5 couplets on mother/baby unit

[RUNBNursing]

Hello all, I need some advice!

I just interviewed for a position in the mother baby unit (nights). This hospital has the most deliveries in my region (5000+) a year and they are known for their maternity units. They are rarely any open spots in this unit and they are so sought after that new grads at this hospital do an unpaid internship (basically orientation) before getting hired and tons of people do it. I couldn't afford as a new grad to be unpaid for 6 to 8 weeks so I worked elsewhere (home visits with first time moms) but am ready to try bedside. Since I'm technically not a new grad (been at my current job for almost 3 years) but have no acute care experience, the nurse manager told me I would have to do the internship at a reduced pay, not sure what the reduced pay is, didn't think I should ask until an offer was extended. But I do know base pay is $32 an hour (I currently make $36 an hour). 

I would love to work at this hospital and the reduced pay doesn't bother me (too much), 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? I did clinicals there back in 2015 and I can't remember if the nurse had 5 couplets, but I do remember the amount of work seemed doable, the environment was very welcoming and the nurses seemed very happy. I do know that the unit always has techs, sometimes one per nurse, who can do a lot, from removing foley catheters to drawing blood on moms, they are paid well and take their jobs seriously from what I saw. I also know the nurses aren't responsible for hearing tests, there are nurses designated for the nursery, and an NICU, so mother baby nurses don't have to worry about phototherapy or babies in observation.

Is this normal? I haven't been extended an offer yet but I wanted to get opinions about this.

Thank you in advance!

[rac1, ASN, BSN, RN]

On 10/22/2020 at 6:39 PM, klone said:

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. 

Thanks for being an awesome nurse leader. We need MORE.

[MCURN]

Our base is 4 couplets. On a crazy understaffed shift we have gone up to 5, however it is rare. I would never work in a place where 5-6 is the norm. Emergencies with moms and infants can occur at anytime during their hospital stay. And that would be on top of helping moms breast feed, dealing with late preterms, infants on phototherapy, infants with sugar instability, neonatal abstinence scoring, basic teaching, c/s protocols, doing bloodwork on moms and newborns, etc etc.  

[AutumnDraidean]

I worked maternal newborn and typically carried 3 couplets and 1-2 surgicals. My hospital did a little under 1,000 births a year.  On occasions where I had more it was only for a partial shift. My nightmare was getting caught in a room helping breastfeeding when others needed me. Even the strongest tech is no substitute for an RN. I've had RNs misjudge situations, never mind aids or techs. 

Any time you get above 8 patients you're at risk to miss something. when I've had more than 8, my colleagues did to and depending on time we were usually calling in our call person to bail us out. 

The only good thing I can say about it is that you will see a lot of different pathology and situations in such a busy hospital. Be careful to build teams and get to know those techs. ALWAYS double check vitals and last baby feeds. Don't assume that you will be told of out of parameter things, or that the tech will respond appropriately to outliers. Because when the rubber meets to road it's the RN who's responsible.

How anyone is supposed to be able to do any decent teaching with 5 couplets I don't know.