Mother/Baby VENT!!!

[BaByNuRsE07, BSN, RN]

I'M DONE!!

I've been working as a Mother/Baby postpartum RN for almost 3 years at a community hospital. My hospital is rated one of the best in the state, and our marketing department is top-notch at letting the area know we deliver 6,000-7,000 babies a year. We have two Mother/Baby Units with a total of 60 beds.

I was in :redbeathe with postpartum since nursing school and thought I'd hit the jackpot when I was offered the chance to transfer after completing one year of Med-Surg nursing. Now, as a 2nd career nurse, I am fully aware that change is constant and customer service/physician loyalty is important.

Our division has undergone a lot of changes since I've been there. On what used to be the postpartum unit, we are now required to care for antepartum's. The c-section rate is through the roof. Our ratio is 5 couplets:1 RN. On a normal day shift, a nurse discharges 2-3 couplets and admits at least two more. Assignments are not based on acuity, but simply rotated between nurses. All patients are to be discharged by noon (on their scheduled d/c day) regardless of what time the baby was born or the fact that the insurance company pays for up to 48-hours for vag deliveries and up to 96 for c-sections. All patients are to be assessed by 1000/2200. Due to budget control, they are blocking off rooms and calling off staff when in-patient census is low-but the policy does not consider how many patients are in L&D, so it's possible for one RN to have 3-4 admissions on a shift. Now, the newest thing is revving up for the Joint Commission's exclusive breastmilk initiave and again the Marketing dept is hard at work to advertise us a 100% breastfeeding hospital.

So, while I (and most of my co-workers) are very good nurses, I do not see how it's possible to admit and discharge this many couplets, assess, intervene, educate, assist with breastfeeding, perform newborn screenings (hearing, pulse ox, daily baths, HBV vaccines, etc) effectively-not to mention the PP hemorrhage, antepartum that goes into labor, jaundiced newborn, freshly circumcised babies-I could go on and on.

We have voiced our concerns to administration only to be told we don't have to do it-we can simply find somewhere else to work. Since we are the only Magnet hospital in the area (gasp), they try to pacify us by making us form commitee's to...well, I'm still not sure what the committee is supposed to do.

Most of the perinatal techs are lazy and useless-for lack of a better term. Nurses have gone to our manager for years and being the non-confrontational people-pleaser she is, she simply asks you what could you have done in order facilitate help or difuse a bad situation from a co-worker, so most people don't report things to her anymore.

The hospital's administration is focused on Patient perception scores more so than actual patient care, because as I was told "patient's expect that you will give them the correct meds, so just providing good nursing care isn't enough". For example: some patient(s) complained about the staff not knocking on doors before entering the room. Management told us we are to knock on the door and wait to be invited into the room-even at night. So that's what we do-every two hour nurse check. Then patients complained we were keeping them up all night checking on them. So we were told to do it quietly . This is just a small example, but hopefully you can get an idea.

Now, I know it's not only me, but most of my co-workers have the same complaints. I have decided that although I still enjoy taking care of mom's and love the babies it's time for me to leave OB. I feel like my hospital is setting me up for failure as I can't provide the type of care my patients deserve not to mention I think it's totally unsafe. I like to know that all patients I am responsible for have received 110% from me but unfortunately, I am unable to give it to them under these conditions. I am planning to attempt a transfer from in-patient to out-patient over the next few months. I'm just afraid that I will miss my patient population and end up regretting my decision, but I also don't feel I should hate my current working conditions either.

I know I'm rambling and for anyone that's still reading, thank you! I try not to complain to my co-workers too much because gossip amongst those women spreads like the flu and my manager will know of it and may block my not too distant future request for transfer. My family is very supportive, but none work in the healthcare field, so they don't quite get it. I just felt the need to get some things off my chest. Of course, any advice/support is much appreciated!

Thanks!

[SAHMStudent]

Sorry to hear you are going through this. I just started working, so have no experienced words of wisdom. ((hugs))

[redessa]

Wow, that sounds like a mess! I don't blame you for wanting out. And really, the new breastfeeding push? I'm sorry to get hung up on that one thing but it boggles my mind. How on this earth can any hospital expect 100% breastfeeding? Aside from them strong arming the women who simply don't want to do it into giving it a try, what about women who have conditions or take medications which preclude breastfeeding? I have a friend who does not have milk ducts. Her first baby nearly starved before they figured out what the problem was. She's physically incapable of making milk so, of course, she never even tried to breastfeed her subsequent children. What does your hospital plan to do in a situation like that? I realize that's an extreme example but what about mothers who are HIV positive? Or need cancer treatments? Or are placing their babies for adoption? Don't get me wrong, I breastfed all 5 of my children, I'm not anti-breastfeeding. I just think are also plenty of legitimate reasons why a woman cannot or may choose not to.

