Mother/Baby units, how do they flow?

mom2michael, MSN, RN, NP · Jul 2, 2008

We have 5 LDR rooms, notice they are not P rooms because we do not postpartum in those rooms unless we have a PP crisis going on and all those rooms are full. After a normal vag delivery and after the mom/baby/FOB bonding, our babies go to the nursery for their warm up time, bath time and assessment time. In the mean time, our moms are moved to our postpartum rooms which are across the hallway. It's like going from the Hilton to Motel 6 :). Newborn care takes about an hour, moving mom and getting her cleaned up takes an hour and in the perfect world and workday mom and baby are reunited in her "new room" and all is good.

Sections are recovered in surgery and then postpartumed in our postpartum rooms.

We are a small unit. We function as L&D and PP nurses interchangeably and will often bounce back and forth each shift about 20 times among the roles. We are not assigned to L&D or PP unless we are obviously not crossed trained in said area.

We are not baby nurses though. We can assist with newborn care at birth and receive a baby cause we are all trained in that aspect, but as soon as the baby goes to the nursery, the nursery RN takes over their care. Ideally the nursery RN comes to all deliveries but we don't work in an ideal world, hence our training in receiving the babes at birth.

It's probably not the most ideal situation and someone else might have a better set up elsewhere but when census is low it keeps us working because our min. staffing regardless of if we have 0 patients is always 3 RN's (2 in L&D/PP and 1 in the nursery). For situations beyond our control we also have an on call RN 24/7 as well as an on call supervisor 24/7 for the staffing crunches.

I love it there and it actually flows much better than I ever could've or would've thought when I first started. I also like it because you do a variety of things each shift. You might start off in L&D, then move and PP your mom/baby. LOVE the continuity of care because we are so small.

Patients also really like it - the ONLY complaint I hear is the fact they are moved from the Hilton to Motel 6.

hoppermom3 · Jul 3, 2008

We currently have LDR rooms, then have to go to a different hallway to the PP and Nursery area. L&D is staffed by RNs only, Mom/Baby uses LPNs also. The Mom/Baby nurse comes to delivery to recover baby. After a couple of hours (or whenever mom is able to stand and feels ready, mom and babe are moved to PP/Nsy. If they have company or just want some more time with babe, they both go to the PP room. When mom is ready, we take babe to nsy for bath and Ballard. Mom, dad, or sibs are welcome to come and watch/participate in first bath. From there on, it is mom's choice - complete rooming in or nsy at night or whatever she wants. Of course, all this is assuming a healthy baby with uneventful recovery.

L&D nurses also work Mom/Baby if there are no labors. Everything flows well (except having to travel through ER to get from L&D to Mom/Baby). We take Mom/Baby assignments as couplets. Often, I will deliver a mom one day, and return the next day and provide PP/Nsy care to mom and baby. This is great, and the moms love it.

We are getting ready to build a new hospital and are considering LDRP rooms.

Elvish, BSN, DNP, RN, NP · Jul 4, 2008

We have LDR and then move our pts to mother/baby. The units are staffed & scheduled separately. After delivery, LDR recovers pt/baby for about an hour. Baby then goes to nursery for bath & assessment (sooner if s/he's in distress) and once bathed & warm goes back out to Mom.

From there, we strive for couplet care; some nurses promote it more than others. Our m/b nurses are also cross-trained to do nursery so we can do mother and baby teaching, as well as assess/bathe/weigh etc. for the babes.

I work nights and really, most of my patients keep their babies with them. It takes some doing sometimes, but most mothers with a little help will keep their babies with them. If Mom or baby is sick for whatever reason, the nursery's there & staffed. But on an average night when we have 30 couplets, we'll usually have 6-8 babies in the nursery, plus new admits & babies that have to stay on after Mom has gone home.

One caveat: if Mom doesn't want baby to leave her room for the inital bath etc. we can do everything in her LDR room. That's offered to everybody but most don't take us up on that bit.

All in all, I like couplet care and it is a great way for families to get to know their babies.

JenTheRN · Jul 5, 2008

We have LDRP rooms and we all do mother-baby. It's the only way I've worked and I love it. Mom's labor and deliver and then housekeeping comes to do the "in-between clean" once they get up.

