Mother Baby Couplet Care

  1. I work in a hospital that delivers about 350 per month! We are in the process of changing from newborn nurses and postpartum nurses, to mother baby couplet care. We have been cross-training each other since March, and have found a lot of resistance to change! I need your opinions, and suggestions! How many couplets do other hospitals assign? Does it differ from days to nights? How are the doctors reacting? How do you staff the Nsy?
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  2. 14 Comments

  3. by   kennedyj
    We do couplet care and It would probably depend on what roles are done by nursing staff. We do complete rooming in where the infants stay with the moms the whole time 1-2 days and only bring the babies to the nursery when they shower or go to the bathroom. It is great for staffing and helps observe care since the moms will be on their own in a day or so anyway. Some say it is cruel because the moms get little rest after a tiresome delivery. I agree with this also. Most moms are ok with provinding total care but I know of some places that staff the nurseries for about 5 hours at night and offer a sleep time for the moms.
    We usually do a generic discharge class each night in the conference for all patients going home then each nurse tailors specific concerns with their patients.

    We have SVD and C/S patients only no gyn surgeries. Usually 6-10 couplets at a time. Nurses shouldn't probably care for more than 4 couplets. We also do NRP and initial baby assessments also which can tie up time.\

    best of luck
    Jared


    This I have heard to work extremely well. Especially in private centers or hospitals. The average cost to deliver a baby at our military hospital is $22-33 total ($11 per day for food). Medical services are equal to others I ve seen in the US. The maternity ward is a little older and has shared bathrooms. The L&D unit is excellent.
  4. by   lactationrn
    THey did this at a facility I use to work at. There was ALOT of resistance and a lot of nurses taht had been there a long time left. Advice...Make sure taht the staff is on board with changes,and remember that change is good. couplet care is easier..i think. youare always teaching the mother stuff anyway, and if you know her story and babies story, caring for the 2 of them is better...continuity of care and all 4 couplets is a safe #. Any more than taht with taht, with the high turn over of patient s is jsut too much. and patients get cheated out of valuable time with their nurses for teaching and such.

    nursury is for admitting only and moms and babies room in.
  5. by   IL RN
    Our hospital made this switch about 4 yrs ago and there was much resistance from staff. I was new to the unit at the time and had done this at other hospitals. At this hospital there is still a well-baby newborn nursery to do initial baths and take care of babies when moms want to sleep, shower, etc. and at night if mom desires. There is only one RN in nsy.

    We have 200+ del/month. The average pt load on mother/baby is 5-6 couplets, sometimes as high as 8 and keep in mind some of these moms are new C/S's. If the census is low and you have only 4 couplets then it's ok. I work mostly L&D but we all have to rotate so I get my share of time in Mother/Baby.

    I also worked for a while at a large teaching hospital with 3 mother/baby units of about 20 rooms each. There the MINIMUM load per nurse was 5 but you usually had 6. You did ALL the baby care as the babies were only allowed in nsy at night (I worked PMs) As soon as you discharged a pt. you would be assigned a new one. No time to chart. Everyone charted at the end of shift, after giving report to next shift. There were many multiples (lots of twins & triplets) so you could have many babies. On my second day there I was assigned 6 moms and had a total of 10 babies - 3 of them were triplets who needed tube feedings that I had to do! That place was a nightmare and I only stayed 4 months.

    Theoretically couplet care is a good idea but it needs to be properly staffed - just like in all the other units - LOL!
  6. by   kennedyj
    yikes!! That sounds like madness! I can only imagine how you felt at the end of a shift. # tube feedings can take you up to a good 45 minutes and they will need it every 3-4 hrs.

    When you get a fresh c/s patient you are moreless in there the first hour and frequently the first day assisting feeding and dealing with pain.

    We use a care hour system that says how many nurses are needed. Today we have 8 patients ( 1 c/s , 3 antepartums, and 4 svd's). We have 2 RN's and a technician who does almost all the baby stuff except assessments.
    If we got another c/s and 3-4 deliveries we would call in a nurse. Sounds cush but is needed for patient safety and to do appropriate teaching and nursing care.

    do should definately get the BYB (bust you butt) award for working there or the BTDT (been there done that).

    Jared
  7. by   OBNURSEHEATHER
    I agree with you Jared, it's all about patient safety and teaching. I don't think 4 couplets sounds cush, because often enough they've kept me running all day! I couldn't imagine some of the scenarios described here! Our average is 4 couplets, sometimes we start with 3, and sometimes we wind up taking a 5th. But I don't recall ever having more than 5.

