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Postpartum couplet care

KYgirlRN KYgirlRN (New) New

Hey guys! We are working on a project for work and I am interested in gathering feedback from other facilities about ratios. For those of you who practice couplet care on postpartum, how many couplets do you care for at a time? Are there any antepartal or NICU moms mixed in with your couplets? Do your babies room-in 24/7 and what level of involvement does your nursery have with care of the babies? (Do they do assessments, etc. for you or are you giving true couplet care?) Thanks for the feedback!

RunBabyRN

Specializes in L&D, infusion, urology.

I precepted on a postpartum unit, so I will speak from that experience.

We had up to 4 couplets (above AWHONN recommendations, which the nurses were fighting to have adhered to). There was an IUP patient that we often had who eventually delivered. If we have NICU moms, we would take them in those 4 couplets/patients. We occasionally had boarders, in which case they were not assigned to a nurse, but more often than not, we had other arrangements for those parents. Babies room in 24/7, and there is no well nursery, only NICU, so we handled our own infant assessments and such.

klone, MSN, RN

Specializes in Women's Health/OB Leadership.

I've worked at a few different facilities. One facility did 4 couplets. The other facility did 3 couplets, the only time there were four was when we were really short staffed. The first place I worked at went through a transition from separate nurses for moms and babies (5 moms or 5 babies per nurse). So when we switched to couplet care, that facility only did 2-3 couplets per nurse.

I found 4 couplets to be extremely challenging, with all the charting required. 3 is good.

Thanks for the responses guys! Right now we are routinely taking 5-6 couplets and it is just short of killing us. When I talk to nurses at other hospitals I am amazed at the differences. I am truly hoping this project will bring to light some of the many issues with this staffing situation- working on some viable solutions is a challenge though! Thanks again!

JessicaDanielle

Specializes in mom/baby, EFM, student CNM, cardiac/tele.

We care for 3 couplets, sometimes 4 at night when we are short staffed but it's rare. This is true couplet care with nursery only doing the first initial assessment before they come to us. Our babies room in 24/7. We can have nicu moms as well and just well babies that mom has already been discharged. In those cases we may have two couplets and two nicu moms.

At my facility we have an antepartum unit and an MBU. Antepartum takes overflow couplets. Ratios are four couplets per nurse. Babies room in 24/7. No designated nursery. Nicu moms generally go to the antepartum ward.

That charting gets out of hand sometimes lol.

Queen2u

Specializes in Postpartum, L&D, Mother-Baby.

Hello. I work at a southern California facility. We are staffed 3:1, unless we are really busy or short staffed, then we go 4:1. No antepartums--they go to out Maternal-Fetal Care Unit...we do care for NICU moms but it doesn't automatically bump our ratio up to 4:1. Babies room in with moms but there is a nursery available for moms who simply want to rest for a few hours, and the nursery nurses do assessments for us at times but are not required to. Nursery nurses also sometimes step in to do newborn screens and they draw labs and start IVs on babies that need them. I love my facility!

klone, MSN, RN

Specializes in Women's Health/OB Leadership.

Thanks for the responses guys! Right now we are routinely taking 5-6 couplets and it is just short of killing us. When I talk to nurses at other hospitals I am amazed at the differences. I am truly hoping this project will bring to light some of the many issues with this staffing situation- working on some viable solutions is a challenge though! Thanks again!

Honestly, in that situation I would probably request a meeting with the manager, try to get several nurses there. Ask the rationale behind 5-6 couplets, and present the AWHONN staffing guidelines. I can't imagine 6 couplets. How do you help with breastfeeding?

Queen2u

Specializes in Postpartum, L&D, Mother-Baby.

5-6 couplets is a lot!!!! I once worked in a hospital that had separate postpartum and nursery units--they hadn't gone mother baby. We went 6:1 then because we were only caring for moms, not babies. But once you put babies in the mix, things become a lot busier!

It is very difficult to provide adequate care, especially breastfeeding assistance. Someone is always losing care so another patient's needs can be addressed. It has been addressed with management, but what we hear repeatedly is that our unit will never follow AWHONN standards and we can't afford to staff with better ratios per administration. We are working on some research to back us and attempting to find cost-saving measures that can help justify adding a nurse, but I am starting to think it is downright ridiculous to have to fight so hard for patient safety and satisfaction.

I worked in 3 different postpartum units. I had 4 patients, standard, pretty much in all of them. Sometimes, when things are rough, I have 5, and once in a blue moon, I had 6 (ridiculous). 3 is a very easy night and doesn't happen often at all. I once had 5 c-section moms one night. It was crazy. We also take care of the babies. The nursery doesn't do much for us unless they are empty. For the most part, we do rooming in, but if mom's request, we take care of their babies, too.

klone, MSN, RN

Specializes in Women's Health/OB Leadership.

