Couplet Care/Postpartum

babyktchr, BSN, RN · Jan 10, 2010

AWHONN states 3-4 mom/baby couplets per nurse. There is no going back and forth to nursery, baby stays with mom, except for testing and circs etc. Your day would incorporate assessment and teaching and discharge planning and so forth. You would have to re-evaluate if you have late preterm, preterm babies or sick mommies. I don't know how couplet care would work with a high census facility as more staff would probably be needed. It would be interesting to hear from some big census places to see if they do couplet care and how it works for them. I am from small facility (but busy) that does 1000 deliveries per year. We have 12 beds total, and do couplet care.

FemmeRN · Jan 10, 2010

My hospital does about 3500 deliveries/yr. We have 45 postpartum beds, with occasional overflow to the antepartum unit. We do couplet care. Each nurse has between six and ten patients, which usually means 3-5 couplets (but it varies, as we have moms whose babies are in NICU, and we also have gyn patients. So you could have, for example, six women, but only four babies). I work 12 hour day shifts, and the babies remain in the room for pretty much the entire day, with the exception of circumcisions, lab tests, and physician exams. At nights, some moms choose to send the babies to the nursery, but we try to encourage 24-hr rooming in, if mom is healthy. I work three shifts a week, and if I work consecutive days, I usually get the same patients back. We have infants 36 weeks and later on our unit. Under 36 weeks (or under 5 lbs) goes to the NICU for at least 24 hours, and then gets transferred back to us if stable.

Elvish, BSN, DNP, RN, NP · Jan 10, 2010

I work in a place that does about 6000 births/year, also 45 beds, and we have 3-5 couplets. We try to shoot for 4 but it's relatively common for us to have 5. Keep in mind that it's a mix - we may have one stable antepartum and 3-4 couplets, or one or more of the PP moms may have a baby in NICU. So no - critically ill babies are not part of couplet care.

We room in as much as possible and/or as much as mom wants. Assessments can be done in the room but we have to take baby out for daily weight, just because we only have one scale, which is in the nursery. We do get some late pretermers (q4 VS/assessments) and/or sicker moms, and if that's the case we try to staff accordingly (maybe 1:2-3). When they say one nurse per mother/baby, it sounds like they mean there is one nurse for the couplet vs. one nurse for mom and another for baby.

I work 12-hour nights, so my shift goes something like this - assess patients depending on when they need assessments (BIDs at 1900, q shifts at 2300), make sure everyone is stable, all outstanding issues are addressed, and finishe d/c teaching on the ones going home the next day. Then I run any NSTs if I've antepartums that need one. Generally by then it's around 2230 so then I start assessing my q8h folks and my babies. After then it's helping folks prn with self-and baby care, making sure pain is addressed. A HUGE part of my night is showing new parents how to navigate the nights with their baby - how to settle/wrap, etc. If there are any 0400 vitals I do them, then just before I go I pull foleys and make sure everyone is stable/settled. If a baby is getting circed that day, I give him his loading dose of APAP around 0600 and if any of my babies need bilicheks I do them around then as well.

Hope this helps. It really does work most of the time. I work a fair bit in the nursery and most nights anywhere from 60-80% (on average) of moms keep their babies with them.

guiltysins · Jan 10, 2010

Thanks you guys! Elvish, more likely my shift will be the night shift, since that's all they seem to offer most of the time. I know a lot of people think that there's less work if you work postpartum through the night. I'm sure you don't agree with this lol.

zahryia, LPN · Jan 11, 2010

I would think there's less work at night, simply because you're not dealing with visitors as much. You'd be surprised how much they are.

RNmomof4 · Jan 11, 2010

Hi! I work at a hospital that delivers 5000+ babies a year and we take an average of 8 patients (any combination of moms and babies, some moms have babies in NICU, some babies have moms on the high risk unit). We encourage rooming-in, but don't require it. Physician assessments are done inthe nursery as are weightsduring night shift. Moms really don't send babies to nursery during the day. I currently work 12 hour day shifts, but worked nights for 15 months. I feel that nights are far busier than day shift. We don't have lactation nurses available to focus solely on breastfeeding, night nurses carrier a heavier patient load and moms tend to be exhausted and, often, so much more emotional at night, therefore needing more attention. Plus, babies that are in the nursey need to be bottle fed or taken back and forth to moms for feedings. The best thing that our hospital does to ease this load is to limit what patients we accept. We don't accept babies on O2 or that need anything but routine meds (no abx) and no moms on insulin, mag, or severe PPH (we do take moms on abx and check cbgs with no sliding scale). I know a lot of nurses don't think post partum, nursery nursing is really nursing, but it is! It's just very different and uses less skills and more teaching! Hope you enjoy your start in moms and babies!

mommybess, BSN, RN · Jan 14, 2010

i am a staff rn/charge nurse unit the postpartum unit in a hospital that recently went from delivering approximately 3000 babies a year to 6000 babies a year! we have 61 postpartum beds, 8 antepartum beds, and about 30 ldr beds. we do couplet care with rooming in. we generally have a ratio of 8:1 patients. that mix can be 4 mommas and 4 babies, or it can include a few moms only (nicu moms) or babies only (moms dc'd but babies staying for bili therapy or weight loss, etc...)

i work nights 7p - 7a. a typical night for me as a staff nurse is:

1845 - report

1900 - initial rounds on all patients and then start q shift momma assessments, pain meds due

2100 - 2300 hs meds, and routine meds, pain meds, q4 vitals/fundal assessments for post c-sections, dc teaching for pts going home next day

