Postpartum couplet care

[KYgirlRN]

Hey guys! We are working on a project for work and I am interested in gathering feedback from other facilities about ratios. For those of you who practice couplet care on postpartum, how many couplets do you care for at a time? Are there any antepartal or NICU moms mixed in with your couplets? Do your babies room-in 24/7 and what level of involvement does your nursery have with care of the babies? (Do they do assessments, etc. for you or are you giving true couplet care?) Thanks for the feedback!

[iPink, BSN, RN]

It is very difficult to provide adequate care, especially breastfeeding assistance. Someone is always losing care so another patient's needs can be addressed. It has been addressed with management, but what we hear repeatedly is that our unit will never follow AWHONN standards and we can't afford to staff with better ratios per administration. We are working on some research to back us and attempting to find cost-saving measures that can help justify adding a nurse, but I am starting to think it is downright ridiculous to have to fight so hard for patient safety and satisfaction.

Since transferring to my postpartum unit, I haven't experienced couplet care. But was told in the past when staffing was very low they have done it. Usually 5 couplets!

Often times it can be very difficult to get management to make the necessary changes that would promote patient safety, especially if they want to see higher satisfactions scores. If you want improvements in the patient-nurse ratios on your unit, nurses have to stick together in presenting their research when making their arguments. Continue to address those issues and concerns during Unit Practice Counsel meetings; make it a priority each and every time.

Good luck!

[mickey1172]

We do 3 couplets at my facility as the norm. We are a small rural community where the RNs are all labor, postpartum, Preop, circulate, PACU, some scrub, and are transitional and well newborn nursery trained! Our hospital doesn't have a NICU so we fly our sick moms/babies out. AWHONN has staffing guidelines you can download that might point you in the right direction.

[debsgreys]

We usually have three couplets, or two couplets an ante and NICU mom. We try to stay at five or six patients. Right now I work day shift so you may go over while your one discharge has not left yet. We have no CNA or tech. It definitely keeps you moving, especially since we will be having a visit from the "Baby Friendly" staff in the spring and the state any day now. Night shift runs with the same staffing ratio. Our patients stay in L&D for two hours after delivery. Hope this helps you.

[taz5869, RNC-OB]

It has been addressed with management, but what we hear repeatedly is that our unit will never follow AWHONN standards and we can't afford to staff with better ratios per administration.

I wouldn't work for a hospital that had that kind of response to the AWHONN Staffing Guidelines and obviously doesn't care about pt. safety. AWHONN's staffing guidelines are evidenced-based... there's a huge bibliography at the end to support the updated 2010 guidelines.

[RN0323]

Our ratios are 6:1 max (2-3 couplets); it changes with acuity. Mag patients are 1:3 and if you have a duramorph, for the first 24hrs its 1:4. We do couplet care so that would obviously be 2-3 couplets. We intermingle our NICU moms. On our unit, the Nursery nurse MUST take at least 2-3 babies, assist nurses if a baby needs monitoring, PLUS be available to LD if they need a baby pick up. Its kinda hard some days to be the nursery nurse... feels like you are pulled a thousand different directions.

As for your facility--unsafe and unrealistic. I'd be seeking another job because its clear your management isn't behind you and doesn't seem to give a rip about safety let alone patient satisfaction. I hope your efforts to promote change are recognized.

[melmarie23, MSN, RN]

my unit follows AWHONN staffing guidelines. We average 3 mom/baby couplets, and never have more than 4.

[haunani, BSN, RN]

At our facility, antes are labor's responsibility. We get the NICU/SCN moms, though. We do our best to stick with the guidelines of 3 couplets/nurse (for us, 2 SCN moms count as 1 couplet), but sometimes it can't be helped that we end up with 4. On VERY rare occassions, 5 couplets.

Being on the baby-friendly track, we no longer have a "nursery" per say, but have a "procedure nurse". When available, they will help with baby admissions.

[calgrrl]

Night shift post partum experience here - 4 couplets were the norm. 5 couplets on a really busy night. 3 couplets was a treat! NICU moms would count as 1/2 an assignment, so you could either get easy antepartums or other NICU moms assigned, or even a twins assignment. Breastfeeding help at night was a lot easier to give than during the days, when they're just discharging patients home as fast as they can. If you spent 1 hour working on bf'ing with a dyad, your night is pretty much shot.

My new facility is usually 3 couplets, but the mothers or the babies can be very sick so that throws everything off.

[EH44]

I saw that you said you precepted on a post-partum floor. I was wondering which unit you worked on after your preceptorship? I also precepted on a post-partum floor and have been offered the job but am now torn between that and med-surg. I loved post-partum but didnt get much experience in medical skills such as I.V.s and other medicines. I hope to one day work in pediatrics and don't know if starting on a med-surg floor would be smarter. Any advice would be helpful!

Thanks!