Hi everyone!! I need some advice, some ideas, some help, and some thoughts!!!
I work in a high volume hospital as it pertains to people giving birth. (Nearly 4000 a year)
We have an L&D unit with their own nurses, NICU with their own, and then the postpartum unit where we are trained to care for babies and mothers. Initially when I Started years ago the babies were brought to the nursery and admitted there, and the mothers were admitted on the floor then the babies brought to the mothers when they were all finished. Now of course we have been doing admissions in the room so we are a non separation hospital. Fine, we made it through that transition tho it was difficult..change always is,. So there would be three nurses assigned to the nursery (they would do admissions on the babies in the room, circs, take care of the withdrawal babies once moms were discharged and assess any babies that were in the nursery overnight before bringing them to moms room in the morning). On the floor we each have 6 couplets. When an admission came to the room one nursery nurse would come out to the room for the baby and the floor RN would admit the mom then the baby nurse would give report to the floor rn who then assumed care for the couplet. This has been working very well for us ... Heres the problem... according to guidelines we should only have 4 couplets each. So to combat this, our nurse manager has decided that there will only be 1 nurse in the nursery (withdrawal babies circs, etc) along with the charge nurse (who is COUNTED in the numbers but does not do actual care of any pt... maybe an occasionial circ) then have 3 nurses on each side (we have a south and north side and then each with 12 rooms and then on the floor below we have the south side with 12 rooms to hold NICU moms... which of course always ends up holding couplets as well). ANYWAY .... they want to have 3 nurses on each side with 4 couplets at the most. However, when you have 3 couplets and an admission comes you are now responsible to admit the baby AND the mother at the same time. We have been piloting it for a couple of weeks and everyone is unhappy and it has been an awful time to come into work everyday. The issue is the baby. the mom admission is really quick comparatively.. The baby is what takes time.. say about an hour and a half from start to finish... bath , measurements, assessment footprints..etc. And THEN if the baby need d sticks, or is not essentially a 'well' newborn but not unwell enough to goto NICU, then that more time. So everyone is unhappy... we feel it is unsafe, and that our other patients are being ignored, and with hourly rounding.. its impossible.. (ALSO , it happens very frequently that there will be 2 admissions brought at the same time if not more .. so a lot of the times 2 of the 3 floor nurses are in rooms and leaving the 1 nurse to care for the others on the floor, and we are NOT allowed to ask L&D to hold onto anyone for any amount of time). We have been discussing and searching high and low to try to come to some kind of compromise that will make the flow smoother, and above all else safer. any suggestions?
What is everyone else doing? And if this is how everyone IS doing it... are we just being babies because its just another change that we don't like??
(Personally I feel that my license is at risk because I have to admit 2 patients at the same exact time while I have 3 other couplets under my care) .. and BTW, they are calling mom's transfers...not admissions because they are technically 'admitted' to L&D and just being transferred to us.,.. but she is still a full admit for us... so?
Specializes in L&D, mother and child, antepartum, gynaecology.
I work in a high risk postpartum unit that does approximately 6000 deliveries a year. We take care of 4 couplets and the nurse assigned to a couplet is responsible for both mom and babe. The major babe assessment (weight, measurements, reflexes etc) and first feeding (usually) are done in recovery on L&D. but then we are responsible afterwards for vitals, a head to toe assessment (slightly less then the initial), and sugars if needed. I will usually delay the bath, especially if its a prime they are exhausted and need sleep. But thats not all the nurses on my unit. Overall I find the admission the easy part lol its the teaching afterwards and help with breast feeding that take up all of my time.
I didn't get to read all the comments yet, but, my initial thoughts:
We delay the the bath for at least 8 hours.
Our newborn nurse that attends deliveries for NRP performs the initial assessment, vital signs, measurements, and footprints right at the bedside in the delivery room. It is so quick and easy to do if the baby is already naked and being weighed anyway. (After the first hour of skin to skin).
the only thing left to do at admission for the baby is the routine CBC that our peds order on our babies and any remaining heel sticks for hypoglycemia protocol and notifying the ped of the birth.
Our bath is dependent on the baby's temperature. The baby must have a temperature of 36.8 C before he/she can have a bath. Some babies can have it at admission...some aren't that warm for an entire shift.
