What is appropriate nurse to patient ratio in stage 2 of labor?

[MVgal]

I live in Pa, and even though AWHONN recommends a nurse ratio of 1:1 in stage 2 of labor, my nurse manager insists that we are expected to stay at a 1:2 ratio, that we should be able to "handle it". I've been in L & D for almost 1 1/2 years now, but don't understand how to allow a pt who is complete to push on her own, and yet be expected to accurately examine and assess a walk in pt who claims to have ruptured membranes, or be in labor, and since this second pt WAS in labor, I also needed to start an IV, and begin external fetal monitoring. We do not have central monitoring, so i jumped from room to room, but insisted that another nurse assist me with the second pt, my nurse manager was not very supportive, even after i showed her AWHONN recommendations, she insisted that PA, had other guidelines that were acceptable. My nurse manager is overall very supportive of us, and I get along with her very well, but don't understand her reasoning on this issue, can anyone out there give me some advice???????

[babyktchr, BSN, RN]

AWHONN states 1:1 ratio....period. I wonder what rationale your manager has for this and what steps she is prepared to take to stand behind this position when something bad happens. When you are in pushing with someone, another nurse should be taking care of your other labor patient.

[ukstudent]

You went to your manager, now it's time to talk to risk management. Ask risk management what they think about your hospital not following national standards of care. The potential risk your managers desicion is putting the hospital in should be of concern to them.

[tammy777]

It can't be done accurately or safely... AWHONN states 1:1 ratio....period... letting your pt push on her own while you go eval another pt??? ugh, your nurse manager is nuts to even imply that is safe... You are right my dear... 1:1...

[hippienurse]

There is no way it is safe to have a pt pushing on her own. At our hospital we are always at a 1:1 ratio unless they are very early cervical ripening inductions!!! Everything else we watch one on one. I can see possible taking 2 if needed, depending on where they were in their labor, but 2nd stage? NO WAY! That is just WRONG. You are putting your license on the line by doing it. I would refuse to do it and go up the chain of command as this is a major safety risk for your patients.

[babyktchr, BSN, RN]

Even in the advent of central monitoring, you still have to evaluate your patient...not just watch a monitor. There should be no reason why you should leave a pushing patient (unless you have someone come in the room while you leave). This is disturbing to me that your manager takes this position. I think it may be a good thing to talk to your risk department and see if they are aware of this practice.

[SmilingBluEyes]

Appropriate monitoring of patients in pushing and epidural placement phases of labor IS one to one. I agree with the others; talk with risk mgt about this situation. Staffing appropriately is critical to safety in OB.