Need input from other postpartum/mother-baby nurses!

[BarbNY]

Hello all -

I would so much appreciate input from any of you working on a postpartum or mother-baby unit. Although I'm a bit older, I graduated last year and have been working on a postpartum/mother-baby unit since the fall. I really love the work with patients but I'm so disenchanted with some of the things that go on in the unit but because of lack of experience, don't really know if these problems are common or not. Please help!

1) Staffing ratios

A full load on my floor is considered 6 couplets. It's extremely rare to get through an entire shift having 5 or less. Not uncommon to wind up with 7 before the night is over or early in the shift before they can get someone else to come in. Is this the norm out there?

2) PCA's

I don't know if that is what they are called everywhere but at my hospital, PCA's do vitals, bloods (can draw on mommy and do heel sticks on babies), keep drawers stocked with diapers, sanitary napkins, etc, keep water pitchers full, do peri-care, assist with first time ambulation, empty foleys - you get the picture) If fully staffed, they usually have about 10 patients/rooms. In my hospital/experience, as a whole, their work ethic and attitude stinks! A night never goes by without doing a lot of the above work at some point ourselves.

3) Covering breaks

Our unit has 2 sides and the nursery so people are always moving around/leaving the floor to cover somewhere else for breaks. So, what may seem like an adequate staffing ratio is often deceiving because there is so much time, especially between 12 and 5 am that nurses and pca's are either on break, or elsewhere covering someone elses break. So for example, if we have 3 nurses on 1 side with 18 patients, there's often a time period where 1 nurse is in the nursery covering a break and the other nurse is on her own break leaving only 1 nurse on the floor with those 18 patients. By the way, although most of the patients are either postpartum or c-sections, we also have antepartums on my floor. In my opinion, this is not safe!

4) Breaks

The nurses work 12 1/2 hour shifts and the PCA's work approximately 8 hour shifts. I'm not saying that this is what is "legally" alloted but the nurses and the PCA's alike take 2 hour nap breaks. It's the way they have been doing it for many years on this floor. Because we are so busy in the early part of the shift, all of these breaks happen between 12 am and 5 am. Starting to see the problem? There's a skeleton crew during these hours and as we all know, babies come when they are ready! So, it's especially problematic getting admissions during these hours. Not to mention that the phones could be ringing, the doorbell ringing (it's a locked unit) and call bells could be ringing and if we're in a patient room or running around, there's no one to respond. There is just no support.

Please... if anyone could give me some input on if any of these issues sound familiar or common I would be greatly appreciative. My stress level at work is over the top!

Thanks!

[ruffhouser]

Welcome! Just a few comments.

Our facility had AWHONN come and evaluate us. According to them, ratios should be no more than 4 couplets to 1 nurse. This is what we are doing now.

PCAs are a different story. There are good ones, and some not so great. I realize that it is hard for them answering to different nurses. I have an agreement with mine that we cover each others' butts. I do expect them to work hard, but I work hard too and am not afraid to pitch in and help them. I tell them that we are a team and work together. They know what I expect of them, and they know what to expect from me. It has worked well for me. Many of them are in nursing school (or doing prereqs), and really want to learn. I invite them in when there is something interesting on, or take the time to teach/encourage questions.

The break thing is just wrong. It seems to be part of the culture there. Probably won't change until something tragic happens. There needs to be adequate coverage at all times, especially with your ratios and acuity level. The 2 hour "nap breaks" are ridiculous and need to be stopped. You are in a difficult position being new and have to fight the culture. Is management aware of this?

[BarbNY]

Thank you so much for your reply!!

I would love to share some additional information but a little bit uncomfortable about doing so publicly. Could I e-mail you directly?

Thanks again,

B

[littlepeach]

We don't even do couplets anymore. When we did, the most was 5. (And that was rare) Our well baby nursery handles the little ones and the moms have the opportunity of sending baby to nursery for the night so they can sleep.

