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Mother/Baby VENT!!!

Ob/Gyn   (7,594 Views 21 Comments)

BaByNuRsE07 has 10 years experience as a BSN, RN and specializes in UM, Care Mgmt, OB, Med-Surg.

2,250 Profile Views; 15 Posts

You are reading page 2 of Mother/Baby VENT!!!. If you want to start from the beginning Go to First Page.

gatherswool has 5 years experience and specializes in Newborns, Adolescents, and Burns.

25 Posts; 1,426 Profile Views

That sounds awful! Yes, probably most women are technically able to breastfeed -- but very large percentages (depending on your populations) will need a LOT of help in order to do it. You can't get *80%* in most communities without lots and lots of help, especially with a high C-section rate. What is the hospital thinking??????

I tend agree with the leave-on-good-terms-once-you've-found-another-job idea. If you're not too exhausted to approach management one more time, you could always call around to Baby Friendly hospitals, find out what their ratios are like, and share that with your administrators. I once worked at a safety-net, Baby-Friendly hospital with union nurses (ie a poor hospital with well-paid staff) where the ratios were virtually never higher than 4:1 -- on nights! With great techs! And downsizing *always* took into account L&D's census.

So sad to hear the hospital is approaching things this way. You can probably abuse nurses to force certain things to happen -- ABX within a given time frame, documented turns q2H, etc -- despite ridiculous ratios, but breastfeeding, like labor, can't be forced by anyone. I won't even get into the risks they're taking with newborns by forcing early discharges (our poor hospital had a policy that any baby born after 8pm got either an extra day or VNA; mom's choice). Ask your administrators to check out the kernicterus case studies sometime and decide what it's worth to them never to risk a sentinel event...

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Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

5 Followers; 4 Articles; 20,896 Posts; 146,908 Profile Views

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.

Magnet certification as in other "Certifications" around these days is just another bunch of usless letters touting that you are better than the next guy in the relentless persuit of appearing to be better than the next door neighbors........a simple bait and switch.........a typical magicians slight of hand manuver whether good intentioned or not........:twocents::twocents:

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506 Posts; 8,490 Profile Views

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:

I mean, there are days of multiple discharges/admits, but not often. And I know in L&D it's a 1:1 thing if the pt is in labor. I'm the PNW. :) Unfortunately, due to how good the ratios are, very very few people leave, so they hire even fewer.

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serenity1 has 7 years experience and specializes in labor & delivery.

266 Posts; 8,203 Profile Views

LOL!! I agree about the wet nurse comment!!! Too funny!

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HvnSntRN specializes in Foot Care.

89 Posts; 4,523 Profile Views

My postpartum position was eliminated due to cutbacks and hiring LVNs. In hindsight, moving to the NICU was the best decision for me. Previously, it was routine to have 4 couplets, a couple of discharges and admissions daily, but once the LVNs came in with their narrower scope of practice (stable/predictable patients only) sometimes the RNs would have to switch-a-roo their assignments if an LVN's admission wasn't stable or a patient became unstable - all the "heavy" and complicated patients were assigned to the RNs. It was so stressful that there were days I'd drive home crying because I felt like I couldn't keep up with the demands, and I have over a decades' worth of experience.

Staffing is a joke... our call-ins were low priority compared to the ER and ICU, so often we worked short, and absolutely no wiggle room for overtime or a lull in the census; as soon as we had shuffled out the discharges, usually someone was sent home without regard for what was happening down the hall.

I am loving the NICU. Three babies, tops. No chance of LVNs coming in. No taking report in a war-zone surrounded by other nurses, students, residents and docs coming in to rip charts away from you. I go home on time more often than not. I feel like I've done my job at the end of my shift, and not missed anything.

If you're looking for a change... look at the NICU... it's a bit of a learning curve from postpartum, but it's been great for my morale.

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walkingrock has 40 years experience as a ADN and specializes in NICU, IBCLC.

