Traditional postpartum care?

[eifan115]

Does anyone here work in a facility that still does traditional postpartum care where mom and baby are cared for by nursery and postpartum nurses separately? I know that couplet nursing is becoming more the way to go but I am interested in hearing from those that still use the traditional model.

Thanks!

[Sandwitch883RN]

Where I am now we do couplet care on PP. I'm in L&D and we are seperate. We have a level II nursery but no well baby nursery. At delivery the RN does the mom and an LPN or Corpman does the baby. I'm in a military hospital. After baby is warm and mom is 2 hours PP both go together to PP. We keep Mag moms or mom's with other issuse if need be. I hate having no well baby nursery though because even our sick mom's have to keep baby at bedside. Another family member has to be present to care for baby and sometimes thats not possible. I worked in a civilian hospital where each unit was seperate and like that model of care much more.

[debswords]

Thank you for sharing your situation.

[A.Nell]

Our hospital is going to couplet care and the hospital is moving into a new facility at the same time.I have been both a nursery nurse and a post-partum nurse. Personally,I feel the word,"couplet"is some nice way to hide the fact that the nurse is responsible for 2 patients. A "couplet" does not equal 1 patient. Our facility want us to care for 3 couplets.This makes for 6 patients. I find that I have a better focus to have 6 moms or 6 babies. I can assess my work and make better decisions on the patients that could have potential problems. These patients are my responsibility and we can not pretend that the word "couplet" makes all outcomes flowing and sugary sweet.

I must also point out that our unit includes-female surgeries,specialized breast flap surgeries,sick pregnant women,preterm patients,and labor patients.

For the 3 couplets,there will be charting on 6 charts.There is reporting to each baby`s pediatrician and reporting to each mom`s ob. Maybe this would work if the doctors were OB/GYN/Pediatricians.

I can predict an increased infection rate among infants,incomplete charting,patients having to wait longer for their needs to be met.

When I take care of mothers-of course I help them with their infants. I also help mothers when my job is infants.

Thanks for letting me vent. I would appreciate suggestions. My first-most priorty is giving the best care and awareness of problems in a timely fashion.

[Barkow]

I've worked in both couplet care and traditional postpartum. I find couplet care easier and more effective because you're dealing with half as many situations. You may have 6 moms on a traditional postpartum unit and that's fine, but those moms all have babies, and it's tricky to draw the line between responsibilities of the postpartum and nursery nurse. I would rather focus on 3 rooms of patients and be fully aware of those 3 situations than running around to 6 different rooms and not being able to provide complete care to anybody.

[A.Nell]

thanks for your opinion.maybe this will work out for me.could be that I am worried about the other types of patients thrown into the mix.I certainly am happy for all info.

[klone, MSN, RN]

Our facility just switched to couplet care a few weeks ago. If we have float nurses in the unit, then we will do traditional postpartum care for that shift.

I agree with Barkow that three couplets is easier and less work than 6 babies, or 6 moms. One couplet usually doesn't equal the patient load of two discrete patients, because so much of the care is shared. If I have five postpartum moms, then I'm often helping 4 or 5 women with breastfeeding, rather than just helping 2 or 3 moms if I have six couplets.

However, the way we've been experimenting with the assignment of labor has been a bit troublesome. As we have it now, the L&D nurse transitions both the mom and baby, and is responsible for doing baby's initial assessment, measurements, eyes & thighs, ballard assessment, bath, first couple blood sugars if baby is on blood sugar protocol, and everything else that is entailed in the first few hours of the baby's life. At the same time, she's recovering mom, removing the epidural catheter, getting mom cleaned up, first trip to the bathroom, etc. Plus she probably has the last hour or two of labor/second stage that she needs to catch up on with charting. Ugh, it really sucks.

[rn/writer, RN]

Where I work, L&D is separate from postpartum. And postpartum is couplet care with a few exceptions.

L&D transitions mom and baby, but does not do the baby bath. Barring any necessary interventions (O2, blood sugars, bleeding in mom), the couplet and dad are given that first 1-2 hours to feed and bond. When they come up to pp, our charge nurse does the bath in the mom's room and does a detailed assessment while the couplet nurse manages mom. After the bath, the couplet nurses takes the baby, as well.

