staffing

[OB Nurtz]

Hi, I'm not a new nurse but I am new to this forum. I'm a labor/delivery and level II nursery nurse. What I would like to hear is how other units staff. We are so understaffed all the time that we border on being unsafe. On my unit we do labor, delivery, level II nursery, we do our own c/sections and of course mother/baby care and numerous outpatients. There is no separate c/section staff, we just drop everything and go, When we have a labor pt, we also have other outpatients, or mother baby couplets, so when we are "pushing" for 3 hours with a patient, our others get neglected, or if we have a stat c/section, we of course are gone for surgery and recovery time. We may have a load of 4 couplets plus have to manage any other labor, preterm, prolapse, etc that walks in the door. Our management wants to staff us at the bare minimum as if there was never a patient who came in in labor. As soon as a patient is delivered, they want to send a nurse home. How are other units staffed? Thanks - OB nurtz

[Thunderwolf, MSN, RN]

Moved thread to OB-GYN Nursing forum.

[rjflyn, ASN, RN]

Personally if one is not comfortable with the situation and management is turning a deaf ear I would be looking for work elsewhere. Seems to me the only way places listen is when we speak with our feet, unfortunately this doesnt seem too work either. There is just to many options for us to put up with this continuous abuse.

Rj

[SmilingBluEyes]

Hi there and welcome to the OB/GYN and Midwifery Forum.

First off, everyone knows the floor you receive report on can be totally different that one you leave at the end of your 12 (or 8) hour shift, so you have to all be flexible and work TOGETHER to get the job done safely. If you have people who are not team players or willing to be flexible, you will have problems, clearly.

Here is how we staff (normally--as you know, the "labor bus" can pull up any minute and upset the apple cart)

Actively laboring patient---esp if pitocin augmentation/induction or epidural: 1:1 or 1 RN to laboring patient and to a stable postpartum couplet, if needed

Healthy, Stable Couplet: 1 RN to 4-5 couplets (max)

Magnesium Sulfate/whether antepartum or postpartum 1 RN to this patient, and perhaps another stable and healthy couplet as we are doing hourly vital signs, I/O and q2 hour neuro checks.

We also have GYN patients (gyn surgical, ectopics, D/C, bladder repair, etc) . IF we can, we do have one nurse to do these, usually 1:4 or max 5 as a rule.

Yes it does get hairy when we have to do a csection, so we try to figure out ahead of time who will "catch" the baby even for a stable labor patient. The Labor RN will be circulator; that is a given. Usually the baby nurse will be the RN on the unit with the lightest load of patients, if at all possible. Naturally, we have our own tech who goes and the Dr lines up his/her own assist. Sometimes, if extremely busy, we have to ask the House Super to come up and answer phones or get the door (we are locked down) if we are doing a csection. This usually is about 30-45 minutes til we get done w/the csection and the patient is returned to her room for PACU recovery. Again, teamwork.

If we have a baby in our Level 2 nursery and a heavy floor of patients, often, this nursery nurse will do the PKU, Vital signs, weights, etc, for all the babies and another nurse will handle moms. We wheel in newborns for their VS, weights, PKU, Hearing screen, Bilirubin checks, etc, for this nurse to do. This will help tremendously for the floor nurses.

You clearly will have to be team players and very flexible. It's always a pain when you get lots of "rule out labor" patients, and triages or you get a couple of labor patients admitted. You have to do some juggling.

We find it works out best when we couple labor care with stable postpartum care, versus one nurse doing two labor patients' care---which AWHONN standards recommend. Or we may give a stable "gynie" to a labor nurse, if her patient is doing ok. You may have to juggle assignments in a given shift. Being flexible is key----but following AWHONN guidelines is not only a "good idea", you really are asking for it if you don't!!!! Check AWHONN and make sure you are staffing the way they recommend it, if in doubt.

Finally if you feel you are constantly "on the edge" or unsafe, you might want to consider NOT working there if you see nothing can be changed. It's not worth your patients' safety or your license to continue in a habitually unsafe OB unit!

[NurseNora, BSN, RN]

Your professional orginazition is your best friend. AWHONN has guidelines for how many patients a nurse may care for depending on their acuity. For instance, active labor should be 2:1, but second stage, delivery and first hour PP should be 1:1. Check the AWHONN standards and document when these guidlines are exceeded. Present this information to your administrator and the hospital risk management staff. If there is a problem and your hospital has been routinely not following AWHONN's staffing guidelines, they'll be in a very uncomfortable position legally.

[OB Nurtz]

Thanks for all your answers. OB is definityely the hard place to staff. We take a lot of "call" in order to have back up. But sometimes its ridiculous, as our staff will be "cut" to the barest, and then they don't want to call in help when the labors start showing up. IT seems to always be a struggle with management. I just wondered if everyone was having the same problems. I have always loved nursing, but can't help feeling nurses are more abused than ever in our modern healthcare environment.