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No nursery but not allowed to tell new moms that their newborn must room in!

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Emberanna Emberanna (New) New

Is this a common practice? My hospital calls itself "family centered" and practices couplet care. As such it claims to support "rooming in." However there is a long standing culture of kowtowing to the patients every wish and customer satisfaction is the golden rule. In this population of well off older professional women, it is a great "dissatisfier" if we say we cannot watch your baby because we have no nursery nurse. We are not allowed to do this- this comes from above our manager who has been trying to change things since she got here.

I have found myself with a bassinett at the nurses station, the other nurse admitting a patient, the CA on her lunch break (as she has a right to do) the secretary answering the phone and door ( and not allowed to watch babies- due to policy/ no NRP) and myself trying to figure out how to answer 3 call lights -

Me;

Dragging the bassinet down the hall and opening the door: "can I help you"

" yes, I was wondering if you could give my baby a bath"

( explained about newborn skin care, not bathing daily etc)

Next room: needed pain medicine so I drag the bassinet to the pyxis etc

And so on.

It's torture and cannot be a safe practice. What can I do?

All this with 4-5 couplets. Usually five with 6-7 counting admissions and discharges.

What recourse do we have when the staffing recommendations of our professional organizations hold little weight and the joint commission which claims to want patient safety turns a blind eye to the biggest problem of all, staffing practices???

merlee

Has 36 years experience.

Where is the office of Risk Managament? Tell them what you are forced to do, and ask about your HOSPITAL's liability. And Infection Control? How is that being managed there? GO ASK STAT.

DebblesRN, ASN, BSN, RN

Specializes in NICU. Has 20 years experience.

First of all, I think the whole "forcing moms to room in" thing is ridiculous. I work in a facility with a nursery, and 95% of our moms send their babies to the nursery for some portion of the day or night so they can rest. Why should they be made to feel guilty about it? They just gave birth (and in some cases had major surgery). They need rest, too!

I think what the administrator is doing is dangerous. Are you supposed to drag the baby into patient rooms if you have to go in?? That's not good. I wouldn't want my baby dragged into some stranger's room. Maybe they need to relook at staffing and policy before they start making rules you can't possibly follow.

Everything is about customer service these days. There is no reason you shouldn't be able to say no when you don't have the means to do it. Maybe if enough moms complain, policy--and staffing--will change.

I can't imagine having 4-5 couplets and dragging one to two of the babies around everywhere because mom wants to rest and there is no nursery, and noone to help me periodically throughout the shift. Unsafe.

My sister had a C/S after 34 hours of labor, and had her baby at a hospital where they still had semi private rooms and NO NURSERY. Her blood pressure was high, the lady in the next bed had 400 visitors all day and into the night, and the nursery nurses refused to take my nephew, even for a few minutes because they only had a sick nursery, and he wasn't sick. She was in the hospital for a week because of this.

I guess you could say, I personally think couplet care sucks. LOL

merlee

Has 36 years experience.

I worked in Israel where all the babies roomed-in with few exceptions - C-sections, multiples, late evening deliveries. And at the time there were 3-4 mom and babies in each room!

Imagine what visiting hours were there!

snazzy-jazzy, BSN, RN

Specializes in Aged Care, Midwifery, Palliative Care.

I'm in Australia and rooming in has been around for years over here. We will take the baby if the mum has had a C.Section and asks us too, or we will help settle a baby, once the baby is settled then I would put the baby back in with the mum. Otherwise its pretty much expected by everyone that the bub will be rooming in with the mum.

I havn't seen a well baby nursery since the mid 90's.

Some mothers even go home with their baby just a couple of hours after the birth if everything is ok, they don't even make it to the postnatal ward.

It seems crazy that there is no nursery but the mothers don't have to comply with rooming in either. Maybe they should open a newborn daycare centre on the ward :o You're not a nanny.

Edited by snazzy-jazzy

I will look into getting risk management involved. Just to clarify though, I am performing these tasks in the doorway as not to have there be an infection control issue. Bu the whole thing is absurd.

DebblesRN, ASN, BSN, RN

Specializes in NICU. Has 20 years experience.

Sorry, I wasn't suggesting you were taking a baby in someone else's room. But, if a patient needs pain meds, they either have to come to the door and get it, or else you take the baby in with you, because for security and safety reasons, you can't leave the baby in the hall. Either that, or mom has to just wait for pain meds. NONE of those choices sound good.

Bottom line, not fair to you, the moms, or the babies.

babyktchr, BSN, RN

Specializes in Nurse Manager, Labor and Delivery.

Although this could go a few different ways...I will jump in with this thought. If your facility touts "family centered care" or provides couplet care without nursery, it would be prudent that your customer/patient base KNOWS this, and can prepare accordingly. If they believe you have the capability, of course you will be dragging babies around in their bassinettes. It is a dissatisfyer initially, but if that is the model you are working with, then work with it. You cannot have patients believe you have a service you do not. Your managment is just wrong there. We went from having a nursery to mom/baby couple care and we did have a few bumps, but we rely heavily on the support person (hahahaha). There are times that we do end up with a baby or two at the desk, but for the most part we room in. Having a baby is hard work and so is taking care of them. How many times have you had a mom come in umpteen times for labor checks and demanding you get the baby out, and the moment it arrives into the world, they want it in the nursery????

Your management is going about this the wrong way, sorry.

NurseCard, ADN

Specializes in Med/Surge, Psych, LTC, Home Health. Has 13 years experience.