171 Posts; 5,241 Profile Views

It is a sad situation. You are not alone in your scenario. Patient care is being compromised by the time it takes to document, act as though the patients and their visitors are "customers" and they are of course king, meet the pressure to be efficient and save money. :mad:

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merlee has 36 years experience.

1,246 Posts; 13,452 Profile Views

100% breastfeeding? Hahahahaha!!!!! Maybe giving breastfeeding info to 100% of moms might be okay.

How things have changed! My now almost 26 yr old son came to me EVERYTIME with an opened bottle of water in his bassinet. Despite that I was breadtfeeding and specifically requested NO WATER. Oy.

But it certainly seems too much to have 10 patients with that amt of turnover.

Best wishes!

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133 Posts; 1,810 Profile Views

Reading your post I was thinking "Wow this sounds like X hospital!". I went and checked your profile and based on where you say your location is, I'm pretty sure I've heard complaints from Mom/Baby nurses at your hospital and the LCs as well. Another area hospital just got Magnet designation and their nurse:couplet ratio went from 1:3 to 1:4 and they're all stressing out. (They just went to couplet care about 2 years ago too.) It really sucks, I don't know how you all do it!

As far as the 100% breastfeeding thing goes, there are definitely some policy and practice changes that need to be made to make your hospital breastfeeding friendly. I had friends who did clinical there, had their babies there and friends who work there. I've heard a lot of complaints about breastfed babies getting formula (excessive amounts) without mom's permission. Little changes could be made like making donor milk available for supplementation, not giving a pacifier to breastfed babies. Things like that. At the same time, there is no way any hospital will succeed on making EVERY mom breastfeed.

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62 Posts; 1,979 Profile Views

I know exactly how you feel, I'm currently working at a hospital, fortunately temporarily as it's a travel assignment and they are trying to get magnet status, which is code for bending over backwards for patients even if it seems like an impossible task?!?!

I work in L&D and the things we are asked to do are just so unrealistic, they have this huge pain initiative going on and I completely understand in other parts of the hospital it's important to control patients' pain. BUt I just received an email today saying that our goal was for our patients to have no pain?!?!? ARE YOU FREAKING KIDDING ME

So are we going to start giving out pain meds to every single patient with the least little bit of pain wile they're talking on their selling phones and hooting it up with their familes???? Are we not to do vag exams because of the pain we might be causing them? Are we do redose epidurals when patients are about to delivery so that they won't have any pain??

I did hear a rumor about the US starting to use laughing gas in the delivery rooms again, but come on, we all know how hard it is to explain to an uneducated or young patient or even not, YOU'RE GOING TO HAVE PAIN YOU'RE HAVING A BABY welcome to the real world.

I'm all for relieving pain when I can, but wehn you come rolling up at 9cm, screaming for your epidural, sorry chick it's not gonna happen, then we get a bad score, saying they made me have my baby without pain medicine, they dont bother to ask the details???

That's just the beginning of the ridiculousness that's happening and unfortunately it's on other units, too, so it's just sad, it makes it impossible to do our jobs.

I just have to say, I admire you postpartum nurses, because the juggling act you have to do on a daily basis is amazing, I have 1-2 patients, and obviously it's an entirely different type of nursing, but im rarely doing discharges admits, pku's, bilis, breastfeeding, and teaching.

If half these patients would do a bit of reading during the pregnancy we wouldn't have to be explaing to them in detail where their uterus is and why tehy still look pregnant and when will their breasts fill and is my baby eating enough etc etc.

Which is one of the reasons I chose to become a midwife, so I could spend time educating my patients and preparing them for discharge from their very first OB visit!

GOod luck with whatever you decide, just know that there are hospitals out there that function entirely differently and they some how meet magnet and JCAHO standards without all the ridiculousness.

ANd thank you for the good care you provide, good post-partum care is hard to come by, and is amazingly hard work.

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 :confused:. 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!

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