I am starting to think it is downright ridiculous to have to fight so hard for patient safety and satisfaction.

I agree with you. Clearly administration does not have the patients' best interests at heart, nor do they have the nurses' backs. Any way you can look around for a job at a different hospital?

iPink, BSN, RN

Specializes in Critical Care, Postpartum.

It is very difficult to provide adequate care, especially breastfeeding assistance. Someone is always losing care so another patient's needs can be addressed. It has been addressed with management, but what we hear repeatedly is that our unit will never follow AWHONN standards and we can't afford to staff with better ratios per administration. We are working on some research to back us and attempting to find cost-saving measures that can help justify adding a nurse, but I am starting to think it is downright ridiculous to have to fight so hard for patient safety and satisfaction.

Since transferring to my postpartum unit, I haven't experienced couplet care. But was told in the past when staffing was very low they have done it. Usually 5 couplets!

Often times it can be very difficult to get management to make the necessary changes that would promote patient safety, especially if they want to see higher satisfactions scores. If you want improvements in the patient-nurse ratios on your unit, nurses have to stick together in presenting their research when making their arguments. Continue to address those issues and concerns during Unit Practice Counsel meetings; make it a priority each and every time.

Good luck!

mickey1172

Specializes in Peds OB.

We do 3 couplets at my facility as the norm. We are a small rural community where the RNs are all labor, postpartum, Preop, circulate, PACU, some scrub, and are transitional and well newborn nursery trained! Our hospital doesn't have a NICU so we fly our sick moms/babies out. AWHONN has staffing guidelines you can download that might point you in the right direction.

We usually have three couplets, or two couplets an ante and NICU mom. We try to stay at five or six patients. Right now I work day shift so you may go over while your one discharge has not left yet. We have no CNA or tech. It definitely keeps you moving, especially since we will be having a visit from the "Baby Friendly" staff in the spring and the state any day now. Night shift runs with the same staffing ratio. Our patients stay in L&D for two hours after delivery. Hope this helps you.

It has been addressed with management, but what we hear repeatedly is that our unit will never follow AWHONN standards and we can't afford to staff with better ratios per administration.

I wouldn't work for a hospital that had that kind of response to the AWHONN Staffing Guidelines and obviously doesn't care about pt. safety. AWHONN's staffing guidelines are evidenced-based... there's a huge bibliography at the end to support the updated 2010 guidelines.

Our ratios are 6:1 max (2-3 couplets); it changes with acuity. Mag patients are 1:3 and if you have a duramorph, for the first 24hrs its 1:4. We do couplet care so that would obviously be 2-3 couplets. We intermingle our NICU moms. On our unit, the Nursery nurse MUST take at least 2-3 babies, assist nurses if a baby needs monitoring, PLUS be available to LD if they need a baby pick up. Its kinda hard some days to be the nursery nurse... feels like you are pulled a thousand different directions.

As for your facility--unsafe and unrealistic. I'd be seeking another job because its clear your management isn't behind you and doesn't seem to give a rip about safety let alone patient satisfaction. I hope your efforts to promote change are recognized.

melmarie23, MSN, RN

Specializes in L&D/Maternity nursing.

my unit follows AWHONN staffing guidelines. We average 3 mom/baby couplets, and never have more than 4.

haunani, BSN, RN

Specializes in Ortho/Neuro (2yrs); Mom/Baby (6yrs); LDRP (<1yr).

At our facility, antes are labor's responsibility. We get the NICU/SCN moms, though. We do our best to stick with the guidelines of 3 couplets/nurse (for us, 2 SCN moms count as 1 couplet), but sometimes it can't be helped that we end up with 4. On VERY rare occassions, 5 couplets.

Being on the baby-friendly track, we no longer have a "nursery" per say, but have a "procedure nurse". When available, they will help with baby admissions.

Night shift post partum experience here - 4 couplets were the norm. 5 couplets on a really busy night. 3 couplets was a treat! NICU moms would count as 1/2 an assignment, so you could either get easy antepartums or other NICU moms assigned, or even a twins assignment. Breastfeeding help at night was a lot easier to give than during the days, when they're just discharging patients home as fast as they can. If you spent 1 hour working on bf'ing with a dyad, your night is pretty much shot.

My new facility is usually 3 couplets, but the mothers or the babies can be very sick so that throws everything off.

Edited by calgrrl
Grammar and additions to text!

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