2300 - 0100 baby assessments and daily weights

0100 - 0300 meds, more vitals and fundal assessments for my q4 pts

0300 - 0700 dc foleys, pain meds, vitals, fundal assessments, pre-circ meds, report off to day shift

generally leave between 0730 and 0830 for home

add in there admit patients, assist with breastfeeding, assiting pts oob to void for the 1st time, showering c-section pts @ 1st 24 hrs post c-section, linen changes, momma and baby accuchecks, im meds, admin insulin, starting ivs, bladder scanning on pts unable to void, cathing pts unable to void, admin iv abx, medicating the post c-section pt with issues from duramorph (puritis, emesis, etc...), drawing baby labs, starting phototherapy on jaundice babies, calling docs, an occassional hemorrhage emergency, answering the non stop calls to my cell phone from pts, and tons of teaching! :bby: etc...

night shift is just as busy as day shift. at out hospital there are no set visiting hours. some patients do have visitors that stay late, like 0200 or later!! esp if they delivered late. the difference is that there are less docs on the floor.

when i am charge nurse it's a totally different experience. making assigments for 100+ patients (mommas and babies), and planning on admissions and discharges can drive you insane!

but i love it! :redbeathe

LuvofNursing, BSN, MSN, RN · Feb 13, 2010

I work in a place that does about 6000 births/year, also 45 beds, and we have 3-5 couplets. We try to shoot for 4 but it's relatively common for us to have 5. Keep in mind that it's a mix - we may have one stable antepartum and 3-4 couplets, or one or more of the PP moms may have a baby in NICU. So no - critically ill babies are not part of couplet care.
We room in as much as possible and/or as much as mom wants. Assessments can be done in the room but we have to take baby out for daily weight, just because we only have one scale, which is in the nursery. We do get some late pretermers (q4 VS/assessments) and/or sicker moms, and if that's the case we try to staff accordingly (maybe 1:2-3). When they say one nurse per mother/baby, it sounds like they mean there is one nurse for the couplet vs. one nurse for mom and another for baby.
I work 12-hour nights, so my shift goes something like this - assess patients depending on when they need assessments (BIDs at 1900, q shifts at 2300), make sure everyone is stable, all outstanding issues are addressed, and finishe d/c teaching on the ones going home the next day. Then I run any NSTs if I've antepartums that need one. Generally by then it's around 2230 so then I start assessing my q8h folks and my babies. After then it's helping folks prn with self-and baby care, making sure pain is addressed. A HUGE part of my night is showing new parents how to navigate the nights with their baby - how to settle/wrap, etc. If there are any 0400 vitals I do them, then just before I go I pull foleys and make sure everyone is stable/settled. If a baby is getting circed that day, I give him his loading dose of APAP around 0600 and if any of my babies need bilicheks I do them around then as well.
Hope this helps. It really does work most of the time. I work a fair bit in the nursery and most nights anywhere from 60-80% (on average) of moms keep their babies with them.

Elvish

Are your antepartum patients on FHM? If so, are all m/b nurses FHM trained?

Elvish, BSN, DNP, RN, NP · Feb 13, 2010

Our antepartums, if they are on mother/baby, are stable enough for NSTs (however often they are ordered by the MD, and depending on gestation) vs continuous EFM.

And yes, we are EFM certified.

cherokeesummer · Feb 14, 2010

Ditto pretty much everything Elvish said here, except we don't care for antepartum patients generally. We do moms/babies and gyn surgical patients. :):) We usually start with 4 couplets and end up with 5, sometimes more depending on how busy it is. There are rare times when we have way more but that is not the usual. Generally speaking we have 10 patients (5 couplets or any mix to equal that like 4 couplets, a gyn and a mom whos baby is in the nicu, etc.).

My shift generally runs about the same as below also (I'm a night shifter as well).

I work in a place that does about 6000 births/year, also 45 beds, and we have 3-5 couplets. We try to shoot for 4 but it's relatively common for us to have 5. Keep in mind that it's a mix - we may have one stable antepartum and 3-4 couplets, or one or more of the PP moms may have a baby in NICU. So no - critically ill babies are not part of couplet care.
We room in as much as possible and/or as much as mom wants. Assessments can be done in the room but we have to take baby out for daily weight, just because we only have one scale, which is in the nursery. We do get some late pretermers (q4 VS/assessments) and/or sicker moms, and if that's the case we try to staff accordingly (maybe 1:2-3). When they say one nurse per mother/baby, it sounds like they mean there is one nurse for the couplet vs. one nurse for mom and another for baby.
I work 12-hour nights, so my shift goes something like this - assess patients depending on when they need assessments (BIDs at 1900, q shifts at 2300), make sure everyone is stable, all outstanding issues are addressed, and finishe d/c teaching on the ones going home the next day. Then I run any NSTs if I've antepartums that need one. Generally by then it's around 2230 so then I start assessing my q8h folks and my babies. After then it's helping folks prn with self-and baby care, making sure pain is addressed. A HUGE part of my night is showing new parents how to navigate the nights with their baby - how to settle/wrap, etc. If there are any 0400 vitals I do them, then just before I go I pull foleys and make sure everyone is stable/settled. If a baby is getting circed that day, I give him his loading dose of APAP around 0600 and if any of my babies need bilicheks I do them around then as well.
Hope this helps. It really does work most of the time. I work a fair bit in the nursery and most nights anywhere from 60-80% (on average) of moms keep their babies with them.