Safe Staffing with New Staff

Published

Specializes in Labor and Delivery, Newborn, Antepartum.

So, we're having an influx of new employees on our unit. We currently have 5 new employees on nights, 2 of which are new grads, 2 that have other medical background, but no OB experience, and 1 with 5 or so years OB managerial experience. 1 with other background and the one with 5 years managerial experience are "off" orientation. They have been with us for approximately 5-6 months, have completed all their competencies, except Special Care Nursery. 1 of the new grads is nearing the end of her labor orientation (although I'm not sure SHE thinks she's ready); and the other 2 are still in the early stages of orientation.

We have had a low census recently and have had a problem figuring out how to staff with these newer people. According to our unit policies, you are not to be in charge or take observation patients with no assistance available until you have been working on our unit for 1 year.

There have been several times recently, when the two that are "off" orientation have been scheduled with another, more experienced, person, and it has been the experienced person's turn for a call off. There is some discomfort that they shouldn't be the only 2 RNs on the unit, because they really shouldn't be taking observations alone yet, and who will be in charge?

Recently, we had an empty unit. The staffing was done so that there was an experienced nurse and the new grad that is about done with her labor orientation. Also according to our policy, there is to be 2 labor nurses staffed at all times. There was a lot of argue that the new grad shouldn't be considered a second labor nurse, because she is not done with her labor orientation yet! I brought this up to the manager and she thought that since she is so far along in her orientation, that she should be considered a second labor nurse. She kept saying that I want black and white rules and it isn't that way. But shouldn't our staffing policies be black and white? And our orientation?

How do you guys do staffing on your units?? Do you have hard, fast rules that you go by and don't bend? How do you handle new employees and call offs?

There is some grave concerns that we are staffing dangerously. We all know that OB is a high risk specialty and things can change at the drop of a hat. I am planning to bring my concerns up at the nurse council meeting next Tuesday, but I am the only representative from the night shift and I am curious if I'm fighting a lost cause. Thanks!

Up Vote Up Vote ×

Is the unit still empty? I am not an L&D nurse, but census means a lot.

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

Regardless of the number of nurses scheduled for a particular shift, there should never be more than 50% inexperienced nurses, meaning nurses with less than 2 years experience in your specialty.

If 2 nurses are scheduled, one of them must have more than 2 years of L&D experience. If 3 nurses are scheduled, 2 of them must have 2 or more years of L&D experience, and so on.

Anything less amounts to failure to staff to meet the expectations and needs of your patients and the providers who are directing them to your facility.

With a zero census, there still must be 2 nurses scheduled who are capable (together) of managing labor, OB emergencies, and C-sections. If any of those patients arrive on your doorstep, you can't ask them to wait while you call in nurses.

Up Vote Up Vote ×
Specializes in Labor and Delivery, Newborn, Antepartum.

Jolie - THANKYOU!! This is exactly the position we were discussing the other night! The managment says, you can't staff for "what ifs," and at least they have us to call in. But, I've seen enough of the "what ifs" happen, and frankly, I'll be quite upset, to say the least, if I get called in after an emergency to clean it up! Many of us also live 30+ miles away. Therefore, yes, they can call, but it will take 30+ minutes for us to get there....and, lets face it, a lot can happen in that amount of time.

Please dont misunderstand me - I have a lot of confidence and faith in our new employees, that, in time, they will be superb OB nurses. But for the most part, the 5 I have mentioned, have seen normal, fine, low risk stuff. They haven't had the "pleasure" of managing a precip delivery, ship a preterm laborer or a bad baby, admit a baby to special care nursery (nor are any of them oriented to that area of the nursery), handle a hemorrhage or stat section or any other situation that would land us in the OR quick. My point is, they need to experience these things with someone that HAS, or at least be given that opportunity for a year or two before they are ultimately responsible for that.

Up Vote Up Vote ×
Specializes in ED, ICU, PSYCH, PP, CEN.

Welcome to the new world of on time staffing. Unfortunately hosplitals today are trying to run like they are a business and don't take into account that they are working with living, brieathing unpredictable humans whose needs change suddenly.

As a pregnant woman I would be horrified to find out that the people taking care of me were so inexperienced.

There is a book by Patricia Benner called Novice to Expert and she looks at how long and what is needed for a nurse to learn a new specialty. According to her research it takes 5 years to go from being a Rookie to being an Expert that can handle almost anything.

So of course you are not demeaning your new staff. You just know in your gut that they are not experienced enough to take care of what they might see.

I work ER, and when I started 8 years ago there was a set number of nurses for each shift and nobody was ever canceled because of what might come in. Then when the economy started to dive badly along about 2009 they started staffing in 2 hour increments.

