Hello from St. Joe

[momredman]

I just joined your little group today and looking forward to asking questions and getting suggestions concerning and upcoming change to our Ob unit. New team leader to solve staffing has decided we should convert to a mother-baby unit even though the unit of 10 yrs was not designed for that style of nursing. The idea was tried twice in my 22 yrs of nursing and did not work. Our unit currently delivers 120-140 babies a month with at least a 30% C/S rate. We currently have 15 ldrp's and an out pt area which sees 300 outpt. a month. We are a level II nursery and most of the time we are full and send inductions home until bed space allows. We have 7 newborn nursery nurses on day shift and 15LDRP, a third of which is crosstrained to normal newborn nursery. The current solution in the air is to have the 7 nursery nurses do mother baby freeing up the L&D staff. I guess my question is what is the nurse ratio to mom-baby couples, who does the delivery and responsible for the newborn, who takes of NICU babies, and how much cross training is given to care for normal mothers? Our leader seems to think 4 shifts is even training to learn care of babies and mothers. I am trying to keep an open mind because couplet care will work in certain situations, but what happens to the patients who fall thru the cracks like new c/s, tubals, moms on mag, situations where mom is unable at the time to care for newborn and needs, a lot of care herself. Would appreciate any suggestions.

Dumbfound in Missouri

[Tweety, BSN, RN]

Welcome. There is an OB forum on this website that I would ask your question. There are a lot of nurses there who can help you. Good luck.

[suebird3]

welcome to allnurses.com! i moved your post to the ob forum so you can get more responses.

enjoy the site!

suebird

[SmilingBluEyes]

Hi there.

Couplet care is WONDERFUL----but cross-training everyone not so wonderful. It will take time and the learning curve can be steep for some. It sounds as if you have a very busy unit----one perhaps a bit busier than most couplet care units (LDRP) usually are. I have some questions you all might consider as this big project is being considered and started:

*Is there a time frame in which this is to be completed and everyone cross-trained?

*Are most of you onboard---or is there a LOT of resistance? Attitude is EVERYthing in this.

*Have you and the nurse management been in contact with units that made this transition to see what works and what does not, when converting like this?

It can be a huge undertaking, but in the end, well worth it. But attitudes need to be positive and people need to be ready and willing to learn "other" areas.

*And most crucial, how will staffing be? Make sure you are all aware of AWHONN patient-nurse ratios, in varying stages (labor, immediate recovery, stable couplet---- as well as special situations like Mag Sulfate, high risk pregnancy complications, etc) and keep to them. Staffing will make or break any unit, and this is particularly true in LDRP situations, where everyone can become scattered when the "labor bus" pulls up.

Being organized is crucial, as well! You can go from caring for stable couplets to dealing with a high risk labor patient, to the OR----all on a dime. You know how fast things can change in LDRP nursing. It happens all the time. All staff must be flexible and willing to change assignments as unit census needs reflect and change rapidly. That is why I say "attitude is everything". When all are trained and up and ready, it flows amazingly well, like on my unit. When not, it can be a disaster.

A couple suggestions:

I would recommend you all get a hold of AWHONN's

Single Room Maternity Care for the 21st Century linked below:

http://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&isbn=0781722330&itm=1

And also, contact AWHONN and get a copy of their standards for nurse-patient ratios.

http://www.awhonn.org

Other than that, I wish you the best. It will be a tough transition, but with proper planning, staffing, consistent and thorough training/orientation and the right attitudes, it CAN be done!!!!! I personally LOVE doing "it all" (I also do GYN patients and level 2 nursery care). I am NEVER bored.

Anyhow, you are understandably nervous. I hope it does go well. Good luck.