[Funlvn]

I know how you feel!!! Sounds like we work at the same hospital. They give you 12 pt total, how do you get all your work completed? And for CNAs forget about it, I do primary care too. Let's just say I'm not happy with my career choice or maybe it's just the hospital I work at!!! Hang in there!!

[babyktchr, BSN, RN]

2 hour NAP BREAKS???? are you kidding me?

[MomBabyUnitRN]

1) Staffing ratios

A full load on my floor is considered 6 couplets. It's extremely rare to get through an entire shift having 5 or less. Not uncommon to wind up with 7 before the night is over or early in the shift before they can get someone else to come in. Is this the norm out there?

Our load is considered no more than 4 couplets and even then, that's not too common. Usually 3 couplets is our load. Have had up to 5 at one point, but that is VERY rare here.

2) PCA's

I don't know if that is what they are called everywhere but at my hospital, PCA's do vitals, bloods (can draw on mommy and do heel sticks on babies), keep drawers stocked with diapers, sanitary napkins, etc, keep water pitchers full, do peri-care, assist with first time ambulation, empty foleys - you get the picture) If fully staffed, they usually have about 10 patients/rooms. In my hospital/experience, as a whole, their work ethic and attitude stinks! A night never goes by without doing a lot of the above work at some point ourselves.

We don't have any PCA's. We have one nurse extender who does a lot of stuff for the babies getting them ready to go home like metabolic tests, hearing tests, blood pressures, etc. They will help us by taking patients out, picking up food trays, but we don't have them do vitals or anything else like that.

3) Covering breaks

Our unit has 2 sides and the nursery so people are always moving around/leaving the floor to cover somewhere else for breaks. So, what may seem like an adequate staffing ratio is often deceiving because there is so much time, especially between 12 and 5 am that nurses and pca's are either on break, or elsewhere covering someone elses break. So for example, if we have 3 nurses on 1 side with 18 patients, there's often a time period where 1 nurse is in the nursery covering a break and the other nurse is on her own break leaving only 1 nurse on the floor with those 18 patients. By the way, although most of the patients are either postpartum or c-sections, we also have antepartums on my floor. In my opinion, this is not safe!

I believe since we don't have the patient load you do, our breaks are taken pretty much all night. We don't have a formal nursery that the parents can send their infant to, but we do have a holding nursery that the infants can spend a couple of hours in while parents catch up on sleep. Our nurse extender usually takes care of those infants.

4) Breaks

The nurses work 12 1/2 hour shifts and the PCA's work approximately 8 hour shifts. I'm not saying that this is what is "legally" alloted but the nurses and the PCA's alike take 2 hour nap breaks. It's the way they have been doing it for many years on this floor. Because we are so busy in the early part of the shift, all of these breaks happen between 12 am and 5 am. Starting to see the problem? There's a skeleton crew during these hours and as we all know, babies come when they are ready! So, it's especially problematic getting admissions during these hours. Not to mention that the phones could be ringing, the doorbell ringing (it's a locked unit) and call bells could be ringing and if we're in a patient room or running around, there's no one to respond. There is just no support.

Some nurses can take cat naps, but nobody sleeps for 2 hours. Cat naps are about 15 minutes, less than 30 minutes. If one of their call lights go off, it's just an unwritten rule that they answer their own call lights. I've never had a problem staying awake on any of my night shifts. Other nurses however, have very small children and their sleep habits during the day aren't that great.

What happens if you have a bleeder? Who can you depend on? Is there anyone there that can look after your patients while you're dealing with a problem patient? When my license is on the line, I prefer to work in a place that nurses work as teams and not a "that's not my problem" type of attitude. I'd fill out a complaint type of form and send it through the proper channels where maybe things can change. It sounds like a dangerous place to work.

[cherokeesummer]

On any given shift I generally have 4-5 couplets, we try to keep it no more than 5 though on occasion we have had more. We do not have PCA's or CNA's or anything like that anymore so we do all patient care ourselves. As for breaks, we just go when we can and eat. We don't ever take a long break but we do what we can. So I have heard it is better some places, but I don't know!