If it was your day to be canceled then you might come in, work 2 hours, get canceled for 4 hours and have to come back for 2 hours, then canceled for 4 hours etc.

Of course there was an uproar, but management just said "Then we will just lay people off in order to meet our bottom line". So we do this.

Unfortunately staff that protest are soon gone.

In my opinion it is ethically wrong to run a hospital dealing with sick and dying patients like a car repair shop with inanimate objects. But what do I know.

Perhaps you could buy and read and share Benners book and educate management a little.

I wish you luck with your delemma and hope this madness turns around before to many lives are lost in the name of bottom line

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Jolie - THANKYOU!! This is exactly the position we were discussing the other night! The management says, you can't staff for "what ifs," and at least they have us to call in. But, I've seen enough of the "what ifs" happen, and frankly, I'll be quite upset, to say the least, if I get called in after an emergency to clean it up! Many of us also live 30+ miles away. Therefore, yes, they can call, but it will take 30+ minutes for us to get there....and, lets face it, a lot can happen in that amount of time.

Please don't misunderstand me - I have a lot of confidence and faith in our new employees, that, in time, they will be superb OB nurses. But for the most part, the 5 I have mentioned, have seen normal, fine, low risk stuff. They haven't had the "pleasure" of managing a precip delivery, ship a preterm laborer or a bad baby, admit a baby to special care nursery (nor are any of them oriented to that area of the nursery), handle a hemorrhage or stat section or any other situation that would land us in the OR quick. My point is, they need to experience these things with someone that HAS, or at least be given that opportunity for a year or two before they are ultimately responsible for that.

I didn't feel you had a lack of confidence in your new grads....you are just the expert voicing concerns over their lack of OB experience. As a supervisor at night I would throw a fit if there wasn't the experience necessary to cover the speciality areas. I would check specifically the speciality areas that I couldn't cover like OB. I can cover the ED, ICU, and other critical areas but OB?? I am at a complete loss, Never worked it , Never will......When things go bad there they go REAL, REAL BAD, REAL, REAL QUICK..:eek:.

Stay strong and stick to your guns......for your patients sake.:heartbeat

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

That was the policy of the first hospital where I worked as a new grad, and I never could understand any other facility (or administrators) believing that anything else was acceptable.

OB is a 24 hour specialty. Unless your facility is willing to inform prospective patients and their physicians and midwives that there may be a 20-30 minute delay in obtaining necessary nursing care in the event of an emergency during a low census period, they are misleading their clients.

The payout of one bad OB case can cover thousands of hours of nursing staffing.

In fairness, nurses who are present during low census times without patients must make themselves useful and document how they are spending their time, for example completing continuing education, taking assignments on post-partum/GYN, accepting nursing assistant duties with non-infectious patients, cleaning, stocking, whetever.

But they must be present in house and immediately available to be pulled back to their home unit.

Up Vote Up Vote ×
Specializes in Labor and Delivery, Newborn, Antepartum.

Jolie - do you know of the 50% rule being a standard like with AWHONN JCOG? If I could find something in writing to present, that would be fantastic!

Up Vote Up Vote ×
Specializes in LTC, PCU, Med/Surg, Hospice, OBGYN.

Welcome to the world of budgets, low census, and well... NURSING!!! We have the same problem. I just got hired on L&D and it's one of those where you float to the Nursery and Women's postpartum & Peds areas of the floor. I myself have no OBGYN experience but am an experienced nurse. However, I got stuck working the other night with new grads and recently off-orientation nurses and trust me it was scary! I can't believe they count new orientees as part of the grid! I would never have my baby on my unit because of what I know! It is crazy! Too bad patient safety is no longer the priority or at least that is what it seems even though they state otherwise!

Up Vote Up Vote ×
Specializes in Women's Services.

As a new grad, just off orientation I was called off even when it wasn't my turn. I remember being upset about this and asking the charge nurse why I was being called off out of turn. She explained to me about the census being low and how they can not have too many newly oriented nurses working on the same shift due to patient safety. This made perfect sense to me and I never questioned it again. However, I do think it should've been explained to us before it happened!

Up Vote Up Vote ×
Specializes in Labor and Delivery, Newborn, Antepartum.

ADPIE2008, I've heard this happening other places, but unfortunately for the patients, we don't do that.

To all: Thank you all for the responses and opinions. I think we have a solution in the works! We are just now starting to recover our own c-section patients, and we are going to start staffing 3 RNs on nights, so that will allow for at least 1 experienced RN to be there.

Up Vote Up Vote ×
+ Join the Discussion