we are in the planning phase for a new ob unit; the staff really wants to go to ldrps, but we are meeting wide-spread resistance among the ob providers. the perinatologist has stated "ldrps were "in" in the 80's but are on the way out, everyone is reverting back to ldrs".
i'd like to have actual statistics to refute (or, hopefully not!) verify this statement . . . anyone have any ideas where i could look for statistics? what are you doing at your place if you are plannig a new unit? thanks for the help.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
It IS all relative. A lot of resistance comes from STAFF, not the inability to do LDRP logistically. It IS doable, IF people are willing to cross-train. but many are NOT.
We don't have enough space. We do LDR, and still have the majority our of PP rooms as semi-private. We are doing between 350-475 deliveries a month now, and we have 12 LDR's and 38 PP beds. Over half of the PP beds are semi-private, so that would SERIOUSLY cripple our unit.
I think LDRP's are great. But if it's not possible, then the staff should be cross trained. For example, it's ridiculous for a L&D or a PP nurse NOT to know how to help a mom initiate breastfeeding. That should NOT be something that only nsy nurses do.
I agree with Deb on this one, LDRP would make me much more marketable in the long run.
As a place to check statistics--check with JCHACO. They might be a good starting place or can maybe point you in the right direction. Our "new" birth center opened 6 years ago and providers wanted LDRP rooms. We do about 400+ births/month. We have 42 LDRP rooms. It can be done--it's not passe' at all. Our nurses are trained to do at least 2 of 3 jobs. Labor, post-partum , and nursery. We're allowed to pick our own assignments so most of the time there is a great continuity of care on a day-today basis.
We used to have 21 LDRPs, but as we are now doing 350+ deliveries a month, it doesn't work anymore. Last year we went to LDRs, transferring stable moms to another unit at 2 hrs pp. The nurses involved seem to like doing only L&D or only pp.
We don't have a normal newborn nursery, all babies room in with mom, only the sick ones are admitted to our Level II nursery. The only other ones that come to us are babies belonging to sick moms, or CPS holds, or babes being adopted out, if mom does not want the baby in her room.
I work in a very small LDRP unit. We do around 300 deliveries per year. Our unit was remodeled in 98. We went from LDR to LDRP. We love it and our patients do also. We have 3 LDRP and one PP room for our c/s patients. The only time we have a problem is when we are really busy. If we have more than 4m/4b then we have to start doubling up, which we hate!!! It's very hard to remember back before the remodeling when we had a 4 patient PP room!
I LOVE LDRP. That's what I oriented into straight out of school. That was what the 2nd and 3rd hospital's I worked in had. Now number 4 is LDR with separate PP. I really wish one of the hospitals around here had LDRP. I think it's wonderful. Incidentally, that first hospital I worked in remodeled and went to LDR. Very sad.
I think LDRP concept is great too, but I interviewed at one hospital where the manager stated she had a hard time recruiting staff to be responsible for all areas. She said she has had nurses that only want to do L&D and are not interested in PP or infant aspect. And nurses who only want to do PP and not L&D or Nsy.
I'm not sure where you would find statistics, but staffing issues may play a big part in the decision.
I think that's true, I worked at a facility where they tried the LDRP thing. Ended up not working because some of the L&D and nursery staff refused to crosstrain to do postpartum. What we ended up with was a labor nurse taking care of the mom/baby through labor and recovery and then transferring her to a postpartum nurse. Nursery nurses, most of them NEVER came out of the nursery to do postpartum. And they didn't build enough LDRP rooms so when things got crazy, a mom who had been told she'd be able to stay in this NICE ROOM her whole stay got booted down the hall to a smaller hospital room like postpartum room to make way for laboring moms. People got really mad and didn't like it. I suppose it could have worked if everyone would have cooperated... but like most things they didn't :stone
As a place to check statistics--check with JCHACO. They might be a good starting place or can maybe point you in the right direction. Our "new" birth center opened 6 years ago and providers wanted LDRP rooms. We do about 400+ births/month. We have 42 LDRP rooms. It can be done--it's not passe' at all. Our nurses are trained to do at least 2 of 3 jobs. Labor, post-partum , and nursery. We're allowed to pick our own assignments so most of the time there is a great continuity of care on a day-today basis.
Ok, I work at a large teaching hospital that does about this many births each month. How on earth are 42 LDRP rooms cost effective and space effective??? We have a limited space in the hospital - and we were renovated 3 yrs ago - and need to be renovated and enlarged again.
We currently have 14 LDR rooms, 3 antenatal assessment beds, and we're capable of having a 6 bed PACU (but in reality, at the most, we have 2-3 pts in PACU). We have 3 OR's for sections/other OB surgeries.
When our patients deliver, they go upstairs to one of the private 34 beds on postpartum. There is a newborn nursery, with a 2nd nursery for overflow.
We have a 6 bed inpatient antenatal unit for long termers (private beds) on other wing on the LDR floor, and I believe we can take 12 or so inpatient antenatals (long termers) up in our women's unit next to postpartum.
I would LOVE to be all LDRP, but I doubt it will ever happen in my hospital. The postpartum nurses (sorry postpartum nurses) are some of the most insensitive people I know, and I highly doubt they would want to cross train into L&D.
I worked for 3 yrs before this unit, in a small hospital with 8 LDRP's, 1 antenatal room, and 1 recovery room, with 2 OR's for sections/ob surgeries. We did mostly low risk patients there, versus where I am now. Our patients at the smaller hospital LOVED the LDRP's, and so did I. Our births were about 30-50 per month though, so it was MUCH slower then where I am now. Needless to say, this unit was closed down (thus my change in employer) due to not enough business to stay open any longer.
I like the concept of LDRP from the standpoint that I get to do all those types of nursing. Sometimes we end up moving patients anyway because we need the LDRP bed (only in a bed crunch). We have a small segment of rooms on our LDRP which have surgical beds in them and are usually for c/s'). I have also worked in an LDR, ehich I liked also. Most times, our patients do not mind moving to a different room anyway, because they know why we are moving them.
LDRP requires a lot more cross training of the nurses and some units are not able to accomplish that because of staff resistance. So unless ALL your RN staff are completely crosstrained, you don't truly have an LDRP anyway. I know that when we made the initial switch-over about 15 years ago, there was some resistance and those resisting left. Our manager was firm about that. The results have been so positive. Those who remain who were there in the "old days" wouldn't go back for anything.
rndani: If your nurses are trained in only two of three areas, then you don't truly have an LDRP. The patients may stay in one room but all staff are not able to do all aspects of nursing in that concept. I realize your place is big and it sounds as though you guys ahve done a great job, but I question whether or not you truly ahve LDRP if your nursews get to choose. There will always be those who like nursery better, or labor, or moms but we all have had to be trained in all thre areas to be able to be truly an LDRP.
SmilingBluEyes
20,964 Posts
It IS all relative. A lot of resistance comes from STAFF, not the inability to do LDRP logistically. It IS doable, IF people are willing to cross-train. but many are NOT.