[cherokeesummer]

Hey everyone, just asking some general questions since I am new to this field (six months) and I am seeing what appears to be commonplace.

How frequently do you see post partum nurses with 5+ couplets and no UAL's to help? I understand that AWHONN makes certain recommendations on staffing ratios but is there a legal precedence or is this just a suggestion?

If you do feel that you are in an unsafe position over and over again with multiple couplets like that, what do you do? Especially if you love your job and don't want to go anywhere else? Just curious!!!!!!! The most couplets I've ever had was 7 once and that was crazy. But as a general everyday thing I don't think I've ever had less than 4 or if I do its b/c I'm getting the first admission and we have a bunch laboring. So its pretty commonplace for us to have a lot (though as said before I've only had more than 6 that one time but I think that is way too many). I just wonder if there are hospitals out there that have a lot of couplets per nurse.

If you are in a place that says no more than 3 or 4 couplets per nurse period, how do they manage the budget? B/c it seems that someone is pulling in the purse strings and that is why we are always short staffed (we have ample nurses at this point from what I can tell, we are just having to not staff too many at one time.)

Anyway just curious!

[Elvish]

That, my dear cherokee, is the million-dollar question.

If you can figure out the answer, then you are 10 steps ahead of me.

[maralenn]

I have been working a postpartum unit for over 2 years and have never had more than 4 couplets. I would be out of my mind having as many as you do. A lot of our mommas have major med/surg issues, and I 'm sure you have those kinds of mommas as well. I could've sworn that our manager said AWOHNN recommends no more than 4 couplets. I'll find out and re-post unless someone else is able to correct me first.

Wow. I don't know how you keep your hair from falling out. You rock.

[cherokeesummer]

LOL, nah I don't think I rock, I think I just pray a whole lot! I mean most of the time our people are routine but you know we always have those not so routine like mag patients, bp issues, etc. etc. But yes it is stressful and I do freak out sometimes, I Just try to remember I have 12 hours to do everything in and most of my teammates are very supportive and will help out a lot.

I do enjoy days when I come in and have four couplets those are normally the majority but lately its been getting a lot different. I usually have a new admission within the shift (if not more than one), like today I had two new admissions but most of my couplets from the am were discharged by the afternoon anyway.

I think what bugs me the most is that I don't get time to teach bf'ing and other teaching in a good manner the way I'd like to. Plus I get annoyed with having to pass and pick up meal trays, change linens and take vitals as well as do all mom/baby assessments/meds, etc. But such is life. I do love where I work so that makes it tolerable LOL!

[jenrninmi]

This is what worries me about moving somewhere else. My husband and I would love to move down south, but I'm afraid of moving to a unit where they have staffing the way you are describing it. I have only had 5 couplets one time in more than a 1 1/2 years. While doing labor, we only have one patient. I don't know if I could handle more than one labor patient. And with the couplet care, once all the assessments etc are done, I feel 5 couplets is easly doable.

[Elvish]

It's pretty much the norm to start out with 4 couplets and get an admission during the course of the shift. RARELY we start out with 3, but with budget constraints it's usually 4. I have steadfastly refused to take a 6th couplet. That is just an accident waiting to happen.

I'm with you cherokee, I don't like the fact that I have so little time to actually spend with my patients teaching them and modeling baby care for them.

Our floor is mixed mother/baby/stable antepartum/occasional GYN. So in that mix we're generally going to have 3-4 couplets and a gynie or an antepartum. Antepartums are great - IF they don't break. Always that possibility, and when it happens it takes up the whole. dang. night.

I feel your pain, cherokee.

[cherokeesummer]

Originally Posted by Elvish

It's pretty much the norm to start out with 4 couplets and get an admission during the course of the shift. RARELY we start out with 3, but with budget constraints it's usually 4. I have steadfastly refused to take a 6th couplet. That is just an accident waiting to happen.

I'm with you cherokee, I don't like the fact that I have so little time to actually spend with my patients teaching them and modeling baby care for them.

Our floor is mixed mother/baby/stable antepartum/occasional GYN. So in that mix we're generally going to have 3-4 couplets and a gynie or an antepartum. Antepartums are great - IF they don't break. Always that possibility, and when it happens it takes up the whole. dang. night.

I feel your pain, cherokee.

What happens when you refuse the sixth couplet? See thats what I'm afraid of, I don't want to be the bad guy and I don't want to be in trouble either. I'm new as it is! Plus my teammates all feel the same way, problem is I don't think anyone does anything about it or if they have in the past maybe it has fallen on deaf ears? I've been blessed that we work very well together and everyone seems to help everyone. I'm always getting the offer, do you need anything. And our charge nurses are a great source of help, they do as much as possible while still being charge. I'm talking baby assessments/baby meds as needed, passing trays if they can, etc. So thank goodness for our team for sure.

But yeah I always wonder what happens when people refuse an assignment.

[Elvish]

Originally Posted by cherokeesummer

What happens when you refuse the sixth couplet? See thats what I'm afraid of, I don't want to be the bad guy and I don't want to be in trouble either. I'm new as it is! Plus my teammates all feel the same way, problem is I don't think anyone does anything about it or if they have in the past maybe it has fallen on deaf ears? I've been blessed that we work very well together and everyone seems to help everyone. I'm always getting the offer, do you need anything. And our charge nurses are a great source of help, they do as much as possible while still being charge. I'm talking baby assessments/baby meds as needed, passing trays if they can, etc. So thank goodness for our team for sure.

But yeah I always wonder what happens when people refuse an assignment.

Well, I don't know what would happen everywhere, but in my facility, I've never seriously been in trouble about it.

I might catch a little crap initially, but nobody's ever really given me a hard time about refusing an unsafe assignment. And 6 couplets = 12 patients, and that is indeed unsafe.

Usually, this happens around the end of the shift after everyone's gotten admissions. The only one still free is the unit charge. If anyone refuses couplet #6 (I'm not the only one who would), the unit charge would probably take that patient. Or we could call management in.....

Seriously, if more people felt like they could refuse unsafe assignments, this world would be a better place. You just cannot expect yourself to be able to safely care for 12 human beings, even 12 more or less healthy ones, in a hospital setting.