    We do have 2 nurses and an aide in the nursery during first and second shift. Their role in the nursery is geared toward helping the physicians, assisting with circs, consults, referrals, etc, along with being a transition nursery for babies without respiratory difficulties.

    Third shift does it differently. They have less nurses on the floor with more patients (moms), and more nurses in the nursery with the babies. The nurse on the floor has absolutely no idea what's going on with baby. The nursery nurse is even responsible for getting the babies out to feed (if mom hasn't requested otherwise). The down side to this is that when I get report in the morning from the night nurse, she can't tell me a thing about the baby. It's really inconsistent. It's a really terrible feeling to walk into a moms room in the morning and there's something major going on with baby that I don't know about, because I don't get an official baby report.

    Other than that, I really enjoy couplet care. I think it provides more continuity, for me AND the patient.

    Heather
  8. by   woopcrane
    I helped a hospital change to couplet care -= Any sort of change, as you know will cause resistance/depression/etc studies show that for the first 6 months, your staff will not be happy campers as the bugs get worked out and the change is asimulated.

    Pitfalls to avoid when changing to couplet care-

    DO NOT create a "nite" or temp nsy where the nurses will watch the baby - this will VERY quickly become a permenent fixture, and destroy the couplet care idea.


    Charts should be kept with the patient - not at a central charting area, so the nurse never has to walk to the central desk -

    MDs can also go into the room to see the charts - they have to see the patient anyway

    if peds wants to see the baby, peds needs to go into the room - not have the baby brought to him/her -

    For C/S patients - arrange a family member to stay overnote to care for the baby - esp the father - makes for a great initiation into fatherhood.

    anyway - good luck

    and no, I can't spell
  9. by   bagladyrn
    One of the big drawbacks/problems with couplet care I've seen is referred to above "no nite nursery" (and no specific nursery nurse) In reality, this means when mom is in tears t 2 a.m.,saying I've got to sleep, the baby ends up out at the nurses station! Frequently, the father is in the room, but mom says "he needs to sleep", too.(he's snoring through baby screaming!)
  10. by   rn500
    I gotta agree with bagladyrn - I've done couplet care for quite a few years now, and the idea of no "night nursery" sounds great on paper, but it sucks in real life. Once upon a time, when we had REAL visiting hours that allowed moms to actually get some rest, it would have been fine. But it's just not practical now. Remember Maslow's hierarchy - you can't teach an exhausted mom much of anything.
  11. by   cindyln
    The hospital I work at has been doing couplet care for about a year now.It met with and is still meeting with alot of resistence.The L&D nurses picked up alot of responsibility.The baby stays with the mom on L&D during the transition period,usually 4 hours before both of them coming to the postpartum side of the floor.We only staff the nursery if we have a baby needing level 2 care and that really throws a wrench in our staffing.Everyone is supposed to be trained to work both areas,L&D and postpartum but that is meeting most of the resistence.The L&D nurses think it is beneath them to work postpartum.They say they are specialized.Of course you can guess this is causing alot of hostility between the 2 groups.Does anyone have any suggestions to this problem?
  12. by   mother/babyRN
    I have to say I don't think it is safe, at least for us, because we just don't have the staff, especially since we float between units and have to go between nursery, post partum and delivery depending upon census. Unless you can do it all the time, I don't like it. AND, the greatest misconception on nights is that it would be easier since people sleep (who??? Not newborns or mommies).In a cushy hospital environment in which you could be certain you either had backup if a mommy or baby went bad, or someone to take over, I am not in favor of it. Consistency is everything...
  13. by   mother/babyRN
    We DO now, if staff permits, try to admit baby in delivery and give the parents quite a bit of time to bond, and then take them over together. We can't do that if we have a bad baby or too many patients, but that is a small concession we have tried to make given our staffing is horrible for what they would like to do...
  14. by   mother/babyRN
    No night nursery DOES suck, and no offense, but the only people that want to room in are excited primips who don't know any better, or lactation consultants who believe it should be so. Any multip worth her salt knows she is not getting any rest once she goes home so back to the nursery they go! And, in our unit, where all of us rotate between all 3 areas and sometimes, on nights ARE staffing all three areas, I just hated it. Babies at the nurses station, so we were told by a liability expert, are NOT a good idea....What are you supposed to do when you have a code either with mommy or baby, or get dragged to delivery, BABYSIT??? (remember, that is STILL my pet peeve...

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