Mother/Baby Care does it really work?

[pscmason]

My unit has been undergoing changes to combine postpartum and infant care for the past 19 months. The problems and concerns are the mom's we get on Mag for PIH, fresh C-Sections, blood transfusions, and this is part of our couplet care. We have one nurse in charge and recieving for the nursery, and no NA so she is unable to take care of circumcisions, PKU, Bili babies, hearing screens, taking infants to ultrasound or any testing. At times we do not even have a NA for the postpartum floor past 3pm and nights. And weekends, if you have a secretary past 3pm, she is running between the nursery and postpartum to try to put orders in. And our management team is still trying to continue couplet care without any changes to the above concerns, is this normal issues in mother/baby care, What happened to safety? Oh did I mention our patient ratio is an average of 85% non english speaking.

[RN0202]

Sure hope it gets better for you. Just remember- protect yourself and your license!! The staffing issues, ratios, etc. just seem unsafe. I work in a Magnet hospital where we get up to 5 couplets max. No pt. with mag, they stay in L&D, Good Luck,

Char

[ABQLNDRN]

I am a mother/baby nurse, and in the combined care concept works very well, but it sounds like you are up against a dangerous staffing situation! They can only expect one person to do so much! If we have a higher acuity mom, the baby stays under nursery care longer (mag pts... fresh C-sections are under nursery care for the 1st 24 hrs, etc.). We always have either an RN and a CNA or two RNs in the nursery. Expecting one nurse to do everything in the nursery is NUTS. Plus, we have hearing screen techs. It's great. Often, our CNAs will do PKUs and bilis. On the floor, we maintain 6 pts, which is usually 3 couplets.

I would be concerned also if I were dealing with your staffing situation. Yikes and good luck.

[MIA-RN1, RN]

We do mother/baby care, with a ratio of about 4 -5 couplets. This includes AP pts, post partum mag patients, postpartum c-sect and vag, and the occasional womens-surgery patient as well. Hemorrhages, transfusions, the list goes on. And everyone's baby of course. The nursery is supposed to be staffed with a nursery nurse, who does what needs to be done in the nursery but we encourage a lot of rooming in and also sometimes have to close the nursery so the nursery nurse can take a patient assignment when census is high or staff is low.

Nurses are responsible for their assigned babies as far as baths, blood, bg's, circ assist etc etc unless of course the nursery nurse can do it. We often do have someone in nursery. We always have an overnight nursery nurse.

When moms deliver, the babies stay with them whether csect or vag, and then provided no problems with baby, they come right with mom to mom's room when she gets to our floor. They don't have to spend any time in the nursery at all. Baths are encouraged to be done in the mom's room with a warmer as well, esp. if its the first baby. (Baths aren't until 4h of age or longer)

Charge nurse has an assignment as well. In theory its a little lighter than other assignments but I have seen that doesn't often happen.

We usually have one or two techs, no overnight tech. Techs do mom vs and not much else clinically. One will draw blood on moms. Answer call bells, stock stuff etc of course. They are vital but I'd like them to have more clinical duties like bg's on moms, help moms get up, empty foleys etc. (yeah thats an issue with me)

Does it work? Yes. But when you have an AP, gyn surgical pt, fresh c-sect and two other vags, plus the babies....its a LONG and BUSY shift. (that was my assignment not too long ago)