(Postpartum) Are babies counted in your census?

HeartsOpenWide, RN · Feb 21, 2011

California has it's ratios on that: Couples 1:4; post-part women only 1:6; NICU 1:2; Labor: 1:2; Antepartum 1:4. The baby exists and is a patient, how can your hospital not include it in the census?

Elvish, BSN, DNP, RN, NP · Feb 21, 2011

We have a nursery for respite care, sick newborns (that aren't sick enough to need NICU), and new admits, but the couplet nurse is responsible for charting and keeping track of them.

We count babies in our census for both couplet care and the nursery. Most of the time we staff the nursery with only two nurses unless there are a lot of deliveries anticipated, or there are a lot of sick newborns.

tntrn, ASN, RN · Feb 21, 2011

Yes, we count moms AND babies.

birthrevolution · Feb 21, 2011

I have no idea how your hospital could not count babies in its census! Our floor counts newborns and moms, they each have separate charts and MRNs.

I don't understand your concern about moms dropping babies at night, that seems so random. I mean, if the mom is stable then at least the baby is getting 1:1 care. When we used to have a nursery the nurses would be at the desks in the other room charting and a bunch of babies would be in the nursery just chillin with no one watching over their every motion or noise (like a new parent does).

rn/writer, RN · Feb 21, 2011

Hello Allnurses,
Just wondering if there are any units that include infants in the census. The hospital I'm working @ does not and the newborns charting, assessments, and general care are triple the amount of work as postpartum moms. On top of that there is a greater liability due to the fact that we do not have a nursery and we have to worry about moms dropping the infants @ night. The nurse:pt ratio can go as high as 1:8 (I've heard of higher), not including the babies. Just wondering if most unit operated in this fashion.
Thanks in Advance

According to the AWHONN guidelines that just came out in 2010, your unit is a dangerous place--for moms, babies AND nurses.

The new recommendation is three stable couplets for one nurse. That means a total of six patients. If caring for just moms, the guidelines call for a limit of six stable patients.

If you are responsible for up to eight moms AND their babies, that is a grand total of 16 (assuming no multiples)--more than double the AHWONN numbers.

Babies are considered full fledged patients when it comes to calculating nursing ratios. Not counting them doesn't negate their needs.

AWHONN is also discouraging the idea of there being no well-baby nursery. The "baby friendly" folks may balk at this, but the reality is that even a vag mom may need time to sleep after a lengthy labor, especially if she is going home to other kids. A section mom on a PCA needs a safe place to send her baby if she doesn't have a reliable adult to stay in the room with her.

You are over-burdened if you are caring for "just" the eight mothers. If you are also responsible for their babies, the administrators at your facility are seriously out of bounds and their gross under-staffing places everyone in harm's way.

I'm so sorry you are being put in that position.

tablefor9, RN · Feb 21, 2011

On our unit the census for the nursery is separate, but counted for staffing for the women & children's division.

Staffing is 1 RN to 3-4 couplets, worst case; 1 RN to 6 babies, worst case; 1 RN to 6 Ob/gyn pts, worst case. It hasn't always been this rosy, but we have been a vocal advocate for pt safety and absolutely fearless about writing incident reports and letters when our staffing did not meet AWHONN guidelines. I say all the time that you have to paint the picture for risk mgmt. Help them understand that whatever pittance they are saving on salary & benefits will be wiped out, engulfed completely by the MULTIMILLION DOLLAR lawsuit that comes from a sentinel event.

While it's not a usual occurance for a mom to drop a baby, it does happen. Babies get apneic & turn ugly blue when no one's looking. Things happen, and while the worst of it is NOT financial, $$$ are the bottom line for the people in the offices out front.

Good luck to you!

NPinWCH · Feb 21, 2011

Well babies are not counted on census for staffing, but any baby in special care nursery (bili-lights, IVs, O2) are. Most times we cared for 3-4 couplets at a time, if any babies were in special care, they were usually 1-1 or 1-2.

klone, MSN, RN · Feb 21, 2011

Totally agree with RN/Writer. Yes, the infant is absolutely counted in the patient load census. That's ridiculous (and unsafe).

We go by acuity scores, but generally take three couplets (there have been a few crazy times when I've taken 4).

wife&mommyRN · Feb 23, 2011

Wow, thank all of u sooooo much for your responses. I'm a new grad and I honestly have felt errie about this from the beginning, but I'm working with nurses that have been working in this area longer than I've been alive. They have complained about the situation amongst one another, but it never reaches management. My biggest concern is the safety issue and this is the main reason I want to run from babies and do only adult care. I'm very uncomfortable with the way things r being managed especially bc this is a baby unit. The reason I mentioned infants being dropped is because we have had more than one incident where a mother fell asleep with the infant and dropped the baby. If anyone has any links/ articles that I could bring to management would be very helpful. I thought this area was what I was meant to do, I guess my search still continues to determine where my place is in nursing.

Thank u all so much :)

rn/writer, RN · Feb 23, 2011

Postpartum may still be your area (I love it). But you'd have to find a facility that staffs responsibly. Believe me, what you described is a terrible exception.

What I would suggest is using the AWHONN guidelines rather than anecdotal reports (although they could certainly back up your argument). Here is a link:

http://www.awhonn-af.org/documents/AWHONN_StaffingGuidelines-101019.pdf

I'd be interested in hearing what Risk Management at your hospital has to say about the extremely unsafe situation.

klone, MSN, RN · Feb 23, 2011

The reason I mentioned infants being dropped is because we have had more than one incident where a mother fell asleep with the infant and dropped the baby.

That's unfortunate, but I don't imagine better staffing ratios would prevent that from happening. Whether you have 3 couplets or 6 couplets, you are still going to have mothers who room in with their infants (as they should).

What were the circumstances in those incidents?