Staffing Issues

Hi all. I work in a small critcal access hospital, in OB/GYN department. We normally have two RN's on a shift (two RN"s scheduled). The problem is we have been slow lately, and sometimes have no patients on the floor. The other problem is, we have this NM in Med/Surg who wishes to pull us off of the floor and help in Med/Surg. I have no problem with one nurse going up to the med/surg floor to help. But this NM (and our CEO as well) feels that if there are no patients, then the unit should be closed and the RN's should float to other units or be put on call.

My feeling is that there should ALWAYS be a nurse on the OB floor even if there are no patients. All of us who work in L&D (our unit is LDRP and NY) know that at any time a woman could come into the unit dialated to 10 and trying not to have the baby at the nurses' station. So what happens if no one is on the unit. There was one instance where one of our OB nurses was in med/surg, and was paged. She couldn't hear the page as she was in a patient room and giving a bath. The m/s nurses then said "oh you had a call but we couldn't find you". This is crazy to me.

So my question is, what do you who work in smaller hospitals do when you have no patients? Thanks in advance!

Our policy was similar to what you describe. One RN remained on the unit, the other could be pulled to another department to take "clean" patients. (That's another story, as there really is no such thing as a "clean" patient.)

Anyway, there is always something that the RN who remains on the unit can do: stock, clean equipment, prepare charts, help with QI, make follow-up phone calls, etc. That may be the key to convincing administration that the RN who stays on the unit is not taking a "free" day, but is contributing to the unit by doing these chores that often go undone when it is busy.

Do patients not go to the ER first? Is the hospital so small that you have laboring moms just wander onto the floor without registration. If this be the case then I think the primary problem would be to fix that problem and require them to register in ER first. If both nurses are pulled to another unit then I think the ER could call if needed and by all means if someone wanders into the ER 10cm and dying to push then they could handle it until you get there or the baby comes whichever happens first. I think it is foolish to pay a nurse when there are no patients to care for.

Do patients not go to the ER first? Is the hospital so small that you have laboring moms just wander onto the floor without registration. If this be the case then I think the primary problem would be to fix that problem and require them to register in ER first. If both nurses are pulled to another unit then I think the ER could call if needed and by all means if someone wanders into the ER 10cm and dying to push then they could handle it until you get there or the baby comes whichever happens first. I think it is foolish to pay a nurse when there are no patients to care for.

Are you an L&D nurse? Our patients always come directly to our unit for admission. They have to walk through ER in the middle of the night, but they don't usually stop there unless they need a wheelchair. The ER dept tries not to even go near our patients--like they're contagious or something! :chuckle

Anyway, we can go from zero patients to 4 patients in a matter of minutes with no prior notice or warning. I swear there are nights when it seem they just keep coming down the hall panting and leaking and we barely get them in a bed! I admit that there are nights when I get aid to sit around, but then all h## breaks out at 0500 and thank God there are two of us and when is the dayshift coming in???

Case in point: Zero patients all night long--two RNs. About 0500 a 29 weeker with twins walks in thinking she may be contracting. EFM tracing is beautiful. Gentle VE after MD orders and there is a foot hanging out and (obviously) she is SROMed for who knows how long. So, we go from being paid to do nothing to having a true emergency situation on our hands. Sh** happens fast on our unit. We need to be prepared.