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?

[BELCJ]

I am new to this site, and am looking for information on staffing for c-sections. I noticed there have been no updates since August, so I'm not sure if I post to this same thread, or if I should open a new one. Here goes. I see the responses regarding a circulator and a "baby catcher", but no mention of a "surgery tech".

Our c-section suite is in the OB department and is staffed by OB staff. We currently provide a circulator (RN), a "baby catcher" (RN), and an OB Tech (UC trained as tech) who passes instruments, and then restocks the suite. Now our docs want an RNFA (seperate thread). Other than the 2 RNs, what other staff do you routinely provide?

[SmilingBluEyes]

This is how we staff csections:

We have our own OR suite of 2 rooms, separate from the central OR suites.

We therefore staff our own csections this way:

1 RN to circulate---typically the labor nurse/ patient's assigned RN; this RN will also be responsible for the PACU recovery of the patient in the first hour after coming back from the OR.

1 RN to "catch" baby---she comes in, recovers baby and then goes back to unit when done---she typically has a patient load of her own to go back to, or is working in the nursery, if there are newborns there.

1 CST from our unit

MD arranges his/her own assistant, who may be an RNFA, PA (trained as an assist) or another MD.

We staff EVERY csection this way.

In the rare occasion we have to do csection in Central OR, we are to provide one RN for baby, and sometimes, the Tech, if they can't spare one.

Does this help?

[BELCJ]

Yes, that helps. Thank you for the info.

[NurseFromTexas]

During our C-sections we always have the OB, physician to assist him, CRNA, Circulator, Scrub tech, RN for baby and nurse from SCN. We never have a pedi on-call for deliveries unless for some reason the baby is known to be high risk. I have always thought prior to working in the area a pediatrician would attend all deliveries and C-sections but that isn't the case and they rarely even come to see the baby till the next day if we have no problems with them. I think to be reimbursed they have to see the patient within a certain amount of time after delivery.

[Marie_LPN, RN, LPN, RN]

One to circulate, one for the baby.

What if they both went bad at the same time?? And you're going to divide the nurse's attention? Bad idea!

(What a potential for disaster.)

[Marie_LPN, RN, LPN, RN]

Our typical staffing:

1 anesthesiologist (2 if this is high risk or emergent)

1 OB, sometimes 2 depending on the situation

1 circulator

1 RN or LPN to assist the surgeon (OR staffing)

1 CST to second (OR staff or L and D staff)

Possibly a third scrub

1 pediatrician (sometimes 2 for twins)

1 baby nurse for each baby

[BELCJ]

Your RN or LPN that 'assists' the OB.... Obviously they're not RNFA since you use LPNs too. You provide an assistant and a surgery tech? Just want to make sure I understand. Our docs want us to provide the assistant, but we are fighting it. Thank you for taking the time to answer.

[SmilingBluEyes]

Its for the DOCTORS, not you, to provide for their OWN assistants unless your policy states otherwise. And ours know it, believe me.

[Marie_LPN, RN, LPN, RN]

Our policy states otherwise.

[Marie_LPN, RN, LPN, RN]

Your RN or LPN that 'assists' the OB.... Obviously they're not RNFA since you use LPNs too. You provide an assistant and a surgery tech? Just want to make sure I understand. Our docs want us to provide the assistant, but we are fighting it. Thank you for taking the time to answer.

We provide it, because that's our policy, unless the doc is bringing his own.

I never said they were RNFA. If they were, i would have stated so.

[SmilingBluEyes]

But you are central OR, different world altogether, Marie. In OB things often go differently.

[Marie_LPN, RN, LPN, RN]

Different worlds, same policy for their C-section staffing (in the P and P book, their policy for this is the mirror image of ours, even though one is labled "OR staffing for c-sections" and their is labeled "Maternity Labor and Delivery staffing for c-sections").