Staffing ratios for C Sections

USA987, MSN, RN, NP · Aug 28, 2005

One to circulate and one for the baby.

The baby goes to PACU where it is assessed and bathed usually before mom arrives. When mom comes into PACU and gets settled in the baby nurse leaves (unless mom is unstable).

rn/writer, RN · Aug 28, 2005

I'm usually in postpartum but I've observed a fair amount of L&D. At our hospital (also a teaching facility), there is never just one nurse for both mom and baby, even for an uncomplicated vag delivery. Babies can go south without much warning. They need someone paying dedicated attention. So do moms. Especially section moms.

Last week, I was watching a difficult vag birth. Mom had pushed for two and a half hours and baby was just shy of +2 for most of it. FHT were good but just beginning to show signs of fatigue. After two unsuccessful attempts to line up forceps, vacuum extraction got baby out (in good shape) in about four pushes. In attendance were baby's dad, grandmother and great-grandmother, along with L&D nurse, attending OB, OB resident, anesthesiologist (epidural needed adjustment several times), baby nurse, on-call pediatrician, anesthesiology resident, two additional L&D nurses to help hold mom's legs back during pushing (McRobert's, I think), another nurse who kept fetching things from outside the room, a med student and me. Twelve of us medical folks! Granted, that was a rare exception, but I've never seen a delivery, especially a section, with only one nurse.

Even when we get them in PP, the charge nurse does the initial baby admission/assessment/bath while another nurse admits mom.

Miranda

suzanne4, RN · Aug 28, 2005

Never just one nurse for mother and baby in a C-section. The patient on the table requires your full attention, and the baby may actually need more than one nurse.

Editorial Team / Admin · Aug 28, 2005

Never just one nurse for mother and baby in a C-section. The patient on the table requires your full attention, and the baby may actually need more than one nurse.

:yeahthat:

Administration could be opening up those malpractice gates.

SmilingBluEyes · Aug 28, 2005

The circulator is just THAT: CIRCULATOR.

THAT IS his/her job in OR during any surgery-----it's a separate and busy enough task ---without attempting to recover a baby......

and what if said newborn goes "bad?"-----

sometimes, it takes several hands to handle an NRP code. The circulator needs to focus on his/her OR task, period.

I agree w/others. That sort of staffing is surely opening up you and your institution for liability you cannot afford---not to mention, patients deserve better.

SmilingBluEyes · Aug 28, 2005

I am not an AORN guru, but I would look there for the standard of care regarding this.

SmilingBluEyes · Aug 28, 2005

Per http://www.aorn.org here are the duties of circulator (sounds as if this is enough to keep this person busy):

Circulator Nurse

The circulator nurse's duties are performed outside the sterile field. The circulator is responsible for managing the nursing care of the patient within the OR and coordinating the needs of the surgical team with other care providers necessary for completion of surgery. Using critical thinking skills, the circulator nurse observes the surgery and the surgical team from a broad perspective and assists the team to create and maintain a safe and comfortable environment for the patient. The circulator nurse assesses the patient's condition before, during, and after the operation to ensure an optimal outcome for the patient. Circulating during surgery is a perioperative nursing function. The role of the circulator may not be delegated to a UAP, Licensed Practice Nurse or Licensed Vocational Nurse.

In the operating room, most patients are anesthetized or sedated and are powerless to make decisions on their own behalf during the intraoperative phase. The circulating nurse serves as the patient advocate while the patient is least able to care for him or herself

I know I am busy as circulator for each csection I do....I can't be counted upon to do a baby too---although if the case is going well, I will sometimes help w/baby if some efforts are needed to get baby stabilized-----but it's not part of my duty do this if I am circulating the csection; that is understood.

Again, refer to AORN for the standard of care. You are held to that standard, whether aware or not.

Editorial Team / Admin · Aug 28, 2005

This is great info, Smilin'!!!!!!!!! :Melody:

BETSRN · Aug 28, 2005

Hello! I am new to the forum and am looking for help. I work at a teaching hospital. We have traditionally had one RN both circulate and do baby care during CS's. This has become more difficult as changes in documentation for both mother and baby have increased. Plus sometimes, an RN can't split herself in 2. I am searching for information about nursing ratios for scheduled and emergent C Sections. Many centers have an RN to circulate and another to care for the baby or babies. What do you do?

One RN to circulate and another for the baby.

BETSRN · Aug 28, 2005

I'm usually in postpartum but I've observed a fair amount of L&D. At our hospital (also a teaching facility), there is never just one nurse for both mom and baby, even for an uncomplicated vag delivery. Babies can go south without much warning. They need someone paying dedicated attention. So do moms. Especially section moms.
Last week, I was watching a difficult vag birth. Mom had pushed for two and a half hours and baby was just shy of +2 for most of it. FHT were good but just beginning to show signs of fatigue. After two unsuccessful attempts to line up forceps, vacuum extraction got baby out (in good shape) in about four pushes. In attendance were baby's dad, grandmother and great-grandmother, along with L&D nurse, attending OB, OB resident, anesthesiologist (epidural needed adjustment several times), baby nurse, on-call pediatrician, anesthesiology resident, two additional L&D nurses to help hold mom's legs back during pushing (McRobert's, I think), another nurse who kept fetching things from outside the room, a med student and me. Twelve of us medical folks! Granted, that was a rare exception, but I've never seen a delivery, especially a section, with only one nurse.
Even when we get them in PP, the charge nurse does the initial baby admission/assessment/bath while another nurse admits mom.
Miranda

You could save a lot of time and man power if the PP nurse admitted BOTH the mother and the baby. There is nothing to it. I work LDRP and we do it as standard of care. It takes no more time to do both than to do one.

rpbear · Aug 28, 2005

We have at least one RN for mom, sometimes more especially if it is a crash section. One L&D RN for baby, plus NICU attends all of our c-sections (one NNP and one RN from NICU). Once baby is fine L&D RN takes baby and dad to recovery, then baby RN leaves once Mom is stable in recovery room and baby is stable.