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.

[mark_LD_RN]

we have a well baby nursery, the babies go there for exams pic"s etc. but usually just when the parents need rest. we also do phototherapy at the bedside.

i personally like couplet care. but i also do not think it is right for us to force new parents to take care of the baby when they are exhausted. I feel a patient that has been laboring and may have been with out sleep for more than 24 hours and through all the hard work of labor and birth desrerves a chance to rest. and dont forget how fussy a baby under bili lights can be. not to mention how stressful it is on new parents. I personally stayed with my wife and child after delivery they never went to the nursery.but many of the patients i deal with do not have that luxury. and i think it is time hospitals address this issue. Ours did after several complaints by patients and request by me, we now have staffing to have a well baby nursey.

I agree with both mother baby and smiling blue eys points. while i do think we need to give patients the chance to rest. i agree with blue eyes that they need to learn to care for their babies because we do not go home with them. i find this mostly with first time moms. the way i usually work it is i encourage them to keep it but if they are to tired we will take it and watch it,but on the second night we explain to them we need to see how and if they can care for the baby before discharge.that way they had a chance to rest, and they do not feel like we are forcing them to do something. now if they can care for it well or if it is their 2 or more baby, i will watch it the second night for them if they want.

our patients are much happier now as it is reflected in our patient satisfaction survey. and census:)

[mother/babyRN, RN]

They don't want to and in some areas that will not change...In the area I am in, we have moms and families across the board.....Many have been taught to "get their sleep" at night and send their babies to the nursery. We do our best to educate them otherwise but there are always a few..I am not forcing anyone to keep their infants in their room at all times...I had 3 sections and the first night was fortunate to have my husband there, or rang if I required assist with getting the baby out of the crib to me BUT one is usually a bit out of it that first night...I have no qualms with either rooming in or otherwise, but I will never force a pt who doesn't want to exclusively room in, to do so......At least not with staffing the way it is now......

[mother/babyRN, RN]

I find that most of the people who elect to send the babies back to the nursery overnight are the multips, and especially the bottle moms....

[fergus51]

I don't know why this is considered a good idea. Our women from healthy vag births often go home by the next day, or they are gone on day 2. That means they get a maximum of 2 nights to learn to care for their babies without us. We just don't have the time to waste (let alone the nurses to staff a well baby nursery). The main reason I don't like well baby nurseries (we had one at my last hospital) was for the breastfeeding moms. We would always have women who wanted to sleep for 8 or 9 hours, but forbid us from feeding the baby while she was asleep. I had a hard time explaining to some of them that the tiny bit of colostrum they got at the first feed (which is usually not a really good feed anyways) will probably not hold them that long (and 8 or 9 hours always becomes 10+).

If a woman is exhausted we encourage the father or support person to stay and provide them with a bed. Otherwise they sleep when baby sleeps and most get a good 4+ hours right after birth. I have only had one woman get really upset about us being unable to babysit, but like I said, this isn't a hotel and I can't give services that we don't have to provide.

[SmilingBluEyes]

If we were staffed better for well baby care in a nursery, I would have no problem with it. I would offer it EVERY night. ON slow nights, I do make the offer. Unfortunately, in small hospitals, this is more often NOT the case. We have several couplets and also labor and GYN to split among 3 or 4 nurses. We have no CNA. WE do have a CST but she is NOT allowed to "take care of babies" as it's out of her scope. This can get hairy. Which take precedence? Pain medication and turning, coughing and deep breathing for your surgical cases, working w/an active labor patient, or the healthy baby sitting in the nursery (or at the desk while we do paperwork)?

Also, what do they do when they go home? Do you think these people who spent all day watching daytime trash tv and cartoons, rather than resting, will change their habits? Their exhaustion will continue at home. Even so, Exhaustion is part and parcel of having a baby; the lucky ones have family to help them. I did not, yet I managed. Those who give birth at home or in birth centers manage to assume care of their newborns immediately. Why do we expect any different in a healthy birth situation in the hospital? (not talking about sick mom's here). Should we when we tout labor and birth as a HEALTHY and NORMAL natural process????? They need to be taught early-on to assume care of their babies and where I work they rarely stay longer than 24 hours. Even when we nurses feel it's against our better judgement and ask dr's to keep them longer, it often does not happen. Chances are they will go home exhausted, yet having spent little time learning how to cope w/a crying or frustrated newborn. Then the calls pour in cause they know very little about what to in the simplest situations....they are understandably scared. That said.....

