Postpartum unit staffing

[NurseryRN12345]

Hi, I was just wondering how other units do staffing as the unit I work on has been constantly changing the way they staff within the last few years. 

I work on a women's center unit. We have 24 rooms and 1 tech usually scheduled. We do couplet care and have breast/gyn surgicals with the occasion of overflow patients. We still have our nursery as well. We get mag patients at about 12 hours, sometimes sooner if L&D is full. Our unit has gone through a lot of changes within the past 3-4 years. Within those years our PCT roles have gone from doing our vitals, blood sugars, I&O, ambulating patients and now to use being responsible for all of those and them doing the newborn 24hr tests (PKU, hearing screen, Pre/post-ductal, Bilirubin checks) and stocking, during days assist with circumcisions. We can delegate tasks for them but sometimes they will just say they are too busy. 

With our mag moms, we usually have 1 other room (usually nicu mom but sometimes a couplet) but may get a 3rd room if busy or even have 2 mag moms. 

Management's goal is to have 4 rooms up to 5 if many singles (with 6-7 heads total including babies) which seems to be a bit much with how much charting, education, lack of tech help. It seems like as time goes on our patients are becoming more complex and busier. There is a rare occasion it feels like we have a "normal" independent postpartum patient. 

Management compares us to other adult floors and how staffing is 1:5 and how we should be able to handle that amount of rooms as well. With covid we have had to float as crisis nurses and by the looks of those floors these nurses are staffed 1:4-5 but their techs do all vitals, blood sugars, bed time cares, ambulating, answering call lights, bed alarms, O2 alarms. 

How does your floor staff with lady partsl, cesarean, surgical and other patients on your floor with couplet care. Usually it seems like for the next shift if you are assigned a new surgical, you are staffed full so you don't get another delivery but then other nurses could have old surgicals (past the hourly checks) and lady partsl patients and not be as busy with less assignment to pick up the next delivery.

Does your nursery nurse get assigned at low baby numbers. Originally nursery was supposed to have a "light assignment" if we had less than 8 babies. But it seemed like while in nursery I would be responsible for 2-3 rooms and sometimes they would try to assign a 4th room while also managing those babies on the floor. Now we have moved to 6 babies and nursery does not have to be assigned but is not black and white. 

I just feel like being responsible for 4 adults and 3 babies (up to 5 adults and 2-3 babies) gets to be a lot when we are doing practically everything. Management said for nursery 1:6 babies, 1:4 couplets, 1:5 singles are the recommendations of ACOG and AWHONN but how do you staff when it's a mixture. Even past 6 babies we only have 1 nursery nurse. 

We are by no means short staffed. We usually have 1-3 nurses at home mandated. On nights it seems like resources (charges) will give you max before they call another nurse in and even then won't call someone in unless there are more patients to come. We are told our productivity numbers are low even if it seems like we a running majority of the shift.  

[Michellelizz]

When I worked postpartum before moving to L&D, it was a 1:5 ratio but the babies stayed with mom in room, we did not have a well-baby nursery. So that’s up to 10 patients, including babies. 
I found it manageable but busy so good time management was needed. We also didn’t have techs or HCAs so we did all the vitals, blood sugars, ambulatory and baby 24h tests. 
We also did not have mag patients and where I work L&D now, we keep the mag patients 1-on-1 in L&D because they’re considered unstable. 

[MCURN]

We do couplet care at my facility as well. Each nurse will have 4-5 rooms. So up to 5 moms and 5 infants. The charge nurse will do their best to spread out acuity which is becoming harder as we get sicker moms and babies. However we would never get a mag mom while mag is running. That would be a 1:1 on LDR.  My usually assignment will include one fresh c/s and one late preterm. Then hopefully two healthy mom/infant pairs. 
 
Our unit is 42 beds with 10 nurses and 1 charge nurse being our baseline. We maybe will have 1 nursing assistant but with covid they usually get pulled to other units.