Oh for crying out loud!!!!! :confused:

If you aren't going to have a nursery, make it a requirement for moms to keep the baby in the room!!!

Hospitals can put a positive spin on it... simply "We practice family centered "couplet care". St. Hubbins Hospital is the first hospital in the region to provide innovative family suites for the mother and the baby to stay in together. We have found that this provides a tremendous advantage for mother/baby bonding. St. Hubbins hospital therefore does not have a nursery." Or something like that.

Personally, I think all hospitals should just have nurseries.

Could be blunt like the hospital I delivered my two boys in. They had no nursery and told me that they wouldn't take the baby because there was going to be no nurse around to take the baby when I got home so I better get used to it fast! I had two c-sections and thought that was a little unfair since I couldn't get up and move for the first day. Needless to say my husband got a crash course in baby care those first days, poor guy, 22 and never had any experience with infants before.

Simply Complicated

Specializes in Med/Surg, Neuro, ICU, travel RN, Psych. Has 5 years experience.

In and of itself there practice and policy is so contradictory. They are so worried about customer service, so they are not enforcing the issue of rooming in, so they expect you to keep the babies with you. How is that providing good customer service to the other patients who you can not even step into their room because you have someone else's baby in the doorway with you.

What if there was an emergency, what are you supposed to do then? I agree, I would contact risk management about this, and see what they have to say. Outline all the problems that it causes and could potentially cause.

RosesrReder, ASN, BSN, MSN, RN

Has 18 years experience.

I encountered similar at a hospital that went to couplet care and the nursery became offices. The solution was convert one of the rooms into a mini nursery with a nurse available at all times an infant was away from mom. Dragging a baby everywhere............ridiculous and aside from the obvious it is a huge risk for that child.

Talk to risk management.

nurse2033, MSN, RN

Specializes in ER, ICU.

Client safety should always trump customer service when push comes to shove. Practices that are not condoned by nursing ethics or a specialty organization should be addressed in an appropriate way. I have no qualms about throwing management under the bus when a patient complains or has an issue with something that is policy driven. I feel if I explain the policy and why it impacts them, they can complain to management and that might drive some change. Our voices are rarely heard by management but customers have a lot of weight. Since your own manger can't effect change, perhaps if you explained the "why" to a dozen of these highly educated, professional moms, maybe their letters might be able to make an impact. Good luck.

I remember that same thing occurring back in '88, '89, in southern CA.

No nursery, rooming in, but if for some reason (blood patch, etc) the mother couldn't take care of the baby the nurse was responsible for caring for that baby as well as the rest of the couplet care assignment.

Mimi2RN, ASN, RN

Specializes in NICU. Has 27 years experience.

We have couplet care, the families are told this right from the start. Most of the mothers have someone staying with them (spouse or significant other, mother, daughter). We have been doing this for 18 years, so everyone knows what to expect. Once in a while I'll see a baby at the desk, but that has not been a problem. Sick babies are in the NICU, and although we sometimes have boarder babies related to mom's health, as soon as possible they go out to mom.

hcox1975, BSN, RN

Specializes in LTC, SICU,RNICU. Has 2 years experience.

Personally, if I knew where I was delivering my baby didn't have a nursery, I wouldn't have my baby there. I have never even heard of this until I read this post. This doesn't sound safe.

The hospital i delivered at encourages rooming-in. Rooming-in can be great if it's possible. It isn't always....for example, my story. I had a C-section and had some complications. First I threw up for the next 8 hrs nonstop, it caused all sorts of problems with everything from my temp to my bp. I wasn't able to care for my baby and my husband was trying to care for me. After throwing up for that period I had completely torn my incision back open and managed to blow out the plug on my epidural site so I developed a spinal headache. They decided not to take me to the operating room until the next afternoon so I was told to lie flat on my back and not even think about getting out of bed. Hubby had to go back to work and care for our other children at home...he doesn't get maternity leave. Again not able to care for her by myself. Thankfully they had a nursery availble. There should always be a nursery available. There are all sorts of situations that could happen and the health and safety of both mother and child should be the priority. Just my experience and opinion.

Where I work we have couplet care AND a nursery. We have private rooms and about 80% of the time a partner or other family member stays the night, but we'll still take babies to the nursery upon request. Sometimes if it's a breastfed baby who is two hours post-feeding, I'll suggest that the mom "top off" the kiddo so she'll get at least a couple of hours rest, but I don't tell anyone that they have to keep baby in the room.

Many of these women (and their significant others) are flat out exhausted. They may have labored for days. They may have labored for days and then had a section. They may have been so excited following the birth that they couldn't sleep the first night and they're going home to two or three other kids who will keep them hopping. They don't have to justify themselves to me.

I would much rather take a baby to the nursery than find that child in bed with a sleeping, darn near comatose mom. I've had several bad scares with a baby being wedged under a large mom, another mom who fell asleep and had her baby fall to the floor, and still another where a baby was stuck between a grandma and the back of the fold-out futon (that was still upright like a couch). All of the women in question were sleeping so soundly that I had to shake them to wake them up.

My part of the country has seen an epidemic of infants dying in unsafe sleep situations. I will offer the nursery option to a mom who seems to need it and be happy to take the wee one out for a couple of hours.

Our nurseries (we have a large unit) are staffed by specially trained PCAs, and the nurses who have babies in there visit frequently. Occasionally, if we only have one or two kids, we'll keep their cribs in the nurse's station and take turns watching them while we chart.

When a hospital promotes itself as family friendly but has rigid rules about not taking babies unless there are dire circumstances, that seems like false advertising to me.

Edited by rn/writer