Specializes in Nurse Leader specializing in Labor & Delivery.
Our bath is dependent on the baby's temperature. The baby must have a temperature of 36.8 C before he/she can have a bath. Some babies can have it at admission...some aren't that warm for an entire shift.
I'm curious why your unit has difficulty stabilizing infant's temp? It's VERY rare that we have a baby who can't keep up the temp, and if it's happening for a full shift, we would have that baby under a warmer, as well as drawing CBC and blood cultures.
Specializes in Ortho/Neuro (2yrs); Mom/Baby (6yrs); LDRPN (4+yr).
I can share how we do it here. When I first transferred in, we did it that same way you used to. Baby to nursery, admit done there, then returned to mom.
Then we started down the baby-friendly path, and all care is done in-room. We had a rough start, but finally have it to a routine now.
We have a patient-free charge RN (who can take up to 2 couplets if needed), floor RNs have 3-4 couplets each, and we have a 'procedure RN' (just a new name for Nursery RN) who handles the baby admits, circs, boarder babies, etc. While couplet RN is admitting mom, procedure RN admits baby. It rarely takes longer than 30 minutes max, and that was when we were still doing footprints (we do digital footprints now, which the birth registrars take care of).
On days where we're either short staffed or just not busy, the charge RN will take on the procedure RN role. This happens most often on nights, which is my shift.
Most babies get bathed almost on admission to the postpartum floor. Like I said, it is dependent on the baby not any magic number on the clock. Our floor tends to have around 40 babies at any one time so there are the few that don't. And the baby's temp is considered "stable" at 36.5....no need of a warmer...usually just a little more skin on skin and educating the parents to leave the baby wrapped up when not skin to skin.
We do about 300-400 births a month. Our L&D is separate from MB. We do 1:1 L&D care and have a transition nurse for baby...ideally for the 2 hr recovery/transition period. If it's crazy we might only have a transition nurse for the birth admit and first set of vitals.
During the 2 hr transition period, baby is s2s with initial breastfeeding, 3 sets of vitals, meds, admit exam w/weight and measurements. At 2 hr we transport to MB where they have 1:3 or 1:4 couplet assignments. An initial head to toe is done on the infant. Baths aren't done until 6 hrs of age and not while babies are being monitored for glucose levels. Baths are normally done by our CNAs in the mothers room.
We have CNA on MB for maternal vitals, and infant baths/footprints.
I'll agree with the others that said that 6 couplets is WAYYYYY too many. I'll admit though, that I've worked on a small PP floor where we routinely had 5 or 6 couplets, and we survived. I'm not sure how, but I think our acuity was really low at that time which helps. AWOHNN standards dictate 3-4 couplets, which is what we follow. We also have a lot of NICU moms, and antepartums, so we would rarely have 4 moms and 4 babies. It's usually 3:2, 4:2, or 4:3, or something like that.
Our L&D does the initial baby assessment. Skin-to-skin for 1hr, then shots/drops, measurements, footprints, assessment, etc. Bath is delayed for 24hrs and is generally done at the bedside by the tech or RN (usually the RN).
Admissions to the floor involve assessment on both mom and baby, and orientation to unit and room (reviewing visiting hours, plan of care, etc). I personally feel the orientation/education portion is the most time-consuming. The RN is generally on her own for admissions but it's really a 1-person job anyway. Although we are supposed to document at the bedside, we usually do it at the desk when we can.
By the time couplets are transferred to us, they're so exhausted they usually just want to be left alone. I can't imagine having to do all the required baby stuff (that our L&D does) when we get them.
MCURN
11 Posts
I work in a high risk postpartum unit that does approximately 6000 deliveries a year. We take care of 4 couplets and the nurse assigned to a couplet is responsible for both mom and babe. The major babe assessment (weight, measurements, reflexes etc) and first feeding (usually) are done in recovery on L&D. but then we are responsible afterwards for vitals, a head to toe assessment (slightly less then the initial), and sugars if needed. I will usually delay the bath, especially if its a prime they are exhausted and need sleep. But thats not all the nurses on my unit. Overall I find the admission the easy part lol its the teaching afterwards and help with breast feeding that take up all of my time.