I work in a hospital known for HIGH RISK Antepartum and HIGH RISK Postpartum. We deal with patients with high acuity whether its uncontrolled diabetes, Gestational Hypertension, ROM, Post ICU (Post-Partum Hemorrhages), Heparin drips, Insulin drips, Magnesium Sulfate, etc...
I usually do not have no ancillary help, i.e., Unit Secretary or Tech for basic vitals. The ratio is recommended to be 1 RN 4 stable Antepartum patients. When there is a postpartum mom with Gestational hypertension on Magnesium Sulfate, the ratio should be the patient on Magnesium Sulfate and two other stable patients for one nurse. Full assessment needs to be done on the patient on Magnesium Sulfate every hour with strict I/Os.
The issue arises when the postpartum patient comes with a baby. Most of the time the babies need to be watched carefully, due to the mom being on medication before delivery. Not to mention if the baby has high bilirubin, blood sugars, cardiac issues, gaggy, circumcisions or breastfeeding help. We do not have a Nursery on our unit as in years past. The hospital does have a Nursery for admission or any boarder babies.
Our Manager, ANMs, Charge RNs and Hospital Supervisors cannot agree is the baby should count as a patient. The Charge RN states that babies DO NOT COUNT AS A PATIENT. The Hospital Supervisor states that BABIES ARE HALF A PATIENT. I never heard of HALF A PATIENT. Newborn charting is very detailed and time consuming and takes time from a HIGH-RISK NURSE, who is trained for HIGH RISK MOMS.
The hospital does not want to count a baby as a patient so that the nurse can care for more patients with high acuity, which so unsafe. We are a Magnet Hospital and have had meeting with the Director and nothing is done to fix the situation. We have all banded together to speak out for the SAFETY OF OUR PATIENTS but have hit a brick wall.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
I know this is a slightly older post, but I will say the only thing that made our staffing change when it got really dangerous was a nurse going to the Joint Commission with documentation of what her shift looked like. If your workload is blatantly unsafe, JCAHO will come down on your facility with a hammer. I work in a 900+ bed regional referral center and we almost lost accreditation last summer because of staffing issues.
I'm talking a night where one of our sister ICU units had multiple four patient assignments, and filled up the morgue because of inability to properly take care of the patients. Every nurse in my unit had a three patient assignment that night.
Our amount of staff RNs has not changed dramatically, but now we usually have several travelers with us every night. We didn't have any travelers at all before that person went to JCAHO.
Kudos to all of you! Yes, internal memos go nowhere. The paper trail only helps if you have someone to show it to. For organizations with no union or other advocate, Joint Commission is the way to go.
TriciaJ, RN
4,328 Posts
Kudos to all of you! Yes, internal memos go nowhere. The paper trail only helps if you have someone to show it to. For organizations with no union or other advocate, Joint Commission is the way to go.