staffing in ob triage

[emmborn2trek]

I have worked in L/D for 19 years and usually I have enjoyed my job. The place where I work takes care of all kinds of maternal/fetal concerns. We take care of highrisk, lowrisk, and everything in between. My concern is that we are buiding a new ob triage area. The current triage area is a 4 bed open area with one nurse staffing. It is like a mini emergency room where anyone between 20 wks to term is evaluated and seen. This may include monitoring, labs, and treatment. In my time there I have seen the usual labor to tooth ache to lacerations. If you can see it in the emergency room you can see it here the only difference is that these patients are pregnant. The new ob triage room is going to increased to eight beds with no increase in staffing on night shift. They plan to increase staffing on day shift to 2 RNs. Due to hippa concerns all the beds will be self inclosed. I cannot find any literture on ob triage staffing and would appreciate any one opinon on the subject. Although we have central monitoring it is called ob trace vue and has some quirts. When you are charting on the current pt you can't see the other patients. We have no telemetry which would solve some problems but as usual adminstration does not feel the cost is justified. Thanks in advance for your opinion and help. emmborn2trek.

[HappyNurse2005, RN]

Our unit sounds similar to yours, in the high risk-low risk everything in between. Except that if its anything acute and non pg related, they get seen in ED first, or we'll ahve to go down to monitor. Lacerations, chest pain, broken ankle-seen in ED. nausea, vomiting, headaches, PIH, labor, PPROM, diarrhea, backache, etc etc etc.

We have a 3 bed open area, with walls between the beds. One nurse. We do have central monitoring and from the nurse desk I can see all the strips.

I cannot imagine one nurse to 8 beds if all 8 beds were full. If you have 8 beds and only 3 are full, then thats great. I mean, when they come in rocking and rolling, moaning loudly, 7cm you can't really pay any attention to anyone else until you get them out of there!

I would definitely talk to your manager to see why you dont get another triage nurse at night, or maybe your charge nurse will assign someone else there as well. good luck

[SmilingBluEyes]

I don't work in a hospital where there is a separate triage unit, so I would not be of much help. I just wanted to welcome you to allnurses.com and our forum. We are glad to have you. Good luck in finding the answers you need and setting things up that are safe and effective.

[tntrn, ASN, RN]

Our triage is 3 beds, one big (well not big enough for privacy) room. Usually 1 nurse. Actually we try to staff triage as needed. Always 1 nurse, but sometimes on one of those really busy days, there are two. Of course, sometimes triage patients have to go to our other rooms, if there are more than three.

We schedule NST hourly, but it's really common for NST to go long, the next one comes in as well as 2 or 3 others: those with those toothaches! And we had one of those not long ago. Pregnant and toothache.

WE have one computer in the triage room and you cannot see all the strips while charting on one patient. I should say, we have one at each bedside and 1 on the desk, but if you're charting, you can't see any of the other screens.

8 triage beds for one nurse, is nuts!

[cassioo, RN]

We're kind of in the same boat. We do have central monitoring from the desk but not from each patients room which is also bad for labor if you have 2 patients and you're in a room.

My question is do you often have a long wait for those 4 rooms you have and anticipate the 8 being fulll if they are you need more help.

[emmborn2trek]

The thing with our unit we do 250-300 deliveries a month. That does not include the preterm, the high risk delivied pts nor the what I call the home steadiers who are admitted in their teen wks (0 -20 wks) who for whatever reason stay till they are delivied. The space in the l/d unit is limited to 15 ldr's and 4 Recovery room beds. The screening room or ob triage room stays full and we have holding chairs where pt's sit to be seen which in itself is a liability. When the ldr's are full and the recovery room is full the admitted pt stay in the screening room. Could you imagine what it would be like if you had 2-3 admitted pt's there with a potential for 5-6 other pt's with one nurse. It boggles the mind. We have repeatly talked to the nurse manager and she seem to oblivious to the fact that night shift can be just as busy as day shift. The reason I'm writing is to see what prudent nurses say about this sitution.