We do have a nursery and moms can have their babies room-in or go to the ny for the night.

We do have other rooms for the sections and gyn patients.

mommy2boysaz · Jul 6, 2008

Very interesting thread.

Our hospital does about 40-50 deliveries/month. We have LDRPs. Up until a couple of months ago, all RNs did all jobs (PP, L&D, babies). We also had a couple of LPNs that could do PP, etc. and aides for clean-up, opening delivery tables, etc.

Suddenly we're experiencing a major shift in the way things will be done. Basically, all aides and LPNs have been "let go". Now we will have only RNs, but 3 part time RNs will replace 7 fired staff. (And those new RNs have yet to be hired!)

Before, a typical staffing schedule would be 2 RNs and 1 aide on evening shift. We might have 1 RN with a labor pt, 1 RN taking care of 3-4 couplets, with the help of the aide wherever needed. At delivery, both RNs would go in and the aide (or house supervisor PRN) would watch the postpartums during that time. If there were 2 labors, each RN would do one, and kind of tag-team the post partums. Occasionally we might end up with a baby that needed to go to the nursery for some oxygen, monitoring, etc. If that happened, we'd have to call in someone (or hope to get someone to come).

Anyways, now the new RNs are going to be "nursery" RNs and are only going to have baby care. Not sure how this new formula will work in our unit, given that everything is together. We rarely have any babies in the nursery, except at night, when we may have 2 or 3.

We're all pretty upset at losing our aides. Some have been here 20+ years and are great help!

Do any of you use aides or techs? Who does your cleaning of instruments, FHMs, warmers, etc? Who strips and remakes your units? Our aides helped with all of that. Now it will fall to us.

(After delivery in our LDRPs, a nurse and an aide would come in and assist the mom to the bathroom (a couple of hours after delivery, usually), the nurse would stay with the mom and explain pericare, etc. while the aide stripped, cleaned, and remade the bed.) The babies normally never leave the mom's room unless she chooses to send it to the nursery. (Oh, and all of our rooms our Hiltons!)

Would love to hear some more feedback on all of this!

Thanks!

mom2michael, MSN, RN, NP · Jul 6, 2008

We deliver anywhere from 50-70 per month - I think last month was 60 something.......

Ideally I would've loved to have seen mom stay in her same room and all the baby care be performed at bedside and we do couplet care, but I didn't design this unit . And it's a pretty new facility, built in 2002 and this is how the staff actually wanted it done....soooooo.....

Anyway, we don't use techs. We strip our own beds and we restock our own rooms and we provide ADL's for our patients. We tag team a lot especially if someone has a moment. We'll run in, throw a mom in the shower and strip the bed in record time. Instruments are left for our sterilizers who pick those up everyday at 1500 and bring us new kits. When we turn over a room we have a housekeeper who cleans it all for us and they are awesome.

We have a US who works from 7a-3p and she can function as a tech in a crunch and is AWESOME at pitching in.

Our crazy time is in the am when we have all our scheduled C-sections coming in and then our inductions. Throw a spontaneous labor into the mix and WOW we get hoppin'.

We staff 2 RN's outside the fishbowl in L&D and PP. We also have an on call nurse 24/7.

We all take assigned patients, but it changes and fluctuates all shift long obviously depending on what's up. Once cross trained (I'm still working on that aspect) you pretty much do it all. You can have some PP moms and be laboring one or your partner can have the PP moms and you take the L&D side. Whatever you decide it changes about 2 hours later anyway. :lol2: But assuming you take PP, you will have all the PP moms, assessments, discharge teaching, recovering the C-sections, ADL's, ambulation, medications, VS, etc.... We also do hourly round now and we do that on mom and the baby both even though we are technically not the baby nurse. We chart if mom is holding the baby, if the baby is in the open crib, if they are feeding, etc.... That's a CYA thing that just recently started.

We then also staff a nursery RN and her job is the baby. Right now post normal vag delivery, we promote about a 1-3 hour window of bonding time (as long as baby is stable) and the nursery nurse tries to stay with them in the room to provide teaching and continuous assessment of the baby. Then she'll take the baby (and FOB if desired) to the nursery and she'll do the full assessment and the bath then.

