Unsafe staffing in OB dept

Specialties Ob/Gyn

Published

I've been a long time lurker on this site for nearly 4 years now and this is my 1st post!

I changed from cardiac nursing to OB nursing back in June and have loved every minute of working with these types of patients. I work in a smaller hospital (50 beds) in a rural community (15,000 population). I work the night shift from 7pm - 7am. We are staffed with 2 RN's each shift with an occasional CNA if things are really busy. We are a locked down unit and it's nice to have someone do the extra little things when things are chaotic

Anyways, the last couple weeks have been challenging. We are short staffed (isn't every place these days?) and we are down to 2 RN's and 1 LPN who work nights. There are 6 full-time RN's on days. The position has been open for almost a year, with no applicants in sight yet. We've had travel nurses, but we were told they are trying to do w/o as long as PRN staff is willing to pickup the extra shifts. I've also been picking up extra shifts and taking call, which is helping pay off the tremendous student loans!

It's our unit policy (so it's said, I haven't found the actual hard copy of the policy yet) to have 2 nurses on the floor when we have an active labor patient.

Last Wednesday our unit was closed (no patients) so myself and my co-worker floated up to Med/Surg for the night. At 9:30pm I got a phone call that I had a patient coming in with possible ruptured membranes. I called the House Supervisor (HS) that I would be leaving the floor to return to OB. I also told her that I would notify her if the patient was in fact ruptured and would be admitted.

After the patient arrived it was determined that she would be admitted. She was contracting every 2-3 minutes, water was in fact ruptured and she was 3-4cm. After I called the Dr for orders for admission I called the HS to notify her I would need my co-worker back to help.

I was told "no, she can't come until delivery is imminent"

Ok....so I have to labor this patient, BY MYSELF, for the next 9 hours?? Are you freaking kidding? Heaven help me if the baby crashes or the mom has a complication. I had some words with the HS but I didn't get anywhere.

The next several hours went by, the patient progressed to an 8cm and was comfortable with her epidural. At 3am I called the HS again to let her know I needed help at 5am. We had a repeat c-section coming in that needed prepped (IV, foley, meds, monitoring, assessment, consent, etc) and it would not be possible for me to admit this new patient and continue to monitor my current labor patient. I got crap for asking for help. She told me I was "crazy to be asking for help when we have 19 patients upstairs for 3 nurses and 1 aide." I told her that if my backup nurse wasn't available then I suggested that she come and admit the patient for me. She wasn't happy about it, but she agreed to do it. She showed up at 5am to admit the section patient.

I wasn't happy at ALL when I learned that my backup nurse left the hospital to go home at 6am, leaving me the ONLY OB trained person in the hospital. If they were so busy upstairs, how was it possible she could leave?? I don't get it.

So. Yesterday I spoke with my unit director about that night. She told me "I'm afraid you won't like my answer". She agreed with the HS decision to leave my co-worker upstairs and not have her come back to OB to help out. She stated that "if the floor is that busy upstairs and they are needed an extra person to help out, that's where that person needs to be at that time". As long as she was "in house" it was just peachy that I was laboring this patient solo. She then thought it was silly for her to be "just sitting around" in OB when I was managing the labor patient just fine. There had been no complications with the patient, so my co-worker wouldn't have been all that effective.

Okay...but what happens when the babies heartrate drops? How am I supposed to do all the interventions AND call all the right people for help? Doesn't it make more sense to have that 2nd person on the floor? And I can't possible answer the phone and enter the code for the door (we're a locked down unit) for people coming and going.

I talked with her for an hour about this and she wasn't budging on her stance. And either was I. I told her it was a huge amount of liability on my part, and also on the hospital. I told her I wasn't comfortable with working alone with an active labor patient and I never would be. It's not right. I told her that nobody else in our dept stated that they would work alone with a labor patient, so don't expect me to do it. I've had 7 months of OB experience for heavens sake!! Is she crazy??

So, since I wasn't happy with yesterday's meeting I made an appointment with the VP of Nursing for this morning.

She, thankfully, understands where I'm coming from and agrees that this is not approapriate, nor is it safe practice. She is appalled that my boss is "okay" with this and told me that she would be discussing this situation with her today. She told me if it happens again in the next week, that I'm to call my boss at home, and if I don't get anywhere with my boss, I can call her at home to interven.

