Couplet Care Nursing

Jolie, BSN · Oct 5, 2008

I have worked in 2 different facilities during or shortly after the changeover from traditional L&D, PP and Nsy to mother-baby couplet care.

Even with extensive prior planning the change is a difficult one (but well worth it, IMO).

It sounds like your facility rushed into a monumental project without adequate planning, preparation and support.

Is there any hope of forming a committee of management and staff from all disciplines to study the process at other local hospitals that have successfully made the change?

MB15YRS · Oct 5, 2008

We actually have a couplet care committee, compromised of myself, staff nurses, Unit Secretaries, and PCA"s. We did 2 site visits, with staff, to Memphis Baptist, and Good Sam in Cincinnati. We thought during the "trial" runs, we could find the problems. We are well staffed, better than we ever have been in the past, but still hitting hurdles. I have those nurses that just don't want to give up the past and move into a new way of doing things. We are trying to move equipment in places where better needed, meeting with the Pediatricians in their offices to discuss their issues, and talking with the OB's. Some of our Docs are not helping, but instead feeding in with the staff with negativity.

My biggest concern is safety in the nursery. My Director only wants us to staff one nurse in each nursery and figures couplet nurses will migrate in there during their shift. In the early morning, when Docs are moving through, she is the only one in there doing circs, helping with the Physicians, answering phones etc...This leave the baby's that are there in a nursery by themselves while the nursery nurse is assisting with the circs in a room next door. I want another PCA in there during this time, but keep hiting a wall. The couplet care nurses during this time are out doing assessments and not always available. Am I the one who is being stubborn here? :banghead:

Jolie, BSN · Oct 5, 2008

I sounds like you are practicing something of a hybrid between traditional PP & Nsy care and mother-baby care.

I worked in one facility in which there was no well-baby nursery. Moms roomed in 24 hours (with a family member present if desired) unless her condition simply did not allow (fresh C-section, exhaustion, etc.) In those cases, the babies could be wheeled to the NICU or nurse's station to be watched. Post delivery newborn care took place in mom's room (initial assessment, bath, eyes and vit. K, physician exam, etc.), PKUs and circs were done in a procedure room, usually on day 2 of life. All well-baby care was provide by the mother-baby nurse.

The other facility had a well-baby nursery. Babies were admitted there approximately 1 hour after delivery for their initial newborn care. On day shift, there was 1 RN in the nursery who was responsible for admissions, circs and communicating with pediatricians. Routine newborn care was provided by the mother-baby nurse, so if there was a problem or concern, she had to get in touch with the nursery nurse who communicated with the peds. On paper this sounds like an inefficient system, and it probably was, but it limited the number of nurses trying to reach pediatricians, and it worked pretty well to streamline communications. On nights, moms could send their babies to the nursery while they slept. A night nurse staffed the nursery and did shift assessments, weights and baths. The mother-baby nurses took the babies out to their moms to feed.

Overall, I think the first hospital had a better system in terms of consistency and continuity of care. The idea of having one nurse for both mom and baby is somewhat defeated when a well-baby nursery exists for anything other than "holding" infants of exhausted mothers. If that is the sole purpose, then a PCT can certainly supervise the room.

babyktchr, BSN, RN · Oct 6, 2008

We do mom/baby care and have a nurse who strictly does circs in the morning for the mom/baby nurse. They are expected, however, to take care of the babies post circ, as well as other duties of the mom/baby couple. I agree with the above poster...you are caught in limbo between the two dynamics. Seems this "nursery" nurse could bring babies in one at a time to do the circs, instead of piling them up in the nursery. The mom/baby nurse could bring them in as needed, and she can do the assessments while waiting.

MomX2andNurse · Oct 23, 2008

Our nursery nurses do our circs, which is horrible. We do up to 10 to 12 a day. The Couplet nurse does not come in, which makes this very hard on the nsy nurse, because she already has her own admissions and sick babies to take care of. I like PP and nsy myself. It worked so much better for us. Everyone knew their job and knew it well.

Brenda2083 · May 10, 2011

I'm curious if things have changed; attitudes, efficiencies, continue with same problems and concerns trying to do "couplet care". I noticed these are from 2008. Have we come to the age of Babyfriendly and couplet care with or without normal newborn nurseries?

serenity1 · May 16, 2011

We do couplet care and have a well-baby nursery for grower-feeders and respite. If there are more than 3 admitted babies, there are 2 nurses staffing the nursery. If there are only respite infants, a single Rn can take 2 infants; more than that, there has to be another RN or CNA to help out. They have been very good lately about staffing our nursery. The mother/baby nurse helps with the circs for her infants.