[tgiorn]

I work in a small rural area hospital that delivers about 600 a year. We have recently changed from a nonprofit to a for profit hospital. With that, we now find staffing becoming a rather large issue. We have separate L&D, nursery and postpartum areas. Postpartum also accepts those with "female" problems/surgeries etc. Our nursery is used for initial observation, bili babies, and prn according to the mother's wishes. We also have a 2 bed NICU that thankfully is only used occasionally. L&D has 5 prepared rooms--meaning that there are 3 rooms not yet set up for delivery. Due to staffing issues, sometimes postpartum is closed and these rooms are used for delivered mothers. In the past, the postpartum unit had 2 nurses per shift--a secretary worked 7-3. Nursery 1-2 nurses per shift depending on census. L&D -2 nurses. We let people be on call as needed.
It seems to me that staffing regulations are generally for larger hospitals. For example, if we have one nurse in the nursery for five babies it is impossible for her to go out and do teaching with the mothers--no one can watch the others. Also, if there was a baby under the bili lights or just a baby that mom wants or needs to remain in the nursery- the nurse can't help with breastfeeding issues/teaching. Also, if there is a baby being born that might need resuscitation-she is trapped in the nursery. Heaven forbid they need to open NICU - in my experience -it has taken 2 nurses with the baby and one "go for" nurse in the early stages.
In L&D they say one nurse for 2 laboring patients--Well in larger hospitals it might mean they have someone who can help during the delivery until everyone is stable. If we leave one nurse with the only laboring patient in L&D, that nurse would be the only nurse. If fetal distress, prolapsed cord or neonatal resuscitation is required--...............Of course that staff is concerned and quite frankly scared.
Today we have one nurse in the nursery with six infants and one mother laboring---one nurse in L&D. The postpartum unit has 12 patients. They pulled the secretary(they count her the same as a nurse). However they did provide them with another nurse since they are scheduled to get 2 new admissions.
My question is-how do you manage to be a pt advocate in these situations? The above situation is an average occurance. I have learned to live with that. However, there have been really questionable decisions made. These decisions are not related to nursing shortages. These are money making decisions. When we see danger signs, what are the appropriate actions to take--how can we make them see that some ratios are not able to be safely carried out in small hospitals? The people in the community are going elsewhere now.
Sorry about the length!

[charlene]

I have learned that any time you want to make change happen, it takes alot of prep and copperation amongthose involved.

Are there other nurses who share your concerns? Could you form a working group to address the issues. You will need to demonstrate working conditions and workloads in similar situations and compare it with your own This of course all has to be done in writing, talking to supervisors etc with anything being written down will accomplishment nothing.

Your group willneed to brainstorm solutions, can't just say more nurses needed.

You can also get input from pts and get their opinions on the care they received while in hosp, frame it as a quality sasisfaction survery, not that you are looking for trouble;

These are just a few potential suggestion and I am sure you can think of more.
Within your group, delegate someone with acool head who speaks wrll to present your concerns to your immediate supervisor. Provide her with a written copy of your info as well as minutesof the meedting with her. Set a timeline of 2 3 weeks, if you have had no action go above her head to the next level.

Seems like alotof work,and it is.But if you want tobe listened to and taken seriously, you have to do properly or else you will just be a bunch of complaining nurses; Remember Cross you t's and dot you i's.

Charlene