[cassioo, RN]

I like the home steaders :)

I understand the NM not getting it that AWHONN staffing would be great if you just had the 1 or 2 labor patients it's when you have all of those in and outs assigned to the same nurse who is trying to do inductions, epidurals etc....anyplace with that many deliveries I would think would need to have nurses just assigned to triage and if by chance there were no pts to triage that assgned nurse(s) could help between L&D and/or postpartum because you can always use somebody to answer the phone or watch your other patient while you are busy with the others. There are just accidents waiting to happen. I do think we got a little better when some of the doctors started putting in their 2 cents in the OB meetings.... but I quit my fulltime job (of over 15 years) and start a travel position next week so I'll see if the grass is greener :)

[newmidwifehopeful]

8 beds 1 Nurse!!! I think that is ridiculous and UNSAFE. We have an 8 bed triage unit. We have central monitoring. Our beds are all seperated by walls but just curtains for closure. We have one completly private room. We see all pregnant patients. pts up to 6 weeks postpartum and gyn surgery pts up to 2 weeks post procedure. We have 3 nurses for all shifts. When we get really buzy we try to pull a 4th nurse from L&D.

[LizzyL&DRN]

We have a 5 bed triage unit, each bed enclosed by curtain only. We keep fetal monitors next to the bed sound turned up to protect patient confidentiality. If no FM is being used there is a little radio next to the bed that we turn on. We are staffed ideally with 2 RNs but lately due to budget constraints 1 RN and sometimes 1 LVN. Our LVNs are really great, they hook pts pt to monitors, get VS, start IVs, due admissions (except assessment), due discharge teaching if pt is going home etc. Anyway, if we are stuck in there by ourself we only see 3 pts at a time. Others wait in waiting room and we always get brief hx before sending pts to waiting room. If someone needs to be seen more rapidly and 3 beds are full, I call charge nurse to triage that pt. 8 patients and 1 RN is sooooo unsafe! You should have the ability to send patients to waiting room if need be. It's your license and you have to do what is safe for patients, 8 is a ridiculous number! I'm not sure how your unit runs, but I frequently have pts in triage in a holding situation while they are waiting for a bed and in active labor. AWHONN standard is 2:1 with active patients.

[babyktchr, BSN, RN]

Wow. First, I am impressed that an 8 bed triage is needed for your unit. That is amazing. You have the extra added luxury (or not) of seeing anything and everything in an OB patient. I do NOT think this is a good idea, but some hospital ED's think that pregnancy alone is a disease process and that once you are pregnant, a tooth ache or chest pain is somehow different. Why oh why can't people get it thru their heads that is the mother ship isn't doing well, the baby won't fair well either? I digress. AWHONN does not have a guideline for ratio's specifically for triage, but they do for antepartal patients. With that said, what are the guidelines for nurse/patient ratio's for the ED? It should be the same for your unit, especially if you are seeing ED type patients, and staffing is universal, not just shift specific. Last I looked, hospitals operated 24 hours a day, 7 days a week. Why don't you try going to your risk management people and see what they say. You may get some help there. Also, do you track your patients by diagnosis at all? Start doing a shift census for the night shift triage unit. How many patients, how long they were there, the acuity etc. Your manager would have to look at that because it would involve her productive work hours/staffing. That may be helpful, to give you ammunition for your cause. Administration loves statistics.

I only have a 2 bed triage, staffed with one nurse tues-fri on dayshift only. No, it is not fair at all. It is then staffed by the L&D nurse on nights or the charge nurse, taking turns. It is again, not the right thing, but what I have right now. We also only see 20 weeks and above for OB stuff only. They do try to send up (God love them) the 33 weeker with chest pain, and I politely ask them to go ahead and rule out that PE or MI before we do an NST.

[cvssc]

Worked in a teaching hospital that had a 9 bed triage area. There was a time when our core staff was suppose to be 7-for triage, L&D, recovery, and OR. We had 5. I have seen 43 patients in triage in 12 hours. My only partner was a nurse extern-last symester of nursing school.

Now, I don't work there, but the nurse manager has done wonders. I nurse to triage patients and 2-3 to work in the area with patients being evaluated. Much better. You can actually take care of patients instead of praying that nothing happened because you could not or did not do something. Scary!

[ldcmw1]

I work at a hospital that has a four bed triage unit. One nurse is suppose to be staffed for it at all times. When the l&d floor is busy and we have no triage patients we close it off.

When the triage unit is busy I think one nurse isn't enough! On our triage unit we have to be nurse, tech, secretary, and housekeeper. I find the triage unit can be very overwhelming at times and I hope AWHONN comes up with a standard for that. At times we have 2-3 patients showing up at once!! On the floor you would never have a nurse take 2-3 new patients to be assessed at once. It shouldn't be that way on the triage unit either but when l&d and triage are both busy it can happen. When this is brought up to management it is brought to deaf ears. I'm just so sick of working outside AWHONN standards and management not caring.