What exactly are AWHONN's guidelines for staffing?

Jolie, BSN · Apr 7, 2005

Every hospital I have worked staffs 1:5 couplets. That is 10 assessments and we do 2 assessments/shift. Doesn't matter if they are C-Sections either. We also do antepartums. Discharge teaching takes alittle longer because it involves teaching on 2 and charting on 2. Not to mention a new admit which involves 2.
I am told by staffing that the med/surg nurses only get 5 patients. That is only 5 assessments/shift.
I also find it difficult to pick up trays 3x/day. Back in the day, there were people who picked trays up and had a cart. Now we have to struggle with trying to open up doors to get the trays in the dirty utility room, not to mention that it usually is at the other end of the hall, and sometimes there are 2 trays in the room.

I'm not currently working, so I don't know AWHONN's guidelines, but I have never worked in a mother-baby unit that routinely assigned more than 4 couplets, and that was with a tech who assisted with vs, meal trays, etc. Ideally, we had 3 couplets, which was ideal for teaching, breastfeeding support, etc.

jennobrn01 · Apr 7, 2005

I am 95% sure the recommended ratio is 1:4. Yeah I have been in situations where it was 1:6 and even 1:8 :uhoh21:

stidget99 · Apr 7, 2005

QUOTE: "I am told by staffing that the med/surg nurses only get 5 patients. That is only 5 assessments/shift....." I take offense at this statement!! :angryfire

First of all, rarely do I have only 5 pts. More often than not, I have 7 and 8 pts. I would also like to add that med/surg patients are generally older, sicker and with more of a significant negative health history and can go bad in a manner of minutes. I could go on and on about all of the "bad" things that can (and have) happened, but I won't. From my experience, for the most part (mind you not all of the time), new moms are quite stable. Now the babies are less "stable" because their current health is unknown and understandably so require more attention/close monitoring. I believe that there are more emergent situations on a typical med/surg floor than there is on a typical L&D unit.

I guess what I am trying to say is this.........

Please don't assume that med/surg workers have an easy go of things. We are slamming busy most nites. And I resent the insinuation that we "only get 5 patients". On those rare days that we have just 5, those5 pts can be a breeze but then there are those days (which, by the way, are most days that I work), where "just having 5" can be as trying as having 8 or 10.

I think that each "specialty" w/in the profession has it's ups and downs/pros and cons. I understand that L&D can be very very trying and stressful but so can med/surg, ICU (w/ "only" 2 or 3 pts), psych, ED, or any area of the hospital.

We need to respect each other. And, if you find yourself in an area that you are not comfortable/happy working, then you always have the option of transferring to another unit. I think that the whole concept of being pulled to other units is a great idea. It truly gives us the opportunity to see things from another point of view. I also wish that there was more of a chance for nurses to get "pulled" to other shifts for the same reasoning. But that is another whole issue and I won't go there any further than I already have.

This post is not intended to incite discord amongst nurses. I simply wanted to speak my mind. I do honestly hope that I haven't offended anyone.

camay1221_RN · Apr 8, 2005

QUOTE: "I am told by staffing that the med/surg nurses only get 5 patients. That is only 5 assessments/shift....." I take offense at this statement!! :angryfire
First of all, rarely do I have only 5 pts. More often than not, I have 7 and 8 pts. I would also like to add that med/surg patients are generally older, sicker and with more of a significant negative health history and can go bad in a manner of minutes. I could go on and on about all of the "bad" things that can (and have) happened, but I won't. From my experience, for the most part (mind you not all of the time), new moms are quite stable. Now the babies are less "stable" because their current health is unknown and understandably so require more attention/close monitoring. I believe that there are more emergent situations on a typical med/surg floor than there is on a typical L&D unit.
I guess what I am trying to say is this.........
Please don't assume that med/surg workers have an easy go of things. We are slamming busy most nites. And I resent the insinuation that we "only get 5 patients". On those rare days that we have just 5, those5 pts can be a breeze but then there are those days (which, by the way, are most days that I work), where "just having 5" can be as trying as having 8 or 10.
I think that each "specialty" w/in the profession has it's ups and downs/pros and cons. I understand that L&D can be very very trying and stressful but so can med/surg, ICU (w/ "only" 2 or 3 pts), psych, ED, or any area of the hospital.
We need to respect each other. And, if you find yourself in an area that you are not comfortable/happy working, then you always have the option of transferring to another unit. I think that the whole concept of being pulled to other units is a great idea. It truly gives us the opportunity to see things from another point of view. I also wish that there was more of a chance for nurses to get "pulled" to other shifts for the same reasoning. But that is another whole issue and I won't go there any further than I already have.
This post is not intended to incite discord amongst nurses. I simply wanted to speak my mind. I do honestly hope that I haven't offended anyone.

