Background: Staffing to the dynamic volumes of an OB department presents a challenge for staff and leadership. The introduction of the AWHONN Staffing Guidelines further demonstrates the need to respond to patient needs through adequate staffing.  

Our 2 community hospitals 17 miles apart became unified as a healthcare system in 1998. Both hospitals have OB services, 1 a high risk level III with 33 LDRP beds, the other a community hospital with 12 OB beds. Once joined as a system these units were led by a single senior leader. Goals were established to standardize policy and procedures, equipment and workflow. Despite these goals the OB units continue to have unique cultures and great pride in their individual units/hospitals. It was not unusual for these "sister hospitals" to compete for staff.  One hospital could be sending RNs home due to low volume while sister unit had critical needs.

 Framework for the talk: Share our journey to balance staffing across 2 hospital campuses within the same system, through implementation of a cross campus staffing model that responds to changing needs and volume fluctuations.  Spring of 2010 unit managers in both OB units renewed their commitment to professionalism and safety through development of a cross campus staffing model for OB RNs.  Volunteers and new hires were first to orient and participate. The message to RNs: fewer hours lost due to low volumes, enhanced skill development, greater job security and safer patient care. Fall of 2010 cross campus orientation became the standard for all OB RNs.  Clear and consistent messaging from both hospital leadership teams was critical. Identification of champions was necessary, front line RN leaders emerged.

Implications for practice: Development of a a cross campus staffing model provides greater options for staffing OB units in our system, a larger pool of RNs to draw upon for safety in staffing. Hours are more secure for the OB RN staff. In the first 2 months of full cross campus staff (June and July 2011) one hospital realized a 3.5% reduction in cancelled RN hours. Further metrics for success are being established. Our higher acuity RNs are working with colleagues across campus and coaching and skill building is occurring for all involved.  Maintaining and expanding cross campus staffing is making a positive impact upon patient safety, staff satisfaction and fiscal goals for our healthcare system.