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

Specialties Ob/Gyn

Published

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???

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.

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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.

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Specializes in NICU.

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.

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Specializes in LTC, SICU,RNICU.

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.

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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.

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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.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
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!

With that line of thinking they ought to have made you scrub your own toilet too since there wouldn't be anyone around to do it when you got home either. Oi!

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

i've never worked mother-baby nor have i ever aspired to. but it looks to this old icu nurse like it's absolutely crazy not to tell mothers that there is no nursery when there is no nursery . . . what is management thinking?

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Specializes in NICU, Post-partum.
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???

The problem is not the couplet care, it is the organization of your department.

Our hospital does couplet care and this is how they are organized:

1. Couplet care is one nurse to three rooms...that is 6 patients total...that is it.

2. ALL CLERICAL is NRP certified...no exceptions.

3. Nurses doing couplet care DO NOT participate in admissions...that is done by the admitting nurse.

4. A laboring patient is not left alone and that is 1 on 1 care.

The only problems our facilities are running into are single Moms with little support system recovering from a c-section...it is not proper nor safe to expect them to recover from major surgery and care for a newborn...nor is it safe. They cannot breast feed unless someone stays in the room with them as they are at a very high risk of injuring the infant unintentionally.

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What do you do for babies of moms who are too sick to care for them?

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Our setup is like that described by RN/Writer - we do couplet care, but we do have a "well baby" nursery. However, families are HIGHLY encouraged to room in with baby, whenever possible. We don't have a dedicated nursery nurse.

In cases of a sick mom who cannot take care of a baby, or a boarder baby (mom discharged, but baby has to remain), one of the admit nurses (nurses who admit the freshly born babies, do the recovery, give the bath, eyes and thighs, prints, etc) will be assigned to the baby.

In the case of a well couplet, we try to accommodate tired moms, but once in a while if things are crazy, we just have to say "no, I'm sorry there is nobody to watch your baby right now, you will have to keep him in here with you."

And ugh, I cannot imagine having FIVE couplets! That is totally against AWHONN guidelines. When I have four couplets, I'm hustling, with zero time to pee or eat. We generally only have three couplets, four if we're REALLY short staffed.

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Specializes in Intermediate Care.

After I gave birth to my son, i remember being so exhausted that I could not even keep my eyes open when my nurse brought my son in the room to be fed the first time. She took him to the nursery because I could not stay awake for the life of me! Its kind of scary to think what could have happened if he was left in bed with me :uhoh3:

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