[Sun0408, ASN, RN]

You can leave on good terms and go back it the new adventure doesn't suit you.. It is rough in a lot of areas but you will never know until you give it a try.. You may find you really like the other unit better..

[Cessna172]

When management refuses to see the reality of the "monster" they are creating by overloading the nurses, well, it's time to leave. Good luck to you.

[digitalgirl20]

Sounds like a Postpartum dept that i used to work at. I really understand what you are going through, and your experience sounds like the exact experience i had. Except the unit i used to work for combined with the gynecology unit, which got really chaotic. Most of the other nurses felt overwhelmed and we voiced our concern but like your story upper management/administration did not care. And other PCA's did not do a very good job in helping the nurses. I got so fed up that I said Adios!!!

[tralalaRN]

I find it most ironic that this situation involves, once again, a magnet hospital. What the he** is magnet status for if not to support and listen to the nurses? No, you don't have to answer that ques - already know the answer. . grrr. .

[nohika]

5 couplets is RIDICULOUS! Nurses at my Postpartum unit (I'm a volunteer) never take care of more than three at once, maximum six pts (3 moms, 3 babies). Even at night, it's a max of four couplets.

Maybe look for a different hospital with better ratios?

[serenity1]

I hear ya. My place isn't quite that bad, but I could see it becoming that way. We are getting some new breastfeeding "steps" we are supposed to follow at my hospital. When the woman from the state came and spoke with us, she made it clear that if we "properly" educated our patients, they would only choose to breastfeed. Sorry, I'm not the formula police. I have mothers that say right off the bat that they want nothing to do with breastfeeding. How/why am I supposed to change her mind? I hear we are going for magnet status...one of my co-workers said it would never happen because we would have to have happy employees to qualify. Our place has taken away our raises and is trying to restructure our benefits.

I hope you find a great position that you love. And if you decide to come back to ob, I hope you find a better place. I hate reading these posts because I'm new and I don't want to feel that way in a few years.

Take care!

[BaByNuRsE07, BSN, RN]

Wow, that sounds like a mess! I don't blame you for wanting out. And really, the new breastfeeding push? I'm sorry to get hung up on that one thing but it boggles my mind. How on this earth can any hospital expect 100% breastfeeding? Aside from them strong arming the women who simply don't want to do it into giving it a try, what about women who have conditions or take medications which preclude breastfeeding? I have a friend who does not have milk ducts. Her first baby nearly starved before they figured out what the problem was. She's physically incapable of making milk so, of course, she never even tried to breastfeed her subsequent children. What does your hospital plan to do in a situation like that? I realize that's an extreme example but what about mothers who are HIV positive? Or need cancer treatments? Or are placing their babies for adoption? Don't get me wrong, I breastfed all 5 of my children, I'm not anti-breastfeeding. I just think are also plenty of legitimate reasons why a woman cannot or may choose not to.

I KNOW!! Totally burns me up because despite what some Lactation Consultants tell patients, not every woman is able to make milk or has an adequate supply despite our "recommendation" to put the baby to the breast q2-3h or PRN. I have no idea what the hospital is planning to do in those cases where breastmilk is contraindicated. If it were my guess, they would probably make us become wet nurses too:rolleyes:

[BaByNuRsE07, BSN, RN]

I find it most ironic that this situation involves, once again, a magnet hospital. What the he** is magnet status for if not to support and listen to the nurses? No, you don't have to answer that ques - already know the answer. . grrr. .

Tell me about it! We received our re-designation last year and I found it ironic that most of the quotes Magnet used were from management. We had mandatory staff meetings for months leading up to the site visit, so they could coach us in what to say to the surveyors:eek:.

The idea of Magnet designation is great in theory. I hope it doesn't become one of those awards/designations that can be purchased instead of earned.

[sullkath]

5 couplets is RIDICULOUS! Nurses at my Postpartum unit (I'm a volunteer) never take care of more than three at once, maximum six pts (3 moms, 3 babies). Even at night, it's a max of four couplets.

Where do you work I want to go there !

I Did leave Mother /Infant and miss it everyday, It was the same 5 couplets can be fine but throw in the 3 discharges and then 3 admits and the teaching and assessing gets sloppy...and no one see that until there is a complaint or something happens: