5 couplets on mother/baby unit

DrMissitRNfixit, BSN · Sep 11, 2020

Hey girl! If you have the excitement and drive for Mommy & Baby, you will love it! I have done it for 13 years(since graduating), but I will tell you that I feel like I limited my skills. ( I have started working PRN on our gyn/breast Med/Surg Unit to increase my knowledge a bit!) Plus we help with delivery’s by wiping off the babies if they come to the warmer or inputing info into the computer/circulating.

I work nights PRN and love it. That said, we have one tech M-F for our entire unit until midnight, and I often forget she is there. 5 couplets used to be our normal, but now we have 4. Our unit is a LDRP, so we get couplets passed off and on rare crazy nights, I’ve had maybe 7? You just have to laugh and say OK because you know the nurse handing off isn’t in any better shape. Our night crew is a good team
     Once you get a mom past the initial 4 hours with a lady partsl birth and 8-12hrs with a C-section, they’re “less busy”. It is definitely manageable, especially if you get a system down, establish a good rapport, and realize they enjoy your help, but they also want to bond with their new baby without someone over their should every hour. (it took me HAVING a child to realize this ??‍♀️).
I PERSONALLY would not choose another area of nursing and feel blessed to get paid for what I do. I treat most of my patients like my friends and even on crazy nights, I feel like both the patients and I have had good nights.

klone, MSN, RN · Sep 12, 2020

5 couplets is not safe or fair. I think this is mitigated somewhat by having a tech for every nurse, but it's still very heavy. Also, the "reduced pay" training is ***.

I understand your desire to get your foot in the door. If there are truly no other options for inpatient OB, I would consider working there for a year and then looking elsewhere.

RUNBNursing, BSN · Sep 13, 2020

On 9/11/2020 at 1:32 PM, DrMissitRNfixit said:

Hey girl! If you have the excitement and drive for Mommy & Baby, you will love it! I have done it for 13 years(since graduating), but I will tell you that I feel like I limited my skills. ( I have started working PRN on our gyn/breast Med/Surg Unit to increase my knowledge a bit!) Plus we help with delivery’s by wiping off the babies if they come to the warmer or inputing info into the computer/circulating.

I work nights PRN and love it. That said, we have one tech M-F for our entire unit until midnight, and I often forget she is there. 5 couplets used to be our normal, but now we have 4. Our unit is a LDRP, so we get couplets passed off and on rare crazy nights, I’ve had maybe 7? You just have to laugh and say OK because you know the nurse handing off isn’t in any better shape. Our night crew is a good team
     Once you get a mom past the initial 4 hours with a lady partsl birth and 8-12hrs with a C-section, they’re “less busy”. It is definitely manageable, especially if you get a system down, establish a good rapport, and realize they enjoy your help, but they also want to bond with their new baby without someone over their should every hour. (it took me HAVING a child to realize this ??‍♀️).
I PERSONALLY would not choose another area of nursing and feel blessed to get paid for what I do. I treat most of my patients like my friends and even on crazy nights, I feel like both the patients and I have had good nights.

Thank you for your encouraging reply. I was offered the job and will be taking my med exam on Monday! 7 couplets sounds like insanity to me! I hope they treat me nice as a new grad. I agree that coworkers can make or break your shift so I'm hoping mine are real team players.

RUNBNursing, BSN · Sep 13, 2020

13 hours ago, klone said:

5 couplets is not safe or fair. I think this is mitigated somewhat by having a tech for every nurse, but it's still very heavy. Also, the "reduced pay" training is ***.

I understand your desire to get your foot in the door. If there are truly no other options for inpatient OB, I would consider working there for a year and then looking elsewhere.

The reduced paid training is definitely BS. This is a non profit catholic hospital so I guess maybe that has something to do with it? Their new grad internships are very competitive since they are the main perinatal center in the area and I guess no one complains. I am willing to take a HUGE paycut to finally get into a hospital and plan to definitely reevaluate after a year.

rac1, ASN, BSN, RN · Sep 17, 2020

I'd like to give my opinion on this topic. My background is that I have a year of experience in a very busy trauma stepdown unit with overflow of med/surg (throw in lots of psych and an underserved population to boot). On a good day you have 4 patients, on a good night you have 5. On a bad day you have 5 patients and on a bad night have 6. Trend 4-6 patients and you're good. It is a difficult floor - from the trauma/wound care to adding in psych and comorbidities - just a busy, difficult patient population. That is what I stepped into out of school. I think the difficulty of the unit coupled with the amazing team environment helped me to become amazing at time management. When I was brand new I had several seasoned nursing from other units say to me "If you can work here, you can go literally anywhere." Difficult unit. That being said, my dream was always L&D. So fast forward to a year later, I landed my dream job on L&D. We actually float to PP when we are needed there and slow in L&D. And yes, we can take up to 5 couplets there as well. Which is actually 10 patients, right? I was a little shocked at first, but my training on my trauma floor taught me such great time management that transitioning to 5 couplets was a breeze. In fact, 2 laboring patients is sometimes WAY more than 5 patient's (something I never would have believed before I had that experience myself!). However, without my previous experience I would have to say that the initial learning of how to care for 5 couplets would probably be quite overwhelming. The learning of assessments, charting and time management is a lot on 10 patients. Coming into that already knowing assessment, how to chart and how to manage time takes a load off. Where I work, they really try to staff you so that you have 4 couplets or less.

So, I know that one poster said that 5 couplets is unsafe, but I would disagree. I think it does matter what experience the nurse has and I also think that what kind of environment (co-workers and leadership) you're walking into matters as well. Being able to ask for help and get advice when you need it goes a long way. Having a tech for every nurse?? That is seriously golden. Especially if they can do things like blood sugars on babe's and 24 hour tests, etc. I wouldn't shy from the job - but again, my experience definitely colors the glasses differently for me. ? GL!

DrMissitRNfixit, BSN · Sep 17, 2020

100%!! Our Labor girls would have two inductions at most, which is rare, but it would be a slow roasting night in h*ll for them to have 2 active labors. ? (That’s when we all suck it up together.) You go girl! ??
Postpartum/ Couplet care is the way to go RUNBNursing!!!! ?

rac1, ASN, BSN, RN · Sep 17, 2020

1 minute ago, DrMissitRNfixit said:

100%!! Our Labor girls would have two inductions at most, which is rare, but it would be a slow roasting night in h*ll for them to have 2 active labors. ? (That’s when we all suck it up together.) You go girl! ??
Postpartum/ Couplet care is the way to go RUNBNursing!! ?

Two inductions at the same time is not rare for us! I wish it were. =(

Leader25, ASN, BSN, RN · Sep 17, 2020

On 9/9/2020 at 7:06 PM, RUNBNursing said:

but what does is that the NM said their norm is 5 couplets per nurse. That seems like A LOT to me, since I believe the recommendation is 3 to 4?

Five couplets or however they want to call it is still 10 PATIENTS YOU ARE RESPONSIBLE FOR.Things can happen in either section which you have no idea about yet, and those happy loopy sleep deprived moms do drop their babies,....and well babies can have un dx sepsis, with delay in treatment fatal outcome,extreme jaundice which was not picked up because some new nurse misread the scanner...

When hospitals first converted to these "M/B units ,nurses were promised 3-4 couplets....they were supposedly going to follow NANN or Awhon ?guidlines.

When bad things happen you will hang because you accepted the assignment.

klone, MSN, RN · Sep 19, 2020

On 9/17/2020 at 1:13 PM, rac1 said:

So, I know that one poster said that 5 couplets is unsafe, but I would disagree.

It is, though. AWHONN agrees with me. That's why they don't recommend more than 3 couplets per nurse. I am a nurse manager, and I would NEVER dream of expecting nurses to provide good, safe care to 5 couplets.

rac1, ASN, BSN, RN · Oct 22, 2020

On 9/19/2020 at 9:19 AM, klone said:

It is, though. AWHONN agrees with me. That's why they don't recommend more than 3 couplets per nurse. I am a nurse manager, and I would NEVER dream of expecting nurses to provide good, safe care to 5 couplets.

LOL. If only AWHONN managed all the hospitals, paid the nurses, and created the policies.

klone, MSN, RN · Oct 22, 2020

5 hours ago, rac1 said:

LOL. If only AWHONN managed all the hospitals, paid the nurses, and created the policies.

You just need to have leadership that supports it and makes it a priority. I do. Every unit I've ever led, we've followed AWHONN staffing guidelines.