Well baby nurseries

[Tycoben]

I'm a little hesitant to ask this, given the thread on asking questions in another forum , but I'm a paediatric nursing student in the UK, and whilst I get a maternity placement and a NICU placement as part of my training, as far as I know we don't have well baby nurseries over here.

From what I can gather from reading on this board, couplet care is where the mother and baby remain in the same room, which is what happens over here too. The baby always remains in the postnatal unit with the mother, unless of course it's a preemie/ill etc, in which case it will go to either a special care baby unit (less acute) or a NICU.

I've heard people talking about well baby nurseries, but because they are commonplace in america and non-existant over here, at least in my county, I still don't really understand when, why or how long babies go there for.

Would anyone be kind enough to explain to me the basics of the function and role of a well baby nursery?

Thank you very much.

[fergus51]

We flat out refuse to care for well babies. This policy is in place mainly because of breastfeeding women, but applies to everyone because we just don't staff for that anymore. I don't really like it when women expect us to look after their babies for them. I am not there to babysit.

[ShandyLynnRN, BSN, RN]

I agree that it makes it difficult, but doesn't the hospital get paid for those babies? It is really a pain in my rear when moms don't want to keep their babes in the room with them, especially at night, and especially if we have labor/deliveries happening or are really busy otherwise, but isn't the hospital compensated for those babies being patients? On the other hand, I know that if we have pediatric patients in the hospital, the parents are supposed to be required to stay. Is that the same principle?

[OBNURSEHEATHER]

It might work at smaller hospitals, but not at mine. Our census right now is 88. Minus some NICU babies.... That's at least 40 babies! Could you imagine 40 babies in the nurses station in th morning when all the moms shower?

Heather

[fergus51]

Shandy, we may be getting paid for them but we are not staffed for them. Our NICU is chronically short staffed and there is no way they are taking a baby so mom can smoke. At the same time PP is usually 5 couplets a piece, and I don't have the time to look after someone's baby for them. Can you picture me with 5 babies at the nurses' station?

This is one fundamental difference between hospitals here and the 2 I worked in Washington: it doesn't matter what the hospital gets paid for, it is not a hotel with amenities like babysitting. People here don't pay for their stay and even if they do, they get treated the same as everybody else. We do not do anything for our patients that is not medically indicated because this is a hospital.

[cindyln]

Originally posted by SmilingBluEyes

The reason I stated there is no well-baby nursery is cause we are not staffed for it, period. PKUs, pictures, footprints can all be done in the mother's room, at her bedside w/the equipment we have, if she so chooses. Otherwise, we do take the baby out to do these things, at her request. The nurse who is caring for the couplet (mostly nights), does all the PKU's, prints, cord clamp removals, etc. for her mom-baby couplet. If they do elect to have firstfoto pkg done, then we do have to take the baby to the nursery for this. But there is generally NO ONE to staff for wellbabies. If a mom is that sick, oftentimes she goes to a higher level of care e.g. another hospital or, yes we suck it up and watch her baby. But this is accomplished by the staff we have (that does couplet care) taking turns watching her baby. There is no staffing for well babies alone, outside the realm of couplet care.

If there is a special care baby in our SCN, (we have Level II capability only), then there is a nurse assigned specifically to that baby's care and she remains in the nursery. It's at that point the other babies may come in and be watched there while moms sleep, rest whatever. But we never promise we can take a baby out of the room for certain. If it's slow and I have the time, I am more than happy to take a fussy baby out and rock him/her so mom and dad can get rest and gather sanity. I feel for them and want to help out. But oftentimes, we just don't have staffing for it. It's unfortunate.

this is how it works at my hospital too. We even do phototherapy at the mom's bedside. If the special care baby needs to be in the nursery more than 24 hours then they are shipped to a hospital with a NICU. We just don't have the staff to tie up a nurse for longer.

[emily_mom]

Is this new or something that has been in place for a long time? I'm asking because all of the hospitals in our area (5) have well baby nurseries. I've actually never heard of not having one until now. When I worked OB, we encouraged the mom's to take their babies as much as possible. If they breast fed, they usually roomed in. But, the bottle feeders seemed to always be in the nursery. Kinda got hairy at times. But, I was lucky that we were always fully staffed and had some CNA's to help out.

Kristy

[cindyln]

We having been working like this for the last 5 years

[fergus51]

Been like that for over 15 years here.

[SmilingBluEyes]

Originally posted by emily_mom

Is this new or something that has been in place for a long time? I'm asking because all of the hospitals in our area (5) have well baby nurseries. I've actually never heard of not having one until now. When I worked OB, we encouraged the mom's to take their babies as much as possible. If they breast fed, they usually roomed in. But, the bottle feeders seemed to always be in the nursery. Kinda got hairy at times. But, I was lucky that we were always fully staffed and had some CNA's to help out.

Kristy

NO, this is not a new concept. We have NO CNA's on my floor, (we do have a tech, but she does paperwork and surgical cases, etc, NOT functions as a CNA). So, we do it all as RN's. All babies room in w/mom, whether bottle or breast fed. Time and staff permitting, we take babies and rock/watch them to help out. ( I had two very fussy babies I juggled all night long along with 2 very uncomfortable surgical cases).

