Mixed model of care LDRs with some LDRPs thrown in

[PegRNBSN]

Another new hospital question. Awhile back I received many helpful responses to my question about LDRs vs LDRPs. I shared them with my planning team. We planned our unit as an LDR unit and things progressed. At the end of the design development stage, some MDs went to administration and demanded that there be LDRPs included. Now they want us to have our LDR unit and if someone wants and LDRP to do that too, some of the rooms being a great distance from c-section rooms and the rest of the LDR supplies.

Does anyone have any experience with a mixed model of care (not two different units)??

Any opinions on this scenario??

Thanks

[fergus51]

I've seen this in one hospital. They basically ran it as though it was 2 separate units. There was a group of nurses who would work exclusively LDR and one group who would work LDRP and another that would do both. Patients were asked their preference on admission and given LDRP if it was available (practically all of the patients wanted LDRPs). The LDRP rooms were farther from the OR and supply rooms, but it worked fine (as long as the rooms were stocked like they were supposed to be each AM).

[PegRNBSN]

The difficulty we are having is the size of our unit. The farthest rooms are almost two football fields apart.

[fergus51]

You can't put the supplies somewhere in the middle? Or the section rooms? Even still, wouldn't some rooms have to be that far away no matter what?

[tntrn, ASN, RN]

I hear you on the football field size units. Who plans that sort of thing anyway? Our unit is LDRP, but we also do gyn surgeries. Any patient admitted to an LDRP and then has a c/s is moved to one of the surgical rooms. This is necessary because we can't tie up the LDRP for the extra day a post c/s patient stays, AND it creates all kinds of problems when the patient (and family) finds out they are moving to a different room that is smaller, no tub, etc. No more Hilton; more like Motel 6.

Personally, I hate the LDRP thing. On our unit it is never possible for the delivered patients to be away from the laboring patients, so they are trapped into hearing the noise of all-night visitors, the noises of a delivering mom, and the shouts of joy when it's over. If I were a fresh postpartum and needed to sleep, I'd be begging for one of those small, quiet rooms down the hall.

I think it's like a lot of things: if it works perfectly, it's probably fine, but there are too many variables involved and therefore can only work perfectly part of the time.

When we were TOLD we would be getting LDRP's, after we voted as a unit overwhelmingly for LDR's, we were promised 24-7 housekeeping help. That lasted about 2 months and the nurses now are responsible for washing the beds (and floors) when the patient can finally get up to the shower. If the place is not hopping, I don't mind, but that's not what they promised us...like a lot of other stuff.

Our supply situation is pretty sad also. The supply rooms are in the middle of the unit, really really far away from some of the patient rooms. There are no staff phones except at the 50 yard line nurses station, where by the way, there's no wash basin either. It was obviously planned by architects who had not a clue about what nursing units require for efficient operation.

Oh, thanks for letting me rant. I feel better now.