We usually do our best to accomodate people. We juggle the crying babies among us and answer each other's call lights to keep everyone happy. But as we get busier and busier, I see this going away. Security is too big an issue. Having just one baby out means a nurse has to STAY in the nursery or at the desk w/that baby, no matter what. This gets tough to do with a mixed bag of patients on the floor. I see this concept working better when you are an ALL pp or mother-baby floor. But when yours is like mine, LDRP AND GYN, it is VERY tricky. Just one needy patient or active labor throws us all into a tailspin when a baby is out. But we DO try.

Now, if there is a SCN baby in the nursery, in a way that makes it easy. We wheel the newborns in there w/that nurse to keep an eye on them......but then that is one nurse we DO not have for the floor. TRICKY and tough at times. I am not sure what the answer is. They sure ain't gonna give us another body for well-nursery care, whether it's perceived that is a paid service or not......that I promise ya. Maybe survey results that reflect their displeasure will help, I don't know.

[mother/babyRN, RN]

I think everyone has several good points here. But, I also have to add that in all the years I have been a nurse, we rarely ran into bonding difficulties if people chose to rest during the night while inpatients instead of rooming in. They were well rested and more able to comprehend teaching as well.....I have a problem with people who don't want to see their babies. I couldn't wait to have mine with me......But does that make either choice perfect? Hmm...Guess we will never change some people and hopefully will educate most.....:)

[NellieNurse]

How do you all staff for mother-baby care? How do you know when the moms want their babies to go to the nursery? Sho watches them, etc.?

[mother/babyRN, RN]

I think on the night shift, as I am, it is a bit different....Our babies are out to the rooms during days and evenings, and for the majority of people, during the night also...Patients are our clients. In my book, if you decide not to room in despite being made aware of all the benefits to you and your infant, you are the client and we essentially, work for you...I am not paid enough to boss people around, and this is NOT meant to be a lecture. It is, however, the way I do and will continue to feel, whatEVER the staff situation...Ours is a level one nursery, which does not in any way shape or form, confine it to well baby...That can change in a milisecond.....

[SmilingBluEyes]

Originally posted by NellieNurse

How do you all staff for mother-baby care? How do you know when the moms want their babies to go to the nursery? Sho watches them, etc.?

Please read my posts if you are interested in how it works at the two small hospitals in which I work. I won't bore you by repeating it all. If you want a quick answer, we are NOT staffed to do this, period. We juggle at best. Or simply have to decline if it's too crazy.

[SmilingBluEyes]

Originally posted by mother/babyRN

I think on the night shift, as I am, it is a bit different....Our babies are out to the rooms during days and evenings, and for the majority of people, during the night also...Patients are our clients. In my book, if you decide not to room in despite being made aware of all the benefits to you and your infant, you are the client and we essentially, work for you...I am not paid enough to boss people around, and this is NOT meant to be a lecture. It is, however, the way I do and will continue to feel, whatEVER the staff situation...Ours is a level one nursery, which does not in any way shape or form, confine it to well baby...That can change in a milisecond.....

See I just don't buy into the patient being client concept at all. I RESPECT them as PEOPLE, but they are not my CLIENTS. It is what is getting us between a rock and hard place, with management and our patient/family population. But that is me. I will do what I can to help, but my priorities are set by the census and associated acuity, not by my "client's preferences". If I can't take a baby out because the floor is too busy, I have to inform them. If you choose not to room in, you should look into a larger hospital that can accomodate this. Or one who does not do LDRP concept the way we do. Cause that is how they staff us....not to open a nursery for well babies. We even explain all this in our welcome letter that they sign and we keep on file. Really gone are the days when babies were lined up like soldiers in the nursery most the day and all night. I think this is a good move, really. And, Like Fergus said, it is NOT a hotel and I cannot offer services I cannot provide and I am not a chamber maid. I am a nurse, one who does a diverse set of duties on any given night. Changing hats frequently while I am at it.

[fergus51]

Thank you Deb! I hate the notion that we are paid to do what the clients want, whatever that may be. I was actually berrated by one woman when I didn't have the time to wheel her out for a smoke (this was when we were so busy we actually went on diversion and we were putting PP patients in the hallways cause laboring patients were spilling over into the PP beds!!!!). I am there to do what needs to be done for my patient's health. Period.

[OBNURSEHEATHER]

Originally posted by Tycoben

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

I find it interesting how the theme of the thread has turned from what the original poster asked, and into a well baby nursery vs. no well baby nursery debate. Of course everyone likes the way they do it, and everyone has an opinion.

If your hospital does not have a well baby nursery and you have to push babes out to their moms when it gets busy, great. It's what you have to do. And if your hospital does have a WBN staffed with anywhere from 2-5 nurses and can function in that capacity, great.

But let's not turn this into a name-calling and snobbery session, simply because of hospital policy.

Sincerely,

The Chamber Maid