But we are not obliged to do so, because we are NOT staffed to do this. We are an LDRP hospital that does about 70-75 deliveries a mo. We also usually have at least 2 or 3 GYN (on occasion, more), surgical patients to add to that census. THEY can be a LOT of work, trust me, when they are entirely "rebuilt" inside and are frequently elderly with long-standing medical issues/complaints.

So we do labor, pp, GYN and SCN where census dictates, all in one shift oftentimes. And, as you can see, with our situation, our staffing makes rooming-in not only attractive, but necessary at times.

[mother/babyRN, RN]

This subject intererests me from the standpoint that currently in our "official" level one nursery, many of the infants either are not level one.....That said, although we do not currently have mother baby couplet care continuously due to staffing, our new management regime thinks they can insist on that sort of thing and insist that all mothers room in. I feel, though that is an ultimate goal when staffing can warrant it, you absolutely CANNOT insist on rooming in 24/7 for everyone. Won't work in a facility that wants to attract other patients on a continual basis. There are moms who cannot care for an infant just after a section, if they do not have a significant other or helper to attend continuously, and, however many times you may wish it weren't true, there are mothers who insist upon sleeping in between feedings. That does not automatically mean a social service consult. I am all for rooming in continuously. I did it myself but, I do not think less of people who choose not to do it and my problem with management is not that they are going toward this goal, which in my opinion is ultimately a good one, but that they are taking the position of forcing people to do it. We have lost quite a bit of business because of this and they are genuinely shocked that deliveries are down. It doesn't take a rocket scientist to figure this out.....

[SmilingBluEyes]

Originally posted by mother/babyRN

This subject intererests me from the standpoint that currently in our "official" level one nursery, many of the infants either are not level one.....That said, although we do not currently have mother baby couplet care continuously due to staffing, our new management regime thinks they can insist on that sort of thing and insist that all mothers room in. I feel, though that is an ultimate goal when staffing can warrant it, you absolutely CANNOT insist on rooming in 24/7 for everyone. Won't work in a facility that wants to attract other patients on a continual basis. There are moms who cannot care for an infant just after a section, if they do not have a significant other or helper to attend continuously, and, however many times you may wish it weren't true, there are mothers who insist upon sleeping in between feedings. That does not automatically mean a social service consult. I am all for rooming in continuously. I did it myself but, I do not think less of people who choose not to do it and my problem with management is not that they are going toward this goal, which in my opinion is ultimately a good one, but that they are taking the position of forcing people to do it. We have lost quite a bit of business because of this and they are genuinely shocked that deliveries are down. It doesn't take a rocket scientist to figure this out.....

ahh in a perfect world.......

You know, shortages and personnel cutbacks mean rooming-in is necessary, especially in smaller hospitals, like where I work. And while I understand about moms who cannot immediately care for their newborns due to illness, surgery, etc, the majority ARE able to care for them. WE DO make provisions for those physically incapable to care for their babies. On a personal note, I had a csection, but roomed in w/my daughter..she never once went to the nursery and my dh was not there w/me at night, cause we had a 6 year old at home. And, no family were there for me either, cause we live too far away form them all. I managed. I learned I had to GET OUT OF BED and TAKE CARE OF MY BABY AND MYSELF, not the staff. WE (the staff) DO NOT GO HOME WITH THEM, and sooner or later, they have to learn to care for these babies w/o us to take them out everytime they cry or the moms want a break.

I understand about exhaustion, but some of them dont' want to be bugged to nurse, bottle-feed or even change their own baby's diaper! Most of them have a sleeping s/o or friend in the room who often does not budge a muscle when the baby cries. What good is that? They spend all day with numerous visitors, watching Jerry Springer and loud cartoons, rather than heeding my strongest advice to rest up and limit visitors. NO WONDER THEY ARE EXHAUSTED AT NIGHT!!!! so this makes it incumbent on a night nurse to take a baby all night on top of her already-often-heavy patient load? Think again!

Sometimes, THESE LADIES are the ones who NEED rooming-in, so we can see who has the biggest problems adjusting and the most learning needs to address. After all, they go home in only 24-72 hours. WHEN does the adjustment start? AT HOME w/o ANY support or teaching, or in the HOSPITAL where I CAN BE THERE to OBSERVE and assist them to take charge, and address problems early-on? This is what rooming-in allows us to do. I cannot observe mother-baby-family interaction if the infant is spending hours in a "well baby" nursery, can I?

[Sable's mom]

I have worked in large hospitals (60 bed NICU) and small hospitals - 200 births per year, and all of them have had well- baby nurseries.

I think that couplet care and rooming in should be the norm, but as we all know, the norm is always reality.

My present hospital doesn't staff for couplet care or nursery/LDR/PP care, but staffs "OB" nurses and expects us to work it out for the best care of ALL our patients - mommies, babies, and fetuses.

Sometimes babies are in the nursery for a couple of hours at night, but all our parents know that if everything goes crazy, they will be getting their baby back. Very few have ever complained, because they know that they could be the one that needs all the staff next time.

While I agree that mom-baby care can only be assessed if they arre together, sometimes the mom's fatigue is just too much to allow her to safely care for herself and her infant. We try to encourage the mom that is that fatigued to sleep, care for the baby the next day and night and delay discharge until day 3.