I'm documenting everything that has taken place. I'm not going to leave this situation alone until things change. I will not be put in situation where I could risk losing my license. If things don't change, I will not continue to work there. I hate to leave because I really do like it there, but it's too much liability for me. Or for anyone. I've talked to my other co-workers and not one of them said they would be comfortable in this situation.

So, hopefully after today, things will change.

What is your opinion on this matter. Have you been in similar situations? I'm hoping things will change, but if they don't, I'm prepared to find another job. I'm not willing to risk my license for this place.

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Specializes in Nurse Manager, Labor and Delivery.

Oh my word. You poor thing. I can't understand at all the mind set of a facility, to be THEMSELVES at risk for this. It would be a non-defendable thing if something did go wrong. Negligence..no question. What you need to do is make sure that your complaint is filed with the risk manager. I hope you documented that you called the supervisor that you wanted your staff back and she refused. This will establish that you did initiate a chain of command...though you probably should've called your nurse manager to intervene and get you a nurse. Never should you be alone with any labor patient. NEVER NEVER NEVER. I am not sure your speaking to the higher ups will help, but it will make you feel better to get your mind spoken.

I agree with you...don't risk your license for this nonsense. Short staffing is one thing..dangerous is another. If you don't get answers and change..I would definitely look for another job.

Sorry this happened to you. This is the nonsense that makes our job hateful.

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So I have question about documentation. Is it right to document in the patient's chart about the unsafe staffing and that the HS was notified, along with their response?? I wanted to include that in my labor notes, but didn't know if I'd get in huge trouble for doing so. I've never been faced with situation, so this is the 1st time this has come up.

I haven't filed a report with Risk Mgt, but I will now. At least then, maybe they'll realize just how serious I am on the matter.

I'm glad to know I'm not alone in my thoughts on this subject. Thanks for your reply!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Your coworkers and nurse manager need to bone up on safe practices/staffing in OB, if they feel this was a comfortable staffing situation. Mainly the part about there being TWO NRP trained staff for each delivery. Your patient was 8 and could have delivered imminently---clear violation. Never can we have less than 2 RNs who are NRP and labor-trained where I am whether there are zero OB pts or not. And the fact the supe let that nurse go at 6---BIG PROBLEM.

Also, what if an even more emergent situation presented while your patient was active, receiving her epidural or in delivery?

There is so much wrong with this situation, it's crazy. Your instincts are right-on. You Must be sure you document each and every detail, names, times etc in your occurence/incident report...and....

Make sure this very clear and concise incident report is sent to your manager, the specific patient's OB, the OB Chief of Staff, and Risk manager. And if this happens again, write it up again, and go through with your plan to quit.

You are 100% right; this was unsafe and did not meet standards of safe practice for OB.

((((warm hugs)))) I feel for you. You want to do the right thing. You and your pts deserve better. It's not easy taking a stand as a new nurse; I had a doctor tell me he would have my job for writing him up 6 month's out of graduation. But I did the right thing and the situation was rectified. Had it not been, he could have HAD my job, as far as I was concerned. Safe practice is not negotiable.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

NEVER , EVER chart unsafe staffing situation specifics on patient charts. If there is a problem affecting safe care of pt, you can chart "Dr XYZ" or House Supervisor, Nurse XYZ notified, no orders received" and that is about it. You save the information regarding unsafe staffing and the lack of action by the supervisor for the incident/occurence report. I repeat, NEVER chart these things in the patient chart; you open up yourself and the hospital for a law suit doing so.

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That's what I was thinking, but I wanted to be 100% sure. I keep very detailed notes on my "brain sheet" so luckily for me I have all the times I notified everyone of the situation.

I will use the info in my report to RM though.

Thank you for your support on this matter! :)

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Specializes in LTC, Home Health, L&D, Nsy, PP.

I don't really have any words of wisdom for you, but I will tell you that I have walked in your shoes many times. My co-workers and I have talked to management until we are blue in the faces, to no avail.