We do couplet care when we have all our own staff. When we have floats from antepartum, L&D or general staffing, that nurse takes moms and the pp nurse takes the babies. The reverse is true when the float is from NICU. I prefer couplet care to all moms or all babies. As others have mentioned, when you have six moms, you still end up assisting with breastfeeding and answering a lot of questions about the babies. This is especially the case when the nurse taking care of the infants is floating to your unit and doesn't know the regular routine.

For the 3 couplets,there will be charting on 6 charts.There is reporting to each baby`s pediatrician and reporting to each mom`s ob. Maybe this would work if the doctors were OB/GYN/Pediatricians. I can predict an increased infection rate among infants,incomplete charting,patients having to wait longer for their needs to be met.

I guess I don't understand why the infection rate among infants would go up and patients would have to wait longer for their needs to be met. Med/surg nurses often have 6-8 patients without any of the handy overlap that couplets have. I multitask as much as possible, giving breastfeeding direction while straightening a crib, asking about the last (unobserved) feeding as I put the BP cuff on mom, etc. When I leave a room, I am crossing two patients off my to-do list at once. Keeping track of meds/feeds/diapers and the rest is often a two-for-one deal. If anything, efficiency improves.

It's easy to be a little daunted by something just because it's new and different, but you might be pleasantly surprised by how well the couplet system works.

As for a well-baby nursery, yes, we do have one. It's staffed by very capable PCAs and the RNS pitch in as well. This is greatly appreciated by moms who are exhausted, medicated, suffering from complications, or just want to get some sleep before they go home to a houseful of preschoolers. Many babies are "out on demand," so we aren't undermining breastfeeding success by offering this option.

I really like couplet care a lot. There is a continuity of communication and services and teaching goes much more easily. Seems more conducive to including dads and other family members when you see everyone as part of a unit. Patients say they prefer it, as well.

[littleneoRN]

I work at a high risk referral facility, and our post-partum nurses generally have 5-6 couplets. So three couplets sounds pretty doable to them! (Of course, any day, with any number, it can take just one major issue to make any day crazy!)

[Elvish, BSN, DNP, RN, NP]

Where I am we take 4-5 couplets, so 3 sounds like heaven to me!!!

[rn/writer, RN]

I should add that we start with 3-4 and generally add one more couplet throughout the noc. Our assignments usually include a mix of acuity, with new sections, abx treatment, late preterm kiddos, twins, non-English speaking patients and other situations that require extra care being spread around so no one gets totally slammed. At least not intentionally.

I'm sorry, but six couplets--even with no complications--just doesn't sound safe to me.

[melmarie23, MSN, RN]

he only hard time about where I work now we do not staff for a nursery person at nights. So if there is a special care nursery baby, it sucks up a nurse and strains us on the floor and L&D.

this is what we're currently experiencing where I am doing my semester long preceptorship/externship. Except its more of a strain on days v. nights. We currently have a baby in the nursery with NAS, so a RN is always in the nursery with her, and we're expecting another any day now (mom comes in with NSTs 3/week and is on methadone as well as urine tox positive for cocaine, THC and many others).

I do like/enjoy couplet care though, which is what this unit does. I personally find it more efficient.

We get gyn surgical patients as well...and the charge tries to divide the patient load accordingly among floor staff.

[CEG]

I can predict an increased infection rate among infants,incomplete charting,patients having to wait longer for their needs to be met.

.

I don't know why you would think the infection rate would go up. Nurseries are proven to increase the infection rate- that's the only way babies are exposed to anything. If they are in the room with mom there is no way for them to get an infection. Ever seen peds go down a row of babies in the nursery and do exams without changing gloves/washing hands? Gross! Harder to do that if baby is in the room. If you had six moms why does that make a difference in getting charting done vs 3 moms and 3 babies?

Our facility switched over to couplet care last year and those who were unwilling to support the change found other jobs- not in nurseries I might add since they don't really exist anymore.

Couplet care is the standard of care recommended by the AAP because it results in the best care for mom and baby. It is not going away anytime soon.