time frame ob back up

[janeob]

Hi! I am new to this website and have found it very informative. I need your help. I work in a small, rural hospital that has dropped in deliveries per year. We currently have about 290 deliveries per year which has required management to change our staffing. We used to be staffed 3 nurses per shift but now we have 2 nurses per shift. The problem is this: if only one nurse is needed, the second nurse is on call at home. Some of the nurses live 40-50 minutes from the hospital and they are not required to be in house or within the same time frame as surgery or our ob docs:banghead: I feel this is very unsafe. We are a closed unit so the second nurse only receives minimum wage. Management does not want to put a time frame in place because they fear that those nurses will either retire early or quit. I have e-mailed Lisa Miller and Kathleen Simpson for their input. Any input from you all would be greatly appreciated!!!!

[Elvish, BSN, DNP, RN, NP]

The place where I delivered my son and where I work require nurses to be 30 minutes or less from the hospital. I can understand your concern and hope things work out for the best of all, esp for the safety of your pts.

[zinker35861]

In my opinion there should always be enough nurses on the unit to attend to a STAT C/S and a lady partsl delivery at the same time. Leaving you by yourself is crazy. Two nurses on the unit seems pretty tight as it is. Good Luck working that out.

[babyktchr, BSN, RN]

Yikes. 2 nurses at the barest minimum is prudent here. Being more than 30 mins out is also not a good thing. I wonder what you risk management department has to say about this practice. One thing that always impresses.....would you want your loved one coming into a unit staffed with only ONE nurse and there was an emergency and the closest help was an hour away? I think not. Rural hospital or not, safe care if universal.

[hoppermom3]

We are in pretty much the same boat - small rural hospital, 250 or so deliveries/yr, 1 nurse in house, 1 on call. A couple of our nurses live 45-50 minutes away. Our on call person gets $1.50/hr for being on call. We are not a closed unit though, so often the second can be in house working other depts.

[SmilingBluEyes]

In a really small hospital like yours, it would be prudent to require on-call staff who live further than 30 minutes to be in-house, whether sleeping or floating (if that is required). It is simply not safe otherwise. I used to live 45 minutes from my hospital, a closed OB unit. When on-call, I slept in-house. Simple as that....especially during bad weather times. What would you do if that on-call person could not make it in?

[cassioo, RN]

Sometimes 30 minutes isn't close enough. Do you have a protocol for when to call in the 2nd nurse? Is the house supervisor or somebody able to come and help if needed? If you have 1 in labor and another shows up do you call as soon as you determine they are in labor or do you wait for a 3rd to show up or call when the 2nd is there and say look out or do you do mother/baby and is there a postpartum nurse that is able to come and place a pt on a monitor and get that initial assessment done?

If I was swamped I'd turn off any pit going tell docs too bad or tell them to get up there and monitor their patient and write up anytime you felt there were unsafe condidtions...also keeping track of how many patients you had, when you called for backup and what happened...you hate to see it but it might take something really bad before they change their ways.