I don't take offense to your post, but I have to say, having worked postpartum, I know where the poster is coming from. I have also worked med/surg, and IMO, there is no comparison.

What I am getting from the OP is that the mother/baby dyad is only treated as one pt at some institutions and not as two separate pts.therefore, giving an RN up to ten to twelve pts if she is caring for five or six mom/baby couplets. Yes, most moms are stable, but there are also things that should be taken into consideration when staffing an RN to 5 or 6 mom/baby dyads. Who is there to help mom with breastfeeding if she is having problems, who will care for the rest of the mom/baby pts if an RN has a baby 'going bad'. Who is going to do the pt teaching, which is a very large part in caring for mom/baby.

I don't think there was any intent to offend you or anyone else with the OP.

BETSRN · Apr 8, 2005

Every hospital I have worked staffs 1:5 couplets. That is 10 assessments and we do 2 assessments/shift. Doesn't matter if they are C-Sections either. We also do antepartums. Discharge teaching takes alittle longer because it involves teaching on 2 and charting on 2. Not to mention a new admit which involves 2.
I am told by staffing that the med/surg nurses only get 5 patients. That is only 5 assessments/shift.
I also find it difficult to pick up trays 3x/day. Back in the day, there were people who picked trays up and had a cart. Now we have to struggle with trying to open up doors to get the trays in the dirty utility room, not to mention that it usually is at the other end of the hall, and sometimes there are 2 trays in the room.

Why would you need to do an assesment on a well newborn (or mother) more than once a shift?

I would have to say that having done both kinds of nursing, med-surg patients are a lot more complicated than well mothers and newborns.

allevi · Apr 8, 2005

Wow I guess I should consider myself lucky. I work med surg and ob in a small rural hospital. we usually get another nurse back in ob when there is over 2+2, 2 moms and 2 babes. Our laboring moms usually have 1 nurse to 1 laboring mom. If there are any postpartum moms and babes, they should have their own nurse.

We are also lucky on medsurg floor, rarely have over 5-6 patients per nurse, typically more like 3-4. I guess that is what keeps me in my small hospital for now.

RuralNP4KIDS · Apr 8, 2005

Refer to the Guidelines for Perinatal Care 5th edition. This is the accepted national standards for care as developed by ACOG and AAP. Page 24 gives you the staffing standards. Couplets are 1:3-1:4. Keep in mind that if you have 4 couplets thats the max you should be caring for. No antepartums or anything else. Yes it is 8 assessments but if you think about routine postpartum care many of your patients care for themselves (except sections in the first 24 hours). If you are doing true mother baby the moms should be performing most of the infant care. Our role other than assessments is teaching, promoting bonding , and breastfeeding assistance. Med/surg patients have a higher acuity than routine post partum and many of the elderly have difficulty with ambulation and ADLs. The number of medications that med/surg patients receive is much higher that our usual colace and oxycodone. That is just some of the reasons why their ratio is lower.

