staffing issues...any suggestions?

Specialties Ob/Gyn

Published

so i am aware of the standard staffing guidelines for ob. i work in a ldrp unit with no support staff for patient care; just nurses. we currently take 3 mom/baby couplets but managment seems to think that is not enough and is looking to up the ratio. most places this would seem like a breeze but we do everything (vitals, assess, picking up rooms, breastfeeding support, paperwork, teaching, referrels,etc etc). then on top of that we have to care for babies when they are first born and do the initial rescusitation or admit a labor/antepartum that walks onto the unit. i do not feel that i will be giving quality patient care with more than 6 patients (3 moms, 3 babies)! what to do??? any suggestions...

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Specializes in Regulatory Nurse Specialist, State Government.

Wow, When I first heard of the Nurse Patient ratio's for labor and delivery-considering that for every Mom, there is a baby to care for as well-3=6 patients that need various interventions throughout any shift. Yes, Over 6 patients to one nurse, your facility is harming patients at a ratio of 7% for every patient over 4:1 on a PCU; for example. I am a strong advocate of patient safety demonstrated by excellent care delivered with ancillary as well as nursing staff alike. Aikens, in a Pennsylvania study reflects ratios-Hospital administrators bury this study every time it begins to circulate at a facility-budget!

http://www.protectmasspatients.org/docs/IOM%20Nurse%20Rpt%20Executive%20Summary.pdf

http://blog.aflcio.org/2010/04/20/nurse-patient-ratio-laws-save-lives-new-study-shows/

just a few of the research supported issues regarding Ratio's and the importance of good staffing practices at our nations healthcare facilities for the safety of all of us!

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Specializes in L&D/postpartum.

I used to work in an LDRP, and they are so tricky to staff. We had 3 nurses on - 2 would take couplets (usually 2-4, depending on census), and 1 person would take all labor pts that showed up. If there was a c/s or the labor nurse got totally slammed, the couplet nurses would have to help. Basically the whole system relied on us neglecting the postpartum pts to some extent while dealing with more urgent labor-related things. So 3 couplets is perfectly fine, if you were truly only involved with those 3 couplets all night. But once you add labor pts and work that can be done by ancillary staff, you're taking on a lot more. I work in L&D only now, and it's so nice to know that the postpartum nurses are solely focused on postpartum, I am just focused on my labor pt, etc. LDRPs are good in theory as long as management is willing to staff them as if they were staffing 3 separate units, but that never happens.

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Specializes in Hospital Education Coordinator.

I thought the Am. Academy of Pediatrics recommended 2 RNs with NRP certs to be present during a high risk delivery. Who is minding the other patients at that time?

I see your dilemma as a sign of the times - facilities are trying to cut costs. It is important to research and report recommendations from professional organizations and other agencies. This gives weight to your statements and should alert risk management of the situation.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

My understanding is that AWHONN guidelines recommend 3-4 couplets per nurse.

Why is the L&D nurse or transition nurse not doing the initial baby admission/assessment stuff?

Our facility's ratio is 3 couplets per nurse. This is usually without support staff. If it were all well couplets, I could handle 4. But not with also being expected to attend births, recover the baby, etc.

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Specializes in Community, OB, Nursery.

We do 4-5 couplets (possibly a stable antepartum in the mix), and 5 couplets can be hard, esp if there are issues with either mom or baby, or if one couplet is particularly needy. (And yes, I know this is above AWHONN standards; they are cutting staffing to the bare bones around here.)

We aren't responsible for baby's first bath/assessment/shots & drops, as nursery does that. Nights doesn't usually have a tech to get things like ice water or more pads, and lactation at night is nonexistent. We do have a secretary. We don't do mag but we keep pretty much everybody else postpartum.

Four couplets is usually doable but any more than that it can be tricky. If everybody's okay, 5 can be alright, but if not you are really out of luck.

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Specializes in OBGYN, Neonatal.

Wow that is scary! We do not have ldrp, we have ld and then a seperate mother/baby unit. On post partum we do not have any ancillary staff so we are required to do everything for the patients (vitals, trays, discharge teaching, bed linens, etc. etc.) and we start the shift generally with 4 couplets (8 patients) or a mix of couplets and gyn surgical patients. There are times when we've had no choice and been up to 6 or rare occasions 7 couplets. But that is a rarity. Generally 5 couplets, or a combination of couplets/gyns to equal about 10 patients that we do everything for is the norm. (not saying I agree with it but its what generally occurs).

I can't imagine having to divide up with laboring patients as well, that is just so intense, I can only imagine how stressed you would be.

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