MD's trying to change the way we care for newborns

BETSRN · Jan 27, 2005

I am a RN at a regional medical center that does approximately 1,000 births/year in a LDR setting with a separate PP/GYN unit. We have been doing couplet care for the past two years and a majority of the nursing staff are pleased with the change. However, there are a few of the peds who would like us to return to our previous method of care which was a single RN assessing and being responsible for all infants. We are being faced with having to return to the old way as they have said that the trend is moving away from couplet care. I am wondering what is happening out there. So if you have the time, I and my coworkers would really appreciate your input. Thanks in advance.
WE are an LDRP and about the same size. It took our peds a long time to get used to not having the nurse "handmaiden" effect. They got over it. We probably do both. really.
State-- CONNECTICUT
# births/year-- ABOUT 850
Do you do couplet care?YES
Who attends deliveries?WE ALL DO: ONE NURSE IS MOM'S AND ONE FOR BABY AND WE HAVE A NEW PEDIATRIC HOSPITALIST PROGRAM IN THE WORKS, SO PEDI OFTEN ATTENDS IF SHE IS THERE. ALWAYS A PEDI FOR MECONIUM.
Standard's for newborn vitals/assessments?Q1/2 HOUR TIMES TWO AND THEN Q4 X1 THEN QS
Do you have a well-baby nsy or just a NICU or both? NO NICU. DO HAVE NSY BUT TRY NOT TO USE IT AS MUCH AS POSSIBLE
If no, well nsy where do infants go if mom needs a break?INTO NSY OR AT DESK WITH NURSES OR SECRETARY.SOMEONE STAYS AT THE DESK,THEN.
Do you have a charge nurse, or someone who oversees all the newborn assessments done by the couplet nurses?

ALL OF US ARE CROSSTRAINED TO DO LABOR/NSY/PP. AS LONG AS THE ASSESSMENT GETS DONE BY AN RN IT DOESN'T MATTER WHO DOES IT. WE HELP EACH OTHER.

Jolie, BSN · Jan 27, 2005

I am a RN at a regional medical center that does approximately 1,000 births/year in a LDR setting with a separate PP/GYN unit. We have been doing couplet care for the past two years and a majority of the nursing staff are pleased with the change. However, there are a few of the peds who would like us to return to our previous method of care which was a single RN assessing and being responsible for all infants. We are being faced with having to return to the old way as they have said that the trend is moving away from couplet care. I am wondering what is happening out there. So if you have the time, I and my coworkers would really appreciate your input. Thanks in advance.
State--
# births/year--
Do you do couplet care?
Who attends deliveries?
Standard's for newborn vitals/assessments?
Do you have a well-baby nsy or just a NICU or both?
If no, well nsy where do infants go if mom needs a break?
Do you have a charge nurse, or someone who oversees all the newborn assessments done by the couplet nurses?

What is their rationale for requesting this change? I've worked in 2 mother-baby units, and one traditional post-partum/nursery department, and have to say that I believe the quality and continuity of care and patient satisfaction to be far superior in the mother-baby setting, especially among breastfeeding mothers.

Have the doctors noticed a problem with decreased quality of newborn care with the mother-baby set-up? If so, what would that be? Could it be improved thru further inservicing of staff?

Or do they just want the convenience of working and communicating with a single RN, rather than the entire mother-baby staff, regardless of the clear benefits to their patients of mother-baby nursing?

I'm not currently working, but can tell you that in this area (far southwestern Chicago suburbs), the 3 hospitals closest to me have all recently re-done their maternity units to accomodate the LDRP set-up and mother baby care.

Good luck on this issue!

SamOBRn · Jan 27, 2005

They say that "things are being missed, by the nurses who are caring for the couplets." They haven't brought forth these "things" yet, they have just presented a list of demands to our department manager. They are used to having a NICU trained RN assess all the infants, all of the infants were assessed in the nursery, the babies were rounded up for morning rounds and everyone's baby came to the nsy for the MD exam. So it was easy for them just assess all their infants and do their charting in one place rather than moving from room to room to assess the infants in the mother's room, it was like a assembly line moving from one infant to another, washing inbetween.

As a staff we believe that couplet care has improved care because the RN caring for that newborn is having continued contact with that infant throughout the shift, helping with breastfeeding and the like. The parents also get to be present during the newborn exam which we believe encourages them to ask questions of their MD and facilitates a relationship with thier MD. When all assessments were done by one RN it was possible that after that one assessment that the RN may not physically see that infant for the rest of the shift as she may have been tied down in the nsy with a Bili baby or Grower.

Also if anyone knows of any researched based data on couplet care that maybe of help I would appreciate it, I have found some but any other info would be great! Thanks

palesarah · Jan 28, 2005

State-- New Hampshire

# births/year-- 800

Do you do couplet care? yes!

