unsafe staffing in LDRP

htrn · Aug 7, 2006

Unsafe staffing??? How about insane, crazy, oh my God!! understaffing!! I know I am lucky where I work with the staffing we have, but I have never heard of anything so dangerous. We have, bare minimum, one nurse for up to two active labor patients that have no complications - but really work hard to have 1:1 in active labor. We usually have one PP nurse and a CNA for up to 8 PP patients, and 1 nurse for up to 4-5 healthy newborns in the nursery. The worst I have had it on nocs is me and a CNA with 8 PP and 1-2 labor patients - and most of the time the off going shift will stay and get the 8 PP assessments done for me.

SmilingBluEyes · Aug 8, 2006

http://www.awhonn.org

staffing levels by acuity discussed there. Check it out.

fergus51 · Aug 8, 2006

5 nurses....

4 active labors takes 2 nurses getting 2 of the active patients each.

12 postpartum couplets takes 3 nurses getting 4 couplets each.

The charge is still free to help with the active laboring patients.

That's standard staffing in many hospitals. How did your unit divide up the assignments?

I see that you're in Canada. When I worked there active laboring women were 1:1s. It's the main reason I don't do L&D now that I live in the US.

tntrn, ASN, RN · Aug 8, 2006

In our unit, all of the labor patients would be on pitocin, there all would be

1:1. 1 rn for 4 couplets; the OB tech would be present; charge nurse to run the show; and a triage queen. I'd be screaming loudly there. And we do about 900-1100 deliveries a year.

nursie-babie, ASN, RN · Aug 8, 2006

Been there done that...only worse. Your staffing actually seemed pretty good! LOL! I came from a small (30 deliveries a month) rural hospital. We had 3 ldr, 5 pp rooms and 4 rooms for gyn surgeries, peds, med surg over flows, or whatever they needed room for. Typically we had 2 nurses scheduled..one LD & one PP/NN. If we were busy and lucky they might float us a med surg nurse in. One night we started with a 6 hr post fetal demise (and a lot of drama going on with it) and a couplet. 2 nurses, not bad. @ 2100 get a 12 y/o post surgical repair of tib/fib fx, q 1 hr neuro checks, etc. @ 2215 get a 6 y/o 4 dyas post op T & A, had to have surgery to stop excessive bleeding. Now going to get 2 units of blood post op. @ 0045 got a drop in no prenantal care 3/100/-1, bloody show, ctx q 3 min. Then @ 0115 6 monther, c/o vag bleeding. Pushing drop in @ 0230, ER calls, 26 weeker hasn't felt baby move today. Now remember I am the ONLY labor nurse in the building, and there is only one other nurse on this floor(the house sup does come to help out) Finally deliver drop in @ 0315, but now we have to do cbc/blood cultures on baby due to unknown GBS status of mom. Othere to antepartums are fine, thank goodness. But we still have our 2 peds(1 getting blood trfx, one with q 1 hr neuro checks), one couplet, one pp fetal demise(understandably needy) fresh svd, newborn in recovery, and 2 antepartums. And unfortunately this shift isn't that unordinary. Guess you can see why I am no longer there(or even in L&D for that matter!)? :madface:

RNLaborNurse4U · Aug 9, 2006

I work in an LDR (separate PP/newborn unit on another floor) that contains 14 LDR beds, 3 triage beds, 2 OR's for C/S (or other emergent OB surgeries like rescue cerclage, D&E for retained placenta, emergency hyster, etc), and a 4 bay PACU/triage overflow area.

We usually staff with 9-11 RN's on days, 7-9 RN's on eves, 6-7 RN's on nights. We do a very large number of outpatient testing and prostaglandin gels during the day, plus we have our usual 3-4 scheduled c/s during the day. Add in spontaneous labor pts, unschedule c/s for fetal distress/labor/etc, inpatient antepartum (unstable) and postpartum magnesium sulfate pts, r/o labor, r/o uti, r/o ptl, r/o preeclampsia, and a host of other r/o or treatments (please folks, just because you have the stomach flu and are pregnant, does not mean you need to automatically be in OB!).

We also do everything for our c/s - circulate, baby nurse, scrub nurse (or scrub OB tech if we have one on that day), recovery nurse (who also does baby care during the c/s).

We usually have 5000+ deliveries per year, and countless other outpatient visits.

Our staffing, depending on how full we are, and is usually 1-2 active labor patients per nurse. One nurse can do 2 or even 3 ante/post mag sulfate pts. One nurse to 2-3 outpatients.

Some days it's total chaos - all beds full - laboring pts still coming in by the busload - pts being sent up from the ER - pts being sent in from the office (or from home if it's after office hours) for r/o this or that. Days that it gets like that, we pack them into the PACU, where we have some EFM monitors to at least monitor them. Other times, it's so full at the seams, that we have women waiting/laboring in the waiting room, and we truly take them by a triage type of fashion (sorry, can't take the early labor fullterm patient before the 25 weeker who is bleeding and cramping, even if the FT patient came in first and was waiting longer).

We are pressed to get our normal delivered pts up to PP ASAP (an hour after delivery, versus our normal 1.5-2 hrs). The charge nurse herself usually has 2-3 pts, AND has to manage the whole floor.

I have written the situation up when patient care has been compromised, but we all try our best to make sure it doesn't get to that point.

Thankfully, it's not always so busy and chaotic. Much of the chaos is from dayshift - the scheduled c/s and inductions, NST's, etc. It *usually* calms down towards the end of evening shift, into the night - but not always. Hats off to the night shift staff who sometimes work with only 5-6 nurses, and a full unit (been there, done that, got off night shift due to my inability to cope with sleep deprivation).

eden · Aug 17, 2006

No it's not privately funded.

nurseglad · Aug 17, 2006

No it's not privately funded, I'm in Canada so it's universal health care here.

Speaks volumes about publicly funded hospitals doesn't it

eden · Aug 17, 2006

I know the system has it's kinks but I think it's a good one, mostly. It just gets overwhelming and I worry for the patients.

SmilingBluEyes · Aug 18, 2006

WE cannot generalize here. I know of many for-profit hospitals in the USA that staff dangerously as well.

3years · Nov 27, 2008

I also have concerns about the staffing where I work. We are an LDRP, Triage, ante-partum, level 2 nursery and a peds unit. We do everything. Most of our staff is not very experienced, myself being one of the more experienced nurses and I only have a little over 3 yrs experience. I am a charge nurse and we will usually have 2 other nurses on at night and 3 other nurses on days. it is a small hospital delivering only about 50-60 /month. For instance we had 2 staff nurses incl myself on and 1 orientee, me being the most experienced, there was an postpartum Mag pt who delivered that day with PPH, 1 postpartum couplet stable, 1 post partum couplet delivered that day by c-section d/t placental abruption, triage pts and a pt comes in 7 cm, myself and orientee covered the c/s, triage and then took the laboring pt. then the baby had to go to nursery for short time, I was in nursery while 1 nurse and 1 orientee nurse (on floor for about 1 week, out of nursing school) were covering Mag, 2 PP, triage. I may be crazy but this to me is unsafe. We also have nights were you throw in a post op peds, peds pt on an LDRP floor when there may or may not be someone on call. I have addressed issues with the leadership but I have in turn been told that I underestimate myself and that you cant staff for what ifs . Again I am fairly new to this , if anyone has advice please let me know. thanks