safe maternity practice?

[dawnbee]

I work in a 40 bed rural hospital as a Perinatal RN. We have a three bed ward, with two delivery rooms. There is one Perinatal RN in the hospital 24/7, and since provincial protocol demands that there be two qualified assistants at each delivery, our Shift Coordinator is the designated second. We deliver approximately 200 low risk pregnancies per year and do antenatal care on many more high risk pregnancies who are slated to deliver in centres with available nurseries. Our unit is linked to a 18 bed Med/Surg unit and a 3 bed ICU. We are expected to help on the floor, relieve ICU and other RN breaks. and receive admissions of male and female cardiac and surgical postop patients to Maternity when we don't have active labouring patients. We have had as many as 5 off-service patients crammed into our four rooms (one "assessment room"). If a labouring woman comes in, the off-service patients are handed off to the already overburdened Med/Surg staff, while we provide 1-1 to our priority patient. If it's after hours or weekend, we have had to deny our patients epidurals, or offer them transfer to a larger facility, as we didn't have enough staff to monitor the infusion. Oxytocin drip, same thing. Two of our 4 docs also do circumcision in the hospital, and we assist with that and postop observation of the child. And of course, the prebooked and surprise NST's, well baby weights, breastfeeding problems etc. For the past several years, we have had few if any casuals, and we have all logged many hours of overtime and on call hours. We must take on call because the Shift Coordinator is often too busy in Emerg to help with deliveries. In 2006 alone we had 3 time loss injuries in a permanent staff of six, which caused more overtime, exhaustion, etc. Our hospital Maternity service has been closed due to staffing shortage at least ten times in the past year. The next nearest hospital is 100 km away from ours, and well over 200 km from our outlying cachement area.

Our Obs GP's have been incredibly supportive of us, and very vocal in trying to obtain the resources we need to practice safely, and we have had several meetings with upper management about the issue. The upshot of the most recent meeting was that there is not a nickel to spare, and we just have to move human resources around to meet the need. So now, there will be 2 trained Mat nurses per shift (several have been trained but are not comfortable working alone so soon...). Our assignment will now include part of the Med/Surg floor. The senior, experienced Mat nurse will work the Med/Surg patients and the learner will take the Maternity patients. Then, if a second is needed at a delivery, the experienced RN will be the back up, while the Shift Coordinator covers her assignment. Basically, I have been pulled out of my position and put on Med/Surg while the new kid practices my specialty. I'm all for mentoring, but this goes too far for me....

So, one of our docs and myself have been appointed to a sub-committee to find ways to bring our concerns to a higher level of management. We have already obtained stats from 2004/5 regarding workload, patient acuity, ward closures, etc., and 2006 stats are just around the corner. We could use any advice or input anybody has to offer.

Thanks.

[NotReady4PrimeTime, RN]

Have you thought about going to the media? It's been very effective for other nursing concerns. You could organize an information picket in conjunction with your nursing union and call the local radio station, the local weekly paper and the nearest television station to cover it. You also need to be writing to your MLA, your MP, the health minister and the premier, and anybody else in high places who might have a stake in what's happening. Describe what's going on in the clearest and simplest terms you can and list the ramifications of continuing on as you are. Best of luck... you'll need it.