Don't mean to sound preachy. I have worked both sides of the fence.

webbiedebbie · Apr 8, 2005

stidget99....First of all, I am sorry I offended you. My point with that statement was that the hospital where I work staffs 1:5 for med/surg and that you are only responsible for 5 patients. Granted, you can be very busy with them! I WASN'T ASSUMING THAT YOU HAVE AN EASY GO WITH MED/SURG PATIENTS!! As a patient, myself, on a med/surg unit, I was only seen by my nurse once each shift. I spend more time with my patients, seeing them at least 6-10 times each shift. We have to teach the dads too...they stay in the rooms.

I have to chart on 8-10 patients/shift. PP patients can have medical issues as well. Antepartum patients usually require some monitoring.

I am not saying that I am not happy where I am working. I believe it is a safety issue and that is what I am not happy about. I have always worked OB since I graduated in 1989. No, I don't have the option to transfer to another unit...I have been passed over because I lack "specific experience" in other areas. A nurse once told me that she would rather have a new grad on the unit than someone with other experiences. But, that could be a whole other post.....SO PLEASE DON'T PICK ON ME FOR THAT ONE!

And yes, I KNOW we ALL have major frustrations with our jobs in some manner, whether it be scheduling, coworkers, physicians, etc.

For my original post, I am looking for specific staffing ratios given by AWHONN. I read somewhere that C-sections count as 2, but coworkers don't know either.

BetsRN...This unit's standard is 2 assessments/vitals per shift. I personally don't think it is necessary either, but I must follow the rules.

RuralNP4KIDS · Apr 8, 2005

For my original post, I am looking for specific staffing ratios given by AWHONN. I read somewhere that C-sections count as 2, but coworkers don't know either.

The 1:2 ration you are looking at are patients in postoperative recovery which is interpreted as PACU. So if you work in a place where you do sections in your dept (as opposed to main OR) and they are recovering from anesthesia (you know frequent vitals, etc) it should be 1:2. Those are the same as the surgical standards for OR.

SmilingBluEyes · Apr 8, 2005

Refer to the Guidelines for Perinatal Care 5th edition. This is the accepted national standards for care as developed by ACOG and AAP. Page 24 gives you the staffing standards. Couplets are 1:3-1:4. Keep in mind that if you have 4 couplets thats the max you should be caring for. No antepartums or anything else. Yes it is 8 assessments but if you think about routine postpartum care many of your patients care for themselves (except sections in the first 24 hours). If you are doing true mother baby the moms should be performing most of the infant care. Our role other than assessments is teaching, promoting bonding , and breastfeeding assistance. Med/surg patients have a higher acuity than routine post partum and many of the elderly have difficulty with ambulation and ADLs. The number of medications that med/surg patients receive is much higher that our usual colace and oxycodone. That is just some of the reasons why their ratio is lower.
Don't mean to sound preachy. I have worked both sides of the fence.

I thank you for beating me to it. I recommend anyone having questions about AWHONN standards, including staffing, refer to http://www.awhonn.org and possibly look into membership. Since we are held to that standard of care in the USA, it does behoove us to be members and stay abreast of these things. Also, awareness of AAP and ACOG standards is a must. These should be accessible a the sites of those organizations. Good luck and best wishes to all the nurses here!

(no I not a paid endorser of AWHONN or advertising here just in case anyone wonders)

SmilingBluEyes · Apr 8, 2005

and yes to echo the above:

It's 1:4 for couplets in PP/MBU's as standard.

Since we do a mix, we also do GYN's and Labor patients.

I believe the ratio is 5-6 GYN per nurse, but have to go look.

and the Labor patient-nurse ratio is 1:2 (active/pitocin etc) but even that is very difficult to do at times.

Hope this helps.

Please, let's don't make this an "us versus them" thread about who has it "harder". I would not ever say med-surg is easy, because anyone who has ever been there know it's not. But OB isn't so easy, either. The acuity may differ, but couplets can be MIGHTY needy, and all of them need a LOT of teaching in VERY short time. It's not easy to do nursing, period, in today's litigious environment. Let's respect each others' struggles, ok? We are all nurses.