3 Couplets, too much?


Our hospital has recently started using a new staffing grid and it has our mom/baby nurses in a panic. I have never worked in postpartum or routine nursery (only L&D) so I'm not sure what it's like to take on a 6 patient load. Is 3 couplets per RN an unreasonable amount? I'm pretty sure the standard is 4 couplets, right? Our mom/baby unit does not have a tech or aide and is responsible to do all blood draws, hearing tests and help with breastfeeding as we do not have a dedicated CLC. They are also responsible to send one RN to attend our routine deliveries and give APGRS. This can take from 30 mins to 1 hour. Recently they have been refusing to take our postpartum patients once they've been recovered citing the fact that they are "too busy" even though under the new grid they should be able to accept a new admission. We do have a high nurse turn over rate and many of the nurses on mom/baby are new grads or have less than one year of experience. I am a member of UNC and want to make sure that I am advocating for my coworkers if this really is an unreasonable patient load with all the tasks they are responsible for. Any feedback would be appreciated!

Ps-We are a small hospital and do about 100 deliveries a month.

Has 34 years experience.

I can only tell you what our M/B does. They take 3-4 couplets. But....they have aids/tech/care assists for maternal vs/infant baths, answering call lights, a charge nurse that helps with lights and breaks, and they are not pulled for deliveries. They also have a day shift lactation consultant that screens each bf couplet.

klone, MSN, RN

14,490 Posts

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 17 years experience.

Three couplets is absolutely not an unreasonable patient assignment, assuming they're all stable and low risk.


603 Posts

Has 20 years experience.

I did mother baby as a new grad, and had 4 couplets from day 1. HOWEVER, like lavenderskies stated, I also had a dedicated IBCLC to screen all of the breastfeeding couplets, aides to take vitals if I needed it, and it was NOT part of our job description to attend deliveries.

I think 3 couplets is reasonable, but the attending deliveries part is what gives me pause here. They shouldn't be doing that, IMO. That's either the L&D nurses' job or the nursery nurses' job. I think it's unreasonable to expect mother baby nurses to maintain couplet care AND attend deliveries. Usually, we have either a free L&D nurse attend the delivery, or if more advanced care is needed, the nursery team comes. The nursery team that comes is assigned either no assignment or a light assignment, specifically for that reason. I have never worked at a hospital where mother baby nurses attended deliveries. Ever.

klone, MSN, RN

14,490 Posts

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 17 years experience.

I agree with Quazar - I don't think a nurse that already has a full assignment should be expected to attend deliveries.


152 Posts

Has 2 years experience.

I used to work newborn nursery and occasionally mother-baby (our hospital usually split couplets between postpartum for the moms and nursery for the babies even though babies stayed in mom's room). We could have up to 8 babies or 4 couplets. We were small (a bit higher volume than you, around 120-150 deliveries/month) so sometimes, especially on nights, staffing would be a little low (2-3 nurses each for post partum and nursery, and always 2+ in L&D). Nursery nurses, whether doing just babies or doing couplets, would have to attend deliveries, but only high-risk ones (sections and e.g. meconium, vacuum-assist, or dystocia). Normal deliveries, L&D took care of the Apgars and immediate baby care (and called if they needed help from nursery), and nursery would come a bit later and admit the baby (and, if doing couplets, would later admit the mom as well). It's rough when you've got 5+ patients for whom you're doing breastfeeding education and assistance, hearing screens, baths, PKU's and bilirubins, etc. and you get called into a delivery that takes at least 30 min-1 hour.

I agree that for normal deliveries, L&D or a dedicated nursery nurse should be caring for baby. Does your hospital routinely staff a nursery nurse? Would they consider hiring to staff at least one tech per shift?

As far as your question, I believe 3 couplets is ideal, 4 couplets is acceptable but not ideal (hospital I was recently fired from often did 5 couplets at night--though they had techs and hearing screen techs and IBCLC's and lab did all draws and IV team did all IV's--still a lot of work though).

iPink, BSN, RN

1,414 Posts

Specializes in Critical Care, Postpartum. Has 10 years experience.

We do 4 couplets and people are leaving my unit. If I break down what we do for both mom and baby, for example chasing newborn blood sugars all night on top of PKUs/O2s, IV meds, Q4 vitals for pretermers, it is a LOT. And that's just focusing on the newborns. We are fighting hard to get the postpartum units at my hospital to take a max of 3 couplets and I work at one of the top 3 largest Women's hospitals in the country, in terms of deliveries.


208 Posts

Specializes in Med/Surg, Gyn, Pospartum & Psych.

We usually start with 3 couplets and get an admission so we have 4 couplets by the end of the shift. We do not attend the delivery but if the L&D is busy can get the couplet one hour after birth instead of the normal 2 hour wait. We do have a NA who does vitals on the mom (we do the baby) and helps answer call lights and escorts mom to the bath room the first few times. How busy the assignment is really depends on how many of my moms are 1st day c-sections, how many are 1st time moms, if they speak English, how many babies need blood sugars, and if they have anything else like Finnigan scores or bili lights. We do most of the breast feeding teachings, and baby things like bath, Algos, etc. The lactation consult comes for problems and never before 24 hours. I have cared for 5 couplets twice (not good nights for me because I felt my patients were neglected). Lab does all blood draws except the blood glucose checks.

Specializes in Nursing Education. Has 19 years experience.

In my current facility we take 3 couplets. This is manageable when we have 3 healthy couplets, but this is never usually the case. We have sick Mom's down here with high BPs, drug use, scant prenatal care etc etc. Subsequently our babies are SGA, LGA, GDM and req blood sugars, we give IV abx amp/gent to newborns on our PP floor that were exposed to GBS and mom not covered. We have no techs, no lactation at night and we are responsible for all Mom and infant care, VS, baby baths, hearing screens, 24 hr testing, CBC/bilis etc etc. Also, my floor take GYN surgeries and sometimes you can have a mixed group. So to be fair, it really depends on your population and what the RN is responsible for. When I lived in CA, we had 4 couplets and it was a whole different ball game with techs, hearing screens were outsourced, labs came and did our blood work and PKUs too. Find out what these PP/Mother-Baby nurses do and consider the question again.

Thank you so much for all the feedback! We never have a decdicated APGAR nurse from mom/baby and their team lead or resource person usually takes patients. We have a closed nursery (only staff allowed in) so when there is a baby in the nursery a staff member must be in the nursery until it is empty. When we only have 2 mom/baby nurses on nights it makes it hard for them to make it to an APGAR especially when one of them is stuck in the nursery. That also means there is no one to answer call lights when the other nurse is over on L&D! We keep 2 labor nurses on nights and 1 scrub nurse (scrub nurse is not labor trained). I have thought about asking our managers if the labor nurses could be trained to do APGARS but I'm pretty sure my coworkers would kill me í ½í¸µ I think the issue could be solved by giving mom/baby a tech on nights..or better yet an RN with a CLC!! I know it's just a dream but I really do think mom/baby is struggling, the morale is so low and the turnover high. Hopefully if we continue to press the issue management might give in.