Rooming in on another unit?

[Lady_Leijing]

I just want to throw this out here and see if anyone has heard of this before and what you guys think about it. I work on a Postpartum and Newborn unit where the vast majority of infants room-in with their mothers. We do have a small observation nursery, but are usually not staffed to have infants in there for long; our charge nurse has to sit in there if the baby has to stay for more than a couple of hours or if we do not have the time to stay with it ourselves. Most of the time we take care of both mom and baby as a couplet with a few notable exceptions. My question is about two of those exceptions, specifically instances where the baby is our patient, the mom isn't, and they are not on the same floor as the rest of my patients.

Example 1: Mom is discharged, but baby needs to stay another night (usually for phototherapy). The unit was full, so they move baby to pediatrics to make room for another mom that just delivered. Mom still rooms-in and does the majority of the care for the baby, but they are assigned one of our nurses who still has patients on the main unit as well. The nurse has to run down to pediatrics every 2 hours to check on the baby, but otherwise is on the main unit unless contacted by the mom or one of the peds nurses.

Example 2: Baby is healthy and can be admitted to the unit, but mom needs a magnesium drip, which requires monitoring that our unit is not equipped to handle. If the Pediatrician signs off on it, mom can room-in with baby in PCU so long as her support person can stay with her. They take care of the majority of the care for the baby, and are assigned one of our nurses to monitor baby's vital signs (and blood glucoses in some instances). This nurse also has patients on the main unit as well. The nurse has to run down to L&D every 2 hours to check on the baby, but otherwise is on the main unit unless contacted by the mom or one of the nurses.

In the latter example, I spent over an hour off the main unit to take care of the baby in PCU and teach its mom how to breastfeed. I come back and the PCU nurse had taken the baby out to the nurses station "so mom can sleep" and said that she "had thought about just giving [baby] a bottle so we don't have to wake mom up"--this momma wanted to exclusively breastfeed and I was trying my darnedest to make it happen. This nurse also incorrectly "corrected" my breastfeeding teaching while I was in the room. I had told both the family and the nurse to call me if they needed me--we carry work phones--and the family did call once, but the nurse never did, despite the fact she complained to me when I got back about how fussy the baby had been.

I don't feel this is good patient care or is safe. The babies aren't on monitors, the peds nurses aren't supposed to go in the baby's room unless its an emergency (cross-contamination risk), and I am uncertain about the level of cooperation on anything short of a crisis that I would get from our PCU nurses. I don't like having my name on the kid's chart if I don't feel like I'm available enough to monitor their condition.

Do other hospitals do this? Is this the liability issue I feel like it is or am I over-reacting?

[jennylee321]

So if the baby is still requiring care on postpartum but not NICU then we would never discharge the mum. Unless baby is in NICU, mum and baby are always kept together. Just as if mum needed to stay on postpartum for one reason or another but baby was fine we would never discharge the baby alone. There's no reason that baby needs to go to peads floor and if it did it should be under a peads nurse. The only other logical option if postpartum floor insists on kicking them out would be to go to NICU and have mum room in (but again NICU nurse would take over care).

For the second situation of mum still being in L&D, baby would stay with her there and there would be no transfer of care to postpartum nurse until Kim and baby are physically transferred to postpartum floor. OB nurses are more than capable of managing the baby and breastfeeding. It's just not common sense to make the PP RN to come down every 2 hrs.

Lastly if mum is in ICU often baby doesn't come out super happy and goes to NICU. If the baby was alright after initial monitoring in NICU and mum didn't have a support person to care for baby, then NICU would probably hold onto baby until mum is transferred to postpartum.