Texas law concerning staffing in newborn nursery

[phillipians413]

i am a long time lvn and a student in the rn program. i have been working in a newborn nursery for 6 months. i know there is much discussion these days about staffing ratios. our hospital ratio is 1:8 in the nb nursery. that would be ok if we took care of the same babies throughout the shift, but it doesn't work out that way. on a recent day, i started with 8 babies. 2 had to be taken to xray in transporters for hip sonograms 1 had a cardiac consult ordered (i had to do an ekg, bp's x 4, arrange to have the baby there for chest xray and echo). i had 5 discharges and 4 newborn admissions. both the discharges and the admissions require a lot of teaching. we have to make sure we have the amount of each feeding and all wet and dirty diapers logged on the flow sheet which means lots of calls or trips to the rooms. each baby taken off the warmer needs a 1 hour temp after being placed in the open crib. there are also the moms who need help with breastfeeding, the poor bottle feeders, the babies who get cold and have to be put back under the warmers, and on and on and on. how can this be safe practice?

in researching for a school assignment, i found texas hb 1707. the following is from this bill:

sec. 241.257. minimum nurse staffing levels. (a) each

hospital shall have on duty at all times at least one direct care

registered nurse for each:

(1) patient care unit in the hospital;

(2) operating room to serve as circulating nurse who

is not otherwise assisting with the surgery;

(3) emergency department to triage a patient when the

patient arrives in the emergency department;

(4) two patients in a critical care unit, including an

intensive care unit, burn center, coronary care unit, or acute

respiratory unit that provides care to patients who require:

(a) continuous monitoring;

(b) complex nursing interventions;

© direct observation by a direct care

registered nurse;

(d) intensive assessment or evaluation; or

(e) specialized education for the patient or the

patient's family or representative;

(5) two patients in a newborn intensive care unit;

(6) patient who is in active labor or has medical or

obstetrical complications;

(7) patient who is undergoing cesarean delivery or for

whom epidural anesthesia is being initiated;

(8) three antepartum patients who are not in active

labor;

(9) three mother-baby couplets in a postpartum area of

the perinatal service, not to exceed six patients for each direct

care registered nurse in the event of a multiple birth;

(10) four mothers on a postpartum service for a direct

care registered nurse assigned to mothers only;

(11) five well babies in a nursery;

(12) newborn who is undergoing resuscitation or who

the direct care registered nurse determines is unstable;

(13) four recently born infants;

our manager says nann guidelines are 1:8. we live in texas. how can they get away with this?

[Jolie, BSN]

I applaud you for doing your homework and discovering your manager's lack of compliance with state law (which, of course, supersedes a professional organization's guidelines.) I suggest you direct your questions to the Board of Nursing.

Please keep us posted!

[babyktchr, BSN, RN]

If you look at the AWHONN guidelines for staffing (which is posted on the front page of the OB section of these posts) you will see that the they say 6-8 babies receiving well newborn care. This is for traditional nursery set-ups, NOT mom baby couplet care. It does lessen if there are more complicated care required. This is EXACTLY why we went to mom/baby care. Nothing was being done as far as teaching etc. when you are taking care of 6-8 (often more) newborns. I am in awe that your STATE has mandated staffing ratios for patients, especially newborns. You have a few options. You can go to her with this information, AND have working ideas on how to get to this standard, or go to your risk management department and discuss this. It is obvious if there is documented ratios in a state bill, then I would assume you are held to that. Remember though, the AWHONN standard is also clear, so your manager wasn't so out of the ballpark.....and you could end up right where you started. As Jolie said, law supersede guidelines, but she could just reference AWHONN and you are nowhere. Also make sure that that bill is passed, and is currently being utitillized (you know those loopholes can be pesky).

Good luck to you!!!!!!!