Triage

Does your unit allow new nurses to do OB triage?

If not, how do you determine who is assigned to do it?

Thanks in advance for any feedback-

:)

No our unit does not allow new nurses to do triage. New grads have to be on their own for at least 1 year and show good critical thinking, problem solving and calmness in an emergency skills prior to them doing triage. Our unit also doesn't allow travelers to do triage. i'm not quite sure why that is, unless its just because the staff nurses know the doctors better.

Our 3 bed triage "unit" can only be staffed by an RN with at least 1 year experience and at least 6 months of OB experience.

Team leaders who assign RN's to the triage area know who can and can't handle the assignment and try to go with those who are more on the ball in an independent mode.

New nurses who are off orientation ONLY do triage.

New nurses who are off orientation ONLY do triage.

Do you mean that only people who are done with orientation do triage?

Or do you mean they do triage and don't do anything else?

Do they continue to care for triage pts who are admitted or do they turn them over and continue to triage?

If you meant that all they do is triage, is there a rationale for doing it this way?

:)

I mean once off orientation and on their own, only THEN may they do triage. Since we are an LDRP, we do it all, anyhow. Whoever has the lightest load on the floor takes the next rule-out labor/triage case that comes in. We have no set staffing just for triage.

We orient new nurses no less than 6 months on our unit. Being an LDRP, that is the bare minimum time it takes to get them to be able to do everything from antepartum, labor, delivery thru the entire postpartum, well-baby phase. (we also do GYN surgical care). Triage is just one of the things we do in addition to our regular patient load. Generally, the nurses who have only mother-baby couplets take triages. The nurses doing labor patient care keep with that, and take triages or rule-outs only when the others are too busy.

I mean once off orientation and on their own, only THEN may they do triage. Since we are an LDRP, we do it all, anyhow. Whoever has the lightest load on the floor takes the next rule-out labor/triage case that comes in. We have no set staffing just for triage.

We orient new nurses no less than 6 months on our unit. Being an LDRP, that is the bare minimum time it takes to get them to be able to do everything from antepartum, labor, delivery thru the entire postpartum, well-baby phase. (we also do GYN surgical care). Triage is just one of the things we do in addition to our regular patient load. Generally, the nurses who have only mother-baby couplets take triages. The nurses doing labor patient care keep with that, and take triages or rule-outs only when the others are too busy.

Our unit sound like yours (LDRP and the rest), except the labor nurses don't often end up with couplets so we frequently end up with a labor and a triage (if not more!). Ummm... and as you may remember we have a 12 week orientation.

Naturally my unit's volume decided to pick up greatly right when I got hired and staffing/rooms/supplies/everything has not caught up. Supposedly there isn't a traveler or experienced OB nurse in existence on planet Earth that they can get to come... same woes that probably most of you have.

Thanks for the feedback~

I often wonder how true it is when they say they "can't find nurses". Particularly in OB, where as you see here, many people really want to work! Seems to me, when the bonuses and other overtures are offered, they often come out of the woodwork---I have seen nurses recruited from states on the other side of the country, so I know this is true!!!! I have also heard my manager woefully cry about there being "no nurses" as well, but many times, saw no positions posted in our website, nor did I see ads/attempts made at recruitment beyond haunting the local nursing schools. Even nurses in our own hospital were unaware of openings unless we happened to say something to them.

The old saying, "if you build it, they will come" applies to nurses, as well. If you make the position attractive, and invest equally in retention AND recruitment, they (good nurses) WILL COME and they will STAY. But so far, few people doing the hiring seem to care to pay attention to this very fact.

Meantime, you were done a grave disservice as a new grad, being brought on to an LDRP with only 12 weeks' orientation, but we already discussed that. (I was done the same way in my hospital in rural Oklahoma---had 3 whole months' orientation before I was not only on my own as a staff RN, but charge at night, as well----very dangerous thing indeed).

I know you are smart and have risen admirably to the occasion, Mitchsmom. But then, I also know you have a lot of prior knowledge of the birth experience/process, breastfeeding and other issues and are greatly-motivated to be an excellent nurse. It's just a sad fact that all places are not created equally, when it comes to recruitment, retention and orientation of nurses. It really takes a solid 1-2 years (or more) to be fully-competent "on your own" in OB nursing, from my experience and what I have seen in others. And inexperience plus poor staffing can be such a dangerous equation, and not fair to nurses nor patients.

the restrictions we place on triage are due to the logistics of our triage area.

we have a 3 bed triage "unit" that is seperate from our LDRP's and our LDR's and OR's.

our newer RN's can and will triage any pt that is admitted/obs'd to our units, but to be left alone in triage is a little overwhelming for a newby. we had 2 precipitous, RN deliveries in there in the last month.

I often wonder how true it is when they say they "can't find nurses". Particularly in OB, where as you see here, many people really want to work!...

The old saying, "if you build it, they will come" applies to nurses, as well. ...

That's what I tend to think too. There's a place down the road that pays more and I'm sure that's one thing that keeps people going in that direction instead of here (it's too far for me to drive or I'd probably go there - not even for the money part but for other reasons - and I still may, eventually- I just had to have a break after commuting 2 hours to school for 3 years).

...only 12 weeks' orientation ...

yeah, I wish I had choices but in a small area there really aren't any (I can't move)

I was done the same way in my hospital in rural Oklahoma---had 3 whole months' orientation before I was not only on my own as a staff RN, but charge at night, as well----very dangerous thing indeed).

Man, that would be scary. I had one day that it was me and another relatively inexperienced nurse but the manager did stay with us most of the day. I would not continue there if I was put on without other experienced nurses with me.

It's just a sad fact that all places are not created equally, when it comes to recruitment, retention and orientation of nurses. It really takes a solid 1-2 years (or more) to be fully-competent "on your own" in OB nursing, from my experience and what I have seen in others. And inexperience plus poor staffing can be such a dangerous equation, and not fair to nurses nor patients.

I totally agree!

Thanks for "talking" :)

We have a 3 bed triage that has one nurse assigned to do just triage. I believe the thinking is that you have to be off orientation one year before doing triage.

We have a 8 bed triage unit that is staffed by one RN most nights 2 if it is really busy, there are also triage techs that can do a lot, but it still hard having only 1 RN if it is really busy. You have to be "chosen" to do triage by the charge nurses and manager. Usually off orientation for at least 1 year and very confident and capable of handling anythigna and everythign that comes through the door. Not to mention able to deal with the MD's and CNM's with confidence.

We have a 8 bed triage unit that is staffed by one RN most nights 2 if it is really busy, there are also triage techs that can do a lot, but it still hard having only 1 RN if it is really busy. You have to be "chosen" to do triage by the charge nurses and manager. Usually off orientation for at least 1 year and very confident and capable of handling anythigna and everythign that comes through the door. Not to mention able to deal with the MD's and CNM's with confidence.

WOW, that is very unsafe! At what point do they assign the second nurse? Even with two that seems borderline unsafe. The hospital I delivered at was a 5 bed unit and they had two nurses staffing it.

We have a three bed triage unit that is staffed by one nurse and one CNA or ST. You have to at least have two years L&D experience before you can be assginged there. Really the nurses are chosen in the same manner that your facility does it. However, if triage is full we have a nurse on the floor take the patients to L&D to be triaged.

We had a precip vag BREECH delivery in triage just a few weeks ago! I am lunch relief a few days a week in there. Thankfully nothing that exciting had happened in the 30 minutes I sometimes spend there!