pinkgrl

Yes, someone did suggest that. I was replying to MoshRN who stated that they get assigned to a pp mag pt plus 3 couplets (which is 7 pts). And yes, a PP mag can easily be taken care of on a PP floor if staffed appropriately and she's stable on mag. Just like any high alert drip like an insulin, narcan drip, heparin drip could technically be cared for in any IP unit, doesn't mean it's safe. When I worked a medical step down floor I would do insulin drips, heparin drips, argatroban drips, blood, high fall, postassium/mag runs, low alert chemo infusions, radiation tx on a normal day, but our 24 bed unit was always staffed with 8 RNS, and we were never given more than 3 pts, sometimes just 2 if the charge had to take 1 bc of acuity. Our PP unit is not staffed/budgeted for MB nurses to take 3 pts, doesn't make sense, we are staffed to take 3-4 couplets (which is 6-8 total pts). SO, if a mag pt comes up then someone will have to be called in or the charge will have to take the mag pt. Rarely, does this happen on our unit, and when it did, I refused to take a full load with a mag pt, told the charge she could either take the mag pt or take the other couplets. And, after she called the manager she took the mag pt. The intention in my original post is that if you are given an unsafe assignment, then don't take it, regardless of what anyone says, escalate it, it's not worth your license. We are generally staffed according to census, and per the hospital admin policy, high acuity pts are not allowed to be on floor and they define high acuity as a pt requiring VS/interventions/observations/assessments more frequently than q4h along with some other stipulations. Most hospitals in GA are not LDRP, esp the larger ones. I've only seen the very small community hospitals have LDRP set here. Even Northside, which delivers 18,000 babies annually doesn't have LDRP.

We don't use acuity scoring like other ip units. But we, in general, don't take any mag pts on our PP floor after a sentinel event when pt was found over sedated aka mag toxic, and hemorrhaged transferred to icu a couple years ago. Mag is a high alert drug, CNS depressant and smooth muscle relaxant. These pts should never be on a floor where standard of care is observation/intervention is q4h i.e. PP floor. BP measured on Mag is q30 mins - q1h depending on BP; RR, LOS, foley output q1h; DTRs q4h with fundus, full vitals. We also don't do insulin drips or massive transfusion (LD staff, OB come up, resume care of this pt until stable enough to go back to LD or ICU). These pt stay in LD until high alert meds are d/c. Rarely, LD when on diversion will try to send a mag pt. which I will then take no more than 3 pts, our normal is 4 couplets. I love being a nurse, sacrificed time, money to become licensed, and I will protect my treasured livelihood at all costs. Some PP nursses though will take 7 pts plus the mag pt. and I see them struggling, neglecting their pts... I try to help them. Our hospital is very protocol/policy driven so if a nurse accepts an unsafe assignment, he/she better handle it, bc if something happens to that pt and the nurse cut corners or didn't document, escalate concerns timely, she accepts full responsibility.

2 years ago, our 18 bed MB unit became Baby Friendly. We used to staff our nursery(1 RN) and have 3 couplets per RN, 1 charge with no pts. Now we have 4 couplets, 1 procedure nurse, 1 charge nurse no pts, 1+ tech & 1 secretary depending on census. The nursery is no longer staffed, MB budget was reduced and LD budget increased to staff 1 Newborn admission nurse (NAN). The newborn admission nurse does Apgars, footprints, bands & hugs, weight, measurements, eyes/thighs, lab i.e. blood cultures, hemtocrit, cord blood, ivs-- with help of nicu for PIV. The baby is placed skin to skin immediately after birth for 1 hour as long as baby is transitioning well. After 1 hour, mom is OOB to bathroom while NAN does the above tasks. LD puts mom in wheelchair and NAN puts baby in bassinet and the couplet is transferred upstairs to MB. I admit the couplet, do focused assessment on mom (Bubblehe) with VS and education, and I get VS on baby and do quick shift assessment on baby. All baths are delayed 6 hrs according to evidence based research except for babies born to mothers with + infectious labs- only these babies get baths immediately (by any available staff- tech, primary rn, procedure rn, charge). Everything is done in pp room including phototherapy, MDT/PKU, CCHD, hearing screen, baths, routine labs (i.e. bilirubin, glucose, CBC) The only time infant leaves the room is if infant codes (rushed to code bed in nursery), circs, if Ped doesn't do bedside exam in room, if mom is in ICU, or DFACS baby. This is where our procedure nurse comes in- she along with the tech (our techs can only do baths, mdt, poct glucose) and charge do baths, MDTs, labs, circs, corificeat exams as necessary. The only time she sits in nursery with a baby, is if we have a border baby--mom is in ICU or DFACS baby. Then the tech and charge step up to help with tasks on the floor. If Mom is on Mag PP (or HELLP, hemmorhage), couplet stays in LD until mom and NAN or Procedure nurse care for the baby until she is no longer on Mag and stable to come to floor. We don't separate the couplet unless absolutely necessary (i.e mom is in ICU or DFACS puts hold on baby). For c-sections the baby & NAN (of course after NICU determines baby goes to well nursery) go to PACU with mom and remain with mom until she comes to MB. If vag deliveries happen while NAN is in PACU then LD Charge relieves NAN in PACU while NAN attends vag delivery. Multiple deliveries at same time? LD RN will do Apgars, VS, bands, place infant skin to skin. Our unit loves the new changes, lots of communication, team work, and cross training. And the few RNs who loved the nursery, transferred to LD to be the NAN. Oh and the NAS babies just need scores, and collection of 1st void & stool which is done in the PP room. Babies receiving meds for NAS go to nicu. Also, if our baby is on amp/gent we admin in the PP room on IV pump.