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Postpartum couplet care

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by 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. Has 2 years experience.

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 OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

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. Has 3 years experience.

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. Has 7 years experience.

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 OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

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. Has 7 years experience.

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 OB-Gyn/Primary Care/Ambulatory Leadership. Has 15 years experience.

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?