[IndigoCarmine]

Originally Posted by djfam

I work in a separate postpartum unit at a unionized hospital in California. We have couplet care; our max is 4 couplets, and most of the time assignments are made within ratios. Our moms have the choice of sending their newborn to the nursery during night shift which is staffed with one nurse assessing and caring for 8 or less newborns.

Lately though, if a nurse has two or more newborns going to nursery then she is assigned another couplet. Management is saying that as long as we aren't over 8 patients total, i.e. 4 mom/4 babies, 5 moms/3 babies, 6 moms/2 babies, etc... then we are still within ratio. I am hoping to get some input on this because it just seems a little funny to me when the state ratio law for just postpartum moms (no babies) is 1:6. I asked about that and was told by management that we are a couplet unit, not just postpartum and are allowed 8 patients total, doesn't matter the mom/baby mix.

Any thoughts on this? Keep in mind, the nursery newborn(s) might be breastfeeding on demand in which case the primary nurse is still responsible for taking baby back and forth, and helping with breastfeeding. Sometimes moms change their minds and/or want baby back half-way thru the night as well, not to mention the hour after the nursery is closed and the primary nurse has full responsibility of all 5 or possibly more couplets, until the next shift comes on.

Hmmm...

When I worked on PP we *definitely* each had upwards of 7 couplets and frequently no tech or aide, and it was reeeaaaaaly difficult. very little teaching going on there. Four sounds like heaven.

That being said, it doesn't really seem right to keep adding couplets to "replace" the newborns that get sent to the nursery. Not at all.

AND it's dang crazy for on-demand babes to be in the nursery at all. Honestly, I don't find that acceptable. Whenever a BF Only mom tried to send her kid to the nursery overnight it was *strongly* discouraged. Basically, it was a no-go. A trip to the nursery overnight was a trip to Similacville. I understand a woman changer her mind and wanting the baby back, and c/s babies spent their first night in the nursery (breastfeeding or not, unless the Mom was intent on having booboo bedside, which was encouraged) but no way for feeding every two hours. What's the point?

For the couplet nurse to have pairs added to her assignment along with babies that she may still be responsible for seems...really irresponsible.

Curious about what others think of it...

[LandDRN]

We follow all AWHONN recommendations except for this one. It is not uncommon to have a labor pt on mag and pit with a second on an insulin gtt and pit on our unit. We are told it is to keep us busy. We have 3 chairs at a nurses station for 7 nurses. We have been told we are not permitted to sit. Which I am 100% for active bedside nursing but sometime in 12 hrs my feet do need a 5 minute rest!

[Italian RN]

Question about the PP ratio:
Antepartum/postpartum:
1:6 antepartum or pp pts without complications
1:2 pts in postoperative recovery
1:3 antepartum or pp pts with complications but stable
1:4 recently born infants & those requiring close observation

is the 1:6 ratio for PP pt's without complications 6 Couplets or 6 moms w/o infants?

I normally have 4 couplets, but lately I have not gone a single shift without 1-2 complicated patients...

[Elvish]

I believe the 6 PP pts refers to 6 moms, not 6 couplets.

[rnrnrn12]

Soooo..........I have a real serious problem that I need some guidance on......it seems our labor and delivery unit has decided to leave the floor with one RN and one technician when we have no patients on the floor. The second RN is put on-call and to respond within 30 minutes. Isn't there a guidance that states the need for "two trained RN's staffed on unit at all times" for a labor and delivery unit? I thought I remembered reading this somewhere?

WOW do I fear the safety of the patients that show up in emergent situations!! Scary!!

What do you think? Can someone point me in the right direction for some AWHONN/ACOG/AAP guidelines or requirements?

Thank you!!

[DirtBikerMomma]

Oh my, I could have written this post. Graduated same time, went to L&D the same time. I have always dreamed of working OB, and it just THRILLED me to finally get there! Orientation was a nightmare and did a thorough job of ruining my selfconfidence. The term "positive reinforcement" must be a foreign concept to those nurses. Had only 3 deliveries under my belt before I was set loose on my own and expected to manage 2 pts. The nightshift nurses were awesome -- how I wish I had oriented with them, then I would have learned something without my selfconfidence being shattered. Dayshift staff were negative, catty, and punitive. I lasted about 18 months. I went back to school to become an RN in my 30s. Of all the jobs I have ever worked, this was the most destructive to me personally. I have learned first hand, "nurses eat their young...and they enjoy every bite!"

[WomenSvcpromoted]

Does anyone have a tool in which they look at the stability of the patient and rate their ratio from that? I understand the AWHONN guidelines but what happens when they aren't a "normal" couplet. I'm looking for a unit that looks at the patient and their medical issues and determines the ratio based on that instead of a blanket statement of 3 couplets per nurse or 4 couplets per nurse.

[ladybugsea]

Dumb question: how do you say AWHONN? Thanks!

[Elvish]

Long-a - wahn. That's as close as I could get.

[ladybugsea]

That's what I thought, thanks! Stress on the A?