The Pipeline to Labor and Delivery

Pipeline to Labor and Delivery

In late 2003, converging forces resulted in a severe shortage of labor nurses at Pomona Valley Hospital Medical Center (PVHMC) in Southern California.  This community hospital had experienced a divisive unionization battle, an exodus of experienced nurses, and a drastic climb in patient volume for Women’s Services.  From the new grad pool of local nursing programs utilizing PVHMC for clinical experience in OB care, only two nurses joined the staff.  It was impossible to fill empty positions with quality nurses willing to make long-term commitments to the hospital.  Staffing for the 90 bed Labor Delivery Recovery Post-partum unit fluctuated between 20 and 25 per shift, with 12 to 15 of our own nurses, up to 7 travelers and 3-5 daily registry nurses.   

A fresh solution strategy proposed adequate training and support could retain current experienced nurses and attract increasing numbers of new nurses.  We determined to “grow our own” labor nurses.  A unit-specific didactic and mentoring preceptor program offered $1000 in preceptor pay at proscribed intervals following completion of documented milestones for both new grads and labor specialty training.  New grads were hired and trained to work as post-partum nurses for least six months before entering labor training.   An informal contract was developed highlighting the resources committed by the hospital for labor training.  In return for their training, they signed an agreement to work as fulltime labor nurses for at least one year following training.  This innovation lessened attrition rates and added preceptor satisfaction.  We began to call our program “The Pipeline to Labor and Delivery.”  

By 2007, the word was out that PVHMC had a superior new grad program and was training nurses to work in labor and delivery.  For the first time applicants were turned away and we hired twenty superior candidates.  Now totaling 72 hours didactic and 360 hours precepted clinical experience, one success of the program is our first group of labor trainers has enough depth of experience to become preceptors themselves.   It is extremely gratifying to watch these bright young women gain the confidence to train newer nurses.  

Our growing volume demonstrates the need for ongoing training.  In 2004, 189 FTEs covered 17,954 inpatient days resulting in 6,683 deliveries.  In 2006 the FTEs grew to 225 caring for 19,285 inpatient days, yielding 7,855 deliveries.  Current staffing patterns require 40-45 nurses per shift including 15 to 20 labor trained nurses.  

Success depended on financial and motivational support from the Director of Women’s Services.  Training program costs averaged $13,000/nurse.  When added to the following year’s salary, a total of $69,000 is expended for the first year’s salary of a new labor nurse.  This compares favorably to the $131,000 annual expenditure for a contracted traveling nurse.  This program is of interest to hospitals experiencing shortages of qualified, competent labor nurses.   We’ve eliminated chronic staffing shortages buoyed with expensive contract workers by offering adequate mentoring for preceptors, superior educational programs and ongoing staff development of interest to maternal-child nurses.