Staffing & Pt Assignments

[Mrs.S]

I've read a couple posts recently that made reference to one nurse caring for six or seven couplets (OUCH!!) and I am really curious now about what the "norm" is at other hospitals as far as staffing ratios and patient assignments go.

I work on an LDRP unit, and we have mainly RNs providing all the patient care, although we do have a couple LPNs who can do mother/baby only with RN resource. We have this whole scoring system for patient acuity and then a formula we use for determining how many nurses are needed for the next shift. I don't really know all the ins-and-outs of it; as a new nurse I don't need to take on the responsibility for determining staffing just yet. But anyway, these are some pretty typical assignments:

3 or 4 normal healthy couplets (maybe 5 on nocs)

2 couplets if babies are near-term or other issues with baby

2 miso or gel inductions

1:1 nursing care for active labor, Pit, epidural, Mag, or continuous EFM for any reason

Antepartum patients who are not on Mag or continuous EFM can be paired up or put with a stable couplet or a couple NICU moms

[midwife2b]

The hospital where I now deliver follows AAP/ACOG guidelines. So a nurse may have 2 laboring patients but when an epidural is going in or second stage begins she is only responsible for that one patient.

Also recently instituted was the 1:1 for first hour post delivery (started my me as my own safe practice and finally adopted by the wonderful management!)

AP patients is 1:6

Mother Baby is 1:4 vag; 1:3 if someone is

If there are more than 2 babies in the NBN who require O2, oxyhood, IV fluids or IV antibiotics they must add another RN who can oversee the couplets and any admissions.

[SmilingBluEyes]

I've read a couple posts recently that made reference to one nurse caring for six or seven couplets (OUCH!!) and I am really curious now about what the "norm" is at other hospitals as far as staffing ratios and patient assignments go.

I work on an LDRP unit, and we have mainly RNs providing all the patient care, although we do have a couple LPNs who can do mother/baby only with RN resource. We have this whole scoring system for patient acuity and then a formula we use for determining how many nurses are needed for the next shift. I don't really know all the ins-and-outs of it; as a new nurse I don't need to take on the responsibility for determining staffing just yet. But anyway, these are some pretty typical assignments:

3 or 4 normal healthy couplets (maybe 5 on nocs)

2 couplets if babies are near-term or other issues with baby

2 miso or gel inductions

1:1 nursing care for active labor, Pit, epidural, Mag, or continuous EFM for any reason

Antepartum patients who are not on Mag or continuous EFM can be paired up or put with a stable couplet or a couple NICU moms

Sounds a lot like how things go at our LDRP unit. Except we have GYN surgicals in the mix.

[LandDRN]

wow, no wonder our facility is running us ragged. We have "numbers" but they are only a guideline. most typically we have 2-3 patients. These include pitocin induction, mag gtts, insulin gtts with protocol (q hr bs checks with titration of the gtt), epidural placements and 2nd stage labors. For example last week I had a pt that was on magnesium for pih, pitocin to induce the labor and she was an IDDM so she had an insulin gtt. I had a second laboring pt and a third antepartum who was on magnesium at 30 weeks for PTL. Nights on our unit is very strapped, and it's often worsened by the fact that mother-baby will refuse pts after there 4:1 numbers are done. This ends up leaving L&D caring for 2 active laboring pts and mother baby couplets ( in our facility the post partum unit is separate and only stable couplets go there. Anyone on magnesium, post partum hemmorage, babies that need some extra transition time ect. , stay on L&D) so it has created some sore feelings between the 2 units. If we have a section we're pretty sunk, since we also have to pull a second and sometimes third nurse to scrub and assist, so for an hour or two period we have had to occasionally take 4 laboring pts. I feel so lucky to leave those mornings without anyone being hurt by staff issues.

[VickyRN, MSN, DNP, RN]

wow, no wonder our facility is running us ragged. We have "numbers" but they are only a guideline. most typically we have 2-3 patients. These include pitocin induction, mag gtts, insulin gtts with protocol (q hr bs checks with titration of the gtt), epidural placements and 2nd stage labors. For example last week I had a pt that was on magnesium for pih, pitocin to induce the labor and she was an IDDM so she had an insulin gtt. I had a second laboring pt and a third antepartum who was on magnesium at 30 weeks for PTL. Nights on our unit is very strapped, and it's often worsened by the fact that mother-baby will refuse pts after there 4:1 numbers are done. This ends up leaving L&D caring for 2 active laboring pts and mother baby couplets ( in our facility the post partum unit is separate and only stable couplets go there. Anyone on magnesium, post partum hemmorage, babies that need some extra transition time ect. , stay on L&D) so it has created some sore feelings between the 2 units. If we have a section we're pretty sunk, since we also have to pull a second and sometimes third nurse to scrub and assist, so for an hour or two period we have had to occasionally take 4 laboring pts. I feel so lucky to leave those mornings without anyone being hurt by staff issues.

This sounds so very dangerous, and in such a highly litigious field as L & D, you definitely need better staffing :uhoh21:

[nodi0603]

AWHONN and ACOG have staffing guidelines that should be followed-Our hospital certainly does. You should involve your Chief of OB.