Staffing ratios for C Sections

[KRoman4]

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?

[RNmommy]

One circulating RN for mom. The ALS team stabilizes the baby, lets it meet mom and transports it to the well baby nursery, where the nursery nurse performs the admission assessment and bathes the baby while the section is closed.

Our ALS team also attends any high risk, preterm or operative lady partsl deliveries.

[rn/writer, RN]

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.

Our hospital is LDR and then moms and (distress-free) babies are transferred to PP. In LDR, there is an initial post-birth assessment of both patients. Vag moms sometimes have epis or lac repairs and then they try to breast feed. We get them (via wheelchair) in about an hour. Section moms come up (via gurney) in two hours.

The receiving nurse helps mom get settled in bed, takes V/S, does thorough assessment, checks PCA (for sections), IVs and Foley, orients mom to room, goes over pain management options, finds out if mom needs to eat, explains baby security system, and starts the information portion of informed consent (for hearing screen, Hep B, etc.). Meanwhile, the charge nurse takes admission vitals, does a very detailed head-to-toe assessment on baby, gives the first bath (hair can take a while), gives Vitamin K shot, puts security band on and bundles kiddo. If mom is at all recpetive, the charge nurse explains the various things she is doing. Each patient receives unhurried (but still efficient) individual care. Once the charge nurse charts on baby admit, the other nurse cares for mom and baby.

I like this system. Neither patient has to wait while the other one is being seen to. Perhaps with LDRP it's different, but we are meeting both patients for the first time and haven't yet had a chance to establish a relationship with mom/significant others and she hasn't had time to acclimate herself to the room or to us.

Another benefit of having two nurses is that often one of us will ask for a second opinion on something. A couple of days ago, the charge nurse ask me to check hips and I felt the same click she did. I've learned much from watching nurses with many years of experience do the baby admits.

Miranda

[gypsyatheart]

One RN to circulate and another for the baby.

Ditto! :yeahthat:

[fourbirds4me]

One for Mom... one for baby. Although if baby needs rescuscition the circulator will help and or call for more help as needed. ACOG/AAP staffing guidelines call for 1:1 care for mom and baby in c/s.

[kajama]

there are AWHONN and ACOG guide lines and standards Of practice............Can't do both .........In our Facilty they want the circulator to care for the baby once "stable" no............... My concern as the circulator is the mom on the table it is my room.......I have to have eyes all over and listen to everything that is going on.......can't keep an eye on a baby too. Especially at birth I can't give my attention to the baby........sooooo many what if's...

We as Nurses have to stand up for ourselves and our patients.Our license is at stake.........at all times............... Hope this helps ........Good Luck......

[sirI, MSN, APRN, NP]

there are AWHONN and ACOG guide lines and standards Of practice............Can't do both .........In our Facilty they want the circulator to care for the baby once "stable" no............... My concern as the circulator is the mom on the table it is my room.......I have to have eyes all over and listen to everything that is going on.......can't keep an eye on a baby too. Especially at birth I can't give my attention to the baby........sooooo many what if's...

We as Nurses have to stand up for ourselves and our patients.Our license is at stake.........at all times............... Hope this helps ........Good Luck......

The physicians adhere to ACOG and the nurses to AWHONN, with a blending of both worlds.

[SmilingBluEyes]

but the entity which people seem to forget is AORN. We are held to their standard, in the OR, as well.

[sirI, MSN, APRN, NP]

but the entity which people seem to forget is AORN. We are held to their standard, in the OR, as well.

Again, you are correct, Smilin' :wink2:

[asher315]

At our place, we have 2 people for the baby at ALL c/sections. It may be 2 RNs,

RN and special LPNs, RN and Peds or RN and RT, but their only focus is that baby! The circulator does just that, oversees everything and calls for more help if needed. With vag deliveries, there is usually 1 L&D RN for mom and 1 Nsy or PP nurse (RN or LPN) for baby, unless there are possible complications. I believe for atleast the first hour of its life, a baby deserves his/her own nurse!

Sherry T

[kajama]

I ment in can't do both as in both Circulate and baby catch.......I beleive ARON and AWHONN standards do both work along with ACOG as should nurses and doctors............Just get going when Nurses are being pulled to tomany directions ........................... :)

[RNnL&D]

Just as others have said, our Circulator circulates only.

[ObNurse05]

Once the Drs begin to cut mom, we beep the nursery and they attend to the baby *usually 2 nurses for baby* besides the circulator, there is usually another RN, resident, anesthesiologist and resident....