Who attends deliveries? nurse for mom, nurse for baby, MD or CNM (responsible for intubating if needed)- peds attendance at delivery is only required for sections, preterm, & twins; they will come in if the OB thinks they should come for some other situation

Standard's for newborn vitals/assessments? q30min X 3, then q shift

Do you have a well-baby nsy or just a NICU or both? Level 2 nursery that is also used to do tests & procedures on well-babies

If no, well nsy where do infants go if mom needs a break?if there is a nurse in the nursery, we'll park them in there, or at the desk with a nurse or secretary

Do you have a charge nurse, or someone who oversees all the newborn assessments done by the couplet nurses? yes we have a charge nurse, but she doesn't oversee all newborn assesssments

editing this to add- we have an old fashioned ped who likes to have all the babies lined up in the nursery for him. And we, and the patients, humor him, because he's an excellent pediatrician. I always tell the parents that they are welcome to accompany the baby to the nursery, and if mom is unwilling to have the baby go to the nursery I will set up her room for the doc to do his assessment in the room, and just bite the bullet and tell him he needs to go there. But 99% of the parents don't have a problem with us bringing the baby out for a bit at 5:45am (when the good doc arrives), they're usually looking for just a few more minutes of sleep about that time anyway :)

SmilingBluEyes · Jan 28, 2005

State-- Washington

# births/year--about 800-850

Do you do couplet care? YES! and love it!

Who attends deliveries? the doctor, OB on call. And a labor nurse who circulates, as well as baby nurse, who stabilizes the newborn at birth. All of our nurses are NRP and STABLE certified, so we can ALL attend newborns at delivery and afterward. We do have a Pediatrician in, for anticipated problems. Twins are delivered in our OR, in case there is a problem, with the addition of a nurse for the 2nd newborn.

Standard's for newborn vitals/assessments? Depends on the wellness of newborn, really. Well newborns: 3 sets of good vital signs in the first hour of delivery, and then q 1 hour for 4 hours. After that, observe 2 -4 hours, with vital signs q4 hours. Sick newborns go to the nursery and have to be on EKG and Sat monitors, in the servo warmer, so vital signs are constant. But they are recorded at least every hour while in Level 2 care. More often, if conditions warrant.

Do you have a well-baby nsy or just a NICU or both? Just a Level 2 nursery, not NICU. That is to say, we do care for neonatal sepsis, feeder/grower issues, blood sugar stability, stabilizing TTN'ers, etc. More than that, they go up to Children's about 25 mi up the road.

If no, well nsy where do infants go if mom needs a break? We take them for them if at all possible, and give them a break til they need to breastfeed again. Rarely do we say "no" unless the floor is chaotic, or the nursery is in dire straits. (meaning two or more really sick babies). I will emphasize we have NO "well baby" nursery, officially. Moms keep their babies in the room with them almost all the time, and that is the expectation. We rarely get anyone complaining about that. If a mom is sick, or fresh from surgery, our help is a GIVEN. We will care for these newborns for them as much as possible.

Do you have a charge nurse, or someone who oversees all the newborn assessments done by the couplet nurses? Yes we have a charge nurse, but each of us is responsible for our OWN assigned patients' care, including assessments, and vital signs as well as notifying MD's of changes that require reporting. The Charge Nurse is aware of all that goes on, both in nursery and out, but the individual nurse is responsible for her own patients. The Charge nurse communicates problems to the appropriate person, as needed and is responsible for shift reports to the manager and house supervisors.

HTH! :)

Mermaid4 · Feb 6, 2005

We help each other too and I have to say the pediatricians are getting so anal that they actually put "place infant on back" and, "if mother desires to switch to breast feeding, call any time of day or night for order." Ok, I think, will do, so at four am when some exhausted mother has a cluster feeding child ( and the night shift has been talked to for providing an hour or so respite for these moms in order for them to get used to what will happen when they go home), the mother changes her mind, I will call them ( at one, two or three am as well, rather than wait). When they get irate about that I remind them that they all felt the need to consider the nurses not intelligent enough to do these things on their own. Also, they want to be called if a spitty baby, in plain view of a nurse, is to be in any other position than his or her back..After about a month of this malarky and several calls as ordered, by the night nurses, I noticed those ridiculous things were off the order sheet....

allnurses Guide · Feb 6, 2005

Well, I don't think I'll be any help but here goes.

State-- California

# births/year-- I'd have to guess about 100

Do you do couplet care? Mom and babe in one room - one RN, one CNA. The RN can have 4 other mixed patients - 6:1 ratio here in CA and we count the baby.

Who attends deliveries? Doctor and one RN.

Standard's for newborn vitals/assessments? Q 15 min for 1 hour then Q4H

Do you have a well-baby nsy or just a NICU or both? A nursery for bathing and weighing/measuring - not staffed.

If no, well nsy where do infants go if mom needs a break? If we have staff, to the nursery but not for long :)

Do you have a charge nurse, or someone who oversees all the newborn assessments done by the couplet nurses? No.

We rarely have more than one delivery at a time.

Rural nursing. :)

However I do not like what your doctors are trying to do for all the reasons already stated here.

steph