The Art of Staffing in Labor & Delivery: A Tool to Quantify Staffing Demands

Purpose for the program: In Labor and Delivery units nationwide, both large and small, staffing to patient needs can be overwhelming. While those on the units know they feel busy, there has been very little "proof" to relay to administration and leadership peers just how busy the unit can become, or how quickly patient acuity fluctuates with little predictability. The WIDOC tool was developed as  a Labor and Delivery acuity tracking tool that quantifies the staffing pressure felt in all Labor and Delivery units. Through use of this tool to track acuity, patient flow and adequacy of staffing, a platform for creating a common ground in communicating the needs of the unit to administartion is created.

Proposed change: Each Labor & Delivery unit strives to not only provide safe and quality care to our patient population, but also provide exceptional delivery experiences for our growing families. We are challenged with finding ways to adequately staff for these events without patients felling like nursing did not have adequate time to provide needed care and desired experiences. The implementation of use of the WIDOC tool allows us L&D units to track patient acuity, patient flow and adequacy of staffing. In additon, staff, fellow leaders and administration need to recieve education to understand the tool, what it measures and what they can do to provide support to the L&D unit in times of need.

Implementation, outcomes and evaluation: The WIDOC tool was developed originally to simply track acuity on a busy L&D unit.  After data collection of the first version and input from staff using the tool, it was expanded to include the element of patient flow to more accurately capture the true state of the unit. We are currently in the process of validating the tool and collecting data following the WIDOC tool revision. In early 2013, we will  evaluate if all information needed to safely staff the unit is included in the WIDOC tool.

Implications for nursing practice: The WIDOC tool gives charge nurses a communication tool to help those outside of L&D understand the current state of the unit and helps leaders and administrators understand measures they can take to assist in turbulent environments. Is addtion, it gives the charge nurse a toll that can be used to predict what the unit acuity will look like at a specified time to be proactive in summoning help as needed. It has also proven useful in management of productivity.

Keywords: staffing, acuity, safety