When it's time, we get mom up, in the shower and moved to her new room while the baby is in the nursery. As long as baby is stable, they can stay with mom 24/7 if they desire. The nursery nurse will do assessments in the room and the peds doc will also see baby in the room.

Post C-section, it's a bit different. Our babies usually stay about 2-3 hours in the nursery (with FOB if desired). It takes mom about 2 hours to recover in PACU so ideally if the baby is stable we reunite them all when mom comes back.

We don't have babies in the nursery very often (unless mom requests) except post deliveries. Usually by 1 or 2 in the afternoon all our babies from the am are back with mom and it's empty. The nursery RN does most of her partial assessments at bedside with mom and then obviously teaching is done at bedside. The nursery nurse then stocks the nursery, prepares for any more inductions coming in that night or first thing in the am and then does their oodles of paperwork.

The L&D and PP nurses are all cross trained to receive a baby at birth whether that be via section or vag delivery cause if the nursery nurse has an unstable baby in the nursery, she can't leave. And then of course if we have any babies at all in the nursery, regardless of the reason, the nursery nurse can't leave at all.

If they are not busy and have no babies in the nursery, then they are good to help us "outside the fish bowl" with discharges, patient teaching, ADL's, answering the phone, etc....but their primary job lies with the babies and they are also very quick to remind us of that. :chuckle

I hope that helps some mommy2boysaz!!!!

mommy2boysaz · Jul 6, 2008

Thank you for the info!

Basically sounds the same as what we do, except you have a nursery RN instead of the tech, which is what we are now going to do.

Glad to hear that it works! It will just be an adjustment, just like any change is.

luv2laborRN · Jul 23, 2008

Thanks, that is similar to what we would like to do in our unit. How many deliveries do u all do per mo.? Who does transitioning of newborn? Who cares for newborn? When does babe receive 1st meds after delivery, in room? or nursery?

Thanks, very interested in response.

luv2laborRN · Jul 23, 2008

Thanks. The info is great. We do bout 200 deliveries a month. Currently we also do LDR and then transfer to PP, however, newborn transitions in nsy and goes out to mom after bout 2hrs obs. Who transitions ur babies? Do u do 1st meds for NB in LDR when doing recovery with mom? Who takes care of ur other pt if ur do delivery and recovery?

Thanks, ur response is greatly appreciated.

mom2michael, MSN, RN, NP · Jul 23, 2008

Thanks. The info is great. We do bout 200 deliveries a month. Currently we also do LDR and then transfer to PP, however, newborn transitions in nsy and goes out to mom after bout 2hrs obs. Who transitions ur babies? Do u do 1st meds for NB in LDR when doing recovery with mom? Who takes care of ur other pt if ur do delivery and recovery?
Thanks, ur response is greatly appreciated.

We staff a nursery RN who is the baby's nurse, she is there at delivery and gets the baby stable enough to stay with mom for an hour or 2. Mom is recovered by her L&D nurse and transitioned over to PP. When mom is ready to transition to PP, baby goes to the nursery for meds, bath and 1-2 hours obs and as long as they are warm, toasty and having no distress they are bundled up and sent back out to mom for their duration.

If for some reason the nursery RN is busy and unable to attend a birth, another RN on the unit serves as the baby nurse at delivery.

Meds are done in the nursery when we bring them back (around 2 hours post vag delivery).

We *usually* only have 1 delivery at a time going on, so we have 1 RN laboring the patient, 1 being the baby RN and the other RN is watching the rest of the patients on the unit. If we get to hopping, we call in another person.

Sandwitch883RN · Jul 24, 2008

When I started in L&D out of nursing school I worked in a hospital where everything was very seperate. L&D, PP and nursery each had their own staff and did seperate scheduling. The hospital was fairly large and had about 200+ deliveries per month. Each dept. staffed 4-6 RN's per shift and several CNA's and a unit sec. on days. L&D additionally had scrub techs each shift. I've recently gotten a job in a very small rural hospital that is set up much like what had been described with 3 RN's that rotate through a small inclusive unit. I think it's going to take some getting used to but from what i've read on this thread it seems to work well. I'm looking forward to the diversity of doing all three roles! I'm also looking forward to cross training as a "nursery nurse". Even though I have NRP i've only done immediate assessment than shipped baby to nursery. Now I have the opportunity to learn more about nursery care. :nuke: