New staffing model for m/b unit?!?!

[ndknapp]

The unit I work on is the busiest in our state and also handles the highest acuity. It isn't unreasonable on the mother/baby unit to have a fresh c-section and her baby, a mom on mag with a 36 week baby, and another family, hopefully a stable one. Many times if I work mother/baby I'll end up with four families, and not necessarily stable ones.

Our administration has decided that the staffing model in the m/b unit will now include pairing a RN with a CNA to provide total care for up to five families. My terror? I'm already running my bottom off trying to provide care for four families, and now I'll ultimately be responsible for five. Even though our floor is supposed to have 'normal' newborns only, I frequently have 35 or 36 weekers on the floor - poor eaters, sleepy babies and usually jaundiced to boot. Add the breastfeeding problems of primips and low blood sugars in our babies from our gd moms (we get a lot)... you get the picture. I'm terrified that this model simply isn't safe. What if the CNA I'm paired with misses the signs of a low blood sugar? What if the CNA doesn't report to me a bp that's up on a PIH mom? Eesh, can I really expect a CNA to KNOW what PIH is, why we give mag AND strict fluid restrictions, what is considered moderate lochia, etc.? Even with a standardized training program it's still my professional license on the line.

Thoughts? I'd love to hear them. Personally, I think I'm overreacting, but this sounds like a lawsuit in the making to me.

Thanks again for the long read,

Natalie, who's wishing to ALWAYS stay labor and delivery from now on!

[fiestynurse]

I worked 12 years on a Mother/Infant unit. Generally, one nurse cared for 3-4 mother/baby couples on the day shift. Candidates for mother/baby coupling are stable postpartum mothers and babies. 35-36 weekers, who are poor feeders are generally not good candidates for mother/baby coupling. We did have postpartum moms on Mag. Sulfate. These patients were closely monitored and cared for by a RN, sometimes one-on-one, or with a few other stable postpartum patients assigned to her also. Being responsible for 5 mother/baby couples sounds like a lot of work, but it depends on what kinds of tasks you delegate to the CNA. We found that CNAs were not utilized very well on the mother/baby unit and we mostly had all licensed staff.

[timonrn]

We take Tox. pts all the time but they must be stable enough on the mag b/4 they come from LDR, and then it is a 1:3 ratio. All other M&B load is 4-5 on days and 5-6 on PM's and usually includes fresh C/B's--I would LOVE to have just 3 or 4 pts w/ babies for once--and we are a large trauma center so we see everything as far as sick babies goes--and no NA's, either--we never know how to utilize them except in the nursery--

[OBNURSEHEATHER]

I would kill for 5 mother/baby couplets with the help of a CNA! I worked this weekend and had 5 couplets on Saturday and 6 on Sunday. Both days I "resourced" a CNA who had 4 couplets of her own!

But at my hospital all of the CNA's have about 20 years on me in terms of OB experience. It's trickier with a new CNA, not knowing exactly what their knowledge base is. But I have to agree with rdhdnrs, learn how to use the CNA. Having them to do the "tedious" work could really free you up to do all the things that at the end of the day you wished you'd had time to do!

Heather

[fiestynurse]

How do you feel about this Mother/Baby couple idea in general. I can see where it is beneficial to have one nurse taking care of both mom and baby.

Many nurses feel that taking care of a Mother/Baby couple is really being responsible for two separate patients. Each with their own doctor, own chart, own assessments and documentation. It's really a lot of work! What are your thoughts on this?

[rdhdnrs]

Well, I guess if administration has decided this, then you just need to figure the best way to use your CNA. Get them doing vitals, bed changes, d/c ivs, walking your c-sections, etc, and you do RN stuff, assessments, etc. The key is to really use your assistant. You can't, with this kind of patient mix, do everything yourself, even though as nurses, we all think we can!!!

Good luck. :)

[timonrn]

Yes, "technically" we have the baby as a pt. BUT we still have a charge RN in the Nursery so if anything is askew we take it to them and they call docs, call NICU, put protocols into place i.e. cold stress, jittery, etc.. Becuz I also work charge in the Nursery I usually do this any ways on my own babys but most staff are quite happy to pass off a not so well baby to the charge nurse!! (we are one of the last hospitals in this city to even have a nursery).