NURSE/PATIENT RATIO CARE PROVIDED

------------------------------------------------------------------------------

INTRAPARTUM

1:2 Patients in labor

1:1 Second stage of labor

1:1 Medical or obstectric complications

1:2 Oxytocin induction or augmentation of labor

1:1 Coverage for initiating epidural anesthesia

1:1 Circulation for cesarean section

ANTEPARTUM/POSTPARTUM

1:6 Antepartum/postpartum patients without complications

1:2 Patients in postpartum recovery

1:3 Patients with complications but in stable condition

1:4 Recently born infants and those requiring close observation

NEWBORNS

1:6-8 Newborns requiring only routine care

1:3-4 Normal mother-newborn couplet care

1:3-4 Newborns requiring continuing care

1:2-3 Newborns requiring intermediate care

1:1-2 Newborns requiring intensive care

1:1 Newborns requiring multisystem support

1:1 or greater Unstable newborns requiring complex critical care