I have nothing against med-sug, have worked it many times and admire those who work there greatly, but I have problems with getting my second nurse pulled there to take patients (not just be a runner) so they could have 3 or four patients a piece when I am left with a laboring pt, a recovering pt, and a triage who wound up being a mag pt.

I think a lot of our problem comes from management who has never had OB experience. They don't grasp the concept that we are not responsible for one pt, but for two with each admission. They have never seen how quickly these pts can crash. For the most part they view L&D as the "happy" place. They put pressure on our immediate manager, who lost her job as manager once before for being "too employee friendly", and is so afraid of losing it again that she will jump through hoops for the higher-ups.

One member of our hospital administration used to be the L&D head nurse. When she was in our dept, she constantly fought against us being pulled to other areas, now she is one of the main people saying that unless there are more than two laboring pts and one triage, we should be fine alone. She even called us the "vacation station" in front of a couple of our nurses.

I love L&D and even tried working at another hospital, but got the same old stuff there, so I just came back to the hospital I had been at originally because at least I had been there long enough to be comfortable with the OB/GYN's. I'm still trying to decide what to do. It's not like I'm totally alone. Nsy and PP are just down the hall and I can scream to them for help if all else fails and I know them well enough to know that they will come running, but still it would be awesome to feel some support for what I do from management.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

In 10 years' practice working 4 different places, I see it clearly: OB is often disrespected and misunderstood by nurse managers and house supervisors. It's not easy being in our situation. All we can do is consistently write up unsafe staffing situations and practices when we see them. It may cost us our jobs, but then again, at least leaving with an intact license and clear conscience would be a consolation.

It helps if you can get the OB drs and midwives in your corner regarding safe staffing practices. Sometimes this gets results.

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I totally sympathize with you. Thank God the VP is on your side. Kudos to you for speaking up. What would the supv. have done if a pt. came in fully and pushing as the first pt. was delivering and the second ob nurse had gone home? What if the patient's cord had prolapsed while you were alone on the floor w/ her? What if a pt. got up to br and started to deliver in the toilet when you were by yourself? These are all possible scenarios. I worked nights for nine years in a smallish hospital 650 deliveries/yr. We always had 2 nurses on the floor ALWAYS. We do not take assignments on other units, but function esentially as nursing asistants. You shouldn't write it in the chart, but you should write a written summary of your problems and the solutions presented to you. Keep a copy for yourself and put one on file w/ your director. If there is no follow through that this NEVER happens again, let your feet do the talking! Good Luck!!!

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Specializes in Babies, peds, pain management.

I used to work in a small hospital and they had the policy that if there were no OB/PP/NSY pts, that everyone was "on call" (must get there in 30 mins) and 1 nurse was left to sit/help in ER until a pt came in (all pts came in thru ER at night). A pt did come in and everyone was called to come in (2 more nurses).

The problem was the pt began seizing before anyone else came in (how rude!!).

It was several minutes until the nurse could get to the phone to call for help.

After that, there were always 2 nurses on the unit at all times.

Ya know, "outsiders" think there is nothing to caring for a laboring pt (or her newborn) but just ask them to help..."I don't know nuthin' about birthin' no babies" is the standard (trying to be cute) answer.

Such is life!

Bravo for standing up for yourself and the other nurses this could happen to

as well.

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Specializes in LTC, Home Health, L&D, Nsy, PP.

..."I don't know nuthin' about birthin' no babies"

If I had a dollar for every time I heard this ...:cool:

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Specializes in L&D.

Stick to your guns, it was an unsafe situation. The only thing I can add is that the second person that night did not have to be a nurse. I can see why the supervisor didn't want to to send you a second nurse to care for one patient when there were M/S patients needing nursing care. But she could have sent an aide, or secretary, even a housekeeper! Just so there's a second person there to call for help while you're busy bagging your patient (I've seen epidurals go high), or repositioning to do untrauterine resusitation, or delivering the multip who just walked in pushing!

Most of the time they can get away with making bad decisions like that because most of the time nothing bad happens, so each time it's easier to decide to short OB again. Until the one time there is a bad outcome. Then your hospital will be out millions. Nothing makes a jury open the purse strings wider than someone bringing a damaged child into court. It's a shame, but the fear of financial liability often carries the most weight with the administration.

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