Things have been super busy/crazy/insane at work these last several months (welcome results of winter "coziness"!) and it has led us night shift people to think about our staffing situation. I'm asking for your advice/input/ideas!! My question is...how are you staffed on your units? What have you found that works best and what doesn't? How do you handle putting nurses on call? Any suggestions would be MORE than appreciated!!
A little bit about our unit...
We are a 17-bed L&D unit for both labor/delivery and antepartum. We average between 320-340 deliveries a month during most of the year, closer to 300-320 during the winter. We don't have a separate antepartum unit/rooms nor a triage area. We have 17 rooms that we use for all of the above. We triage/labor/deliver then after 2hr recovery move patients to postpartum.
We have 2 OR's and then 4 separate PACU rooms for our 2hr C/S recoveries before we move them to postpartum. Our L&D nurses do both vag and C/S deliveries, and then we are are the ones who are responsible for moving them to postpartm (a good 30minute process). Unless we have to we don't usually have both a C/S recovery and triages out on the floor. If we take a C/S back we're "in the back" until that recovery is over.
We have NICU nurses staffed in our well-baby nursery and the NICU "admit" nurse comes to all our deliveries to catch our babies.
We have one charge nurse who is over L&D/postpartum/NICU and our Women's & Children's unit (usually an extension of M/B but can also take GYN surgeries/peds patients). The charge nurse doesn't do patient care.
We are usually staffed 4:1 antepartums, 2:1 or more often 3:1 labor patients and whoever can handle it takes the next patient that walks through the door. If we have Mag patients we are usually 2:1 as along as they're somewhat stable, sometimes have a mag patient + a labor or something else.
Our L&D nurses can all float to mom/baby and if we're OK on labor and M/B is short then we get floated. None of the M/B or NICU nurses float to L&D.
Our core staffing is minimum of 3RN's. Most of the time we're staffed with 4-5RN's/night. If we're lucky we'll have 6 or 7. We usually have 2-3 scheduled cervidils on the weeknights plus a 0730 C/S that comes @ 0530. Day shift usually brings in between 10-12 RN's. If the day charge nurse thinks we are overstaffed for the night shift someone (rotates by dates or requests) is put "on call." If we need the "on call" person during the shift they have to be there within 30min of being called. If you get "called in" before the shift is half over (0100) it's time-and-a-half 'till 0100, and if you come in extra it's time-and-a-half.