Published Sep 5, 2003
I have a request and I hope some of you will be willing to respond to this thread....
I work on a high-risk post-partum unit in a tertiary care centre. Approximately 3000 deliveries per year are done in our hospital. We have always had a nursery on our floor, which is used for admitting/assessing babies, respite for moms, monitoring of blood sugars, assisting with IV starts and septic work-ups, apprehended and boarder babies, babies being given up for adoption, phototherapy if mom is in a semi-private room (lack of space), etc.
Recently we had a firm doing an "external review" in the entire medical centre, and one of the results was a recommendation to no longer staff the nursery.
We have numerous concerns re safety of babies (being "looked after" by unqualified staff in a non-secure area, namely at the nurses' desk), dissatisfaction from parents when nursery is not available when they need it, and to be honest the very real possibility of layoffs, which is totally ludicrous at a time when there is a serious nursing shortage. Administration has pushed this change through without proper notification to concerned parties, with no regard for safety and infection-control issues, disregard for the wishes of the patients and inadequate physical space and equipment to be able to give safe and adequate nursing care. (I won't make this thread unbearably long by going into all of the details!)
A group of us (jokingly referred to as the sh**disturbers!!) are taking various actions, collecting info, writing letters, etc. to try and have this decision reversed.
What we would like to find out from our colleagues across Canada and the United States is:
1. How many deliveries does your hospital perform per year, and do you have both high and low risk deliveries? If you feel comfortable sharing this info, at which hospital (also location) do you work?
2. Do you have a nursery/holding nursery/observation unit for babies who cannot be with their mothers 24 hours a day? What do you call it? How is it staffed?
3. Do you have babies:
-with IV's and antibiotics?
-less than 37 weeks gestation?
-being monitored for withdrawal?
-receiving phototherapy treatment?
-that are apprehended by a child welfare agency?
Or do these babies go to an Intermediate or Special Care Nursery?
4. Are your patient rooms single or double? Is there room for a cot or fold-down chair for a support person to stay, and sleep?
5. Do you admit babies in the room with the mothers when they are transferred from the labour floor?
6. What do you do with baby when mom needs a break, or a couple of uninterrupted hours of sleep, if you do not have a nursery at your facility?
7. What is your "normal" patient:nurse ratio?
On behalf of my colleagues, thanks for taking the time to read this, and we hope to receive some stats/info to back us up (even though it would be very informal information).
:nurse: :nurse: :nurse:
I now work in a a high risk center that does a few thousand deliveries a year. The nurseries (level 3 and level 2) are for sick babies only. There is no well baby for respite for moms. Well babies stay on the post partum floor and are the post partum nurses' responsibility. Unless they are sick, they stay in mom's room (which are private rooms). If they are sick they go to the nursery for photo, antibiotics, etc. Normal assessments and procedures are done on pp.
ditto fergus. no nursery staffing for well babies. we do couplet care and level 2 care only.
we are a level-2 facility.
I should say, even well babies with certain needs stay in pp. For instance, if a baby needs antibiotics, but is otherwise fine, we put in a saline lock and the baby just somes to the nursery for the antibiotics then goes right back to pp. We don't have the luxury of staffing for well babies anymore.
only babies IN Our Special Care Nursery are those with:
True feeding/growing problems
Intensive bili light therapy
(where dehydration is a true possibility---such as triple bank tx)
Initial sepsis workup/Tx
Blood sugar instability
Others that are stable are cared for with mom in the LDRP suite. If they are sicker than this, they go up the road to the Level 3 facility. Never have been staffed for WELL babies; they are counted in census with moms as couplets.
If moms request respite care, sometimes if it's slow, we will take babies out to nurses desk and watch them or in nursery if there is already a nurse and baby assigned to SCN. BUT we never promise we can/will do respite care. it can cause heartburn w/moms and dads, but we explain politely why and they usually understand. Besides, we dont' go home with them, do we?
My facility is very much like yours. We initially had a nursery with separate staff. Several years ago management decided to eliminate "on paper" the Nursery. We do mother/baby couplet care. after delivery the baby stays with the mother for 1 hour, then is taken to the "transistion nursery" which is staffed by one of the couplet care RNs (we rotate from couplet to nursery). There we do the admission assessment, routine medications, bathe and stabilize the baby. When baby is stable (maintains temp etc.) the baby goes to mother and stays there until discharge. (Management decided that the maximum time for a baby to be in the nursery is 3 hours). This works when you only get 1 admission every 2-3 hours and is a healthy newborn. Unfortunatly this is not reality. We also have high risk mothers...PIH, GDM, drug addicts, no pre-natal care, STD's...Which means a good portion of our newborns need observation, blood work, x-ray, child protection services etc. The best way to deal with "Management" is to prove that it would be a liability to close the Nursery (ie it would cost them MONEY) The nurses got together and made a "list" of why the babies needed to be in the Nursery, this list had catagories such as (Unstable mother-PIH on MGSO4) , No beds available in Couplet care-mother on another unit due to high census. CPS holds, MD holds for observation, Multiple labs-x-rays etc. low blood sugars, low temps, double phototherapy, Mother in ICU-baby ok, whatever you encounter is good to put on the list. We did this for every newborn for 6 weeks. We further broke it down to how many hours the baby needed to be in the nursery (until it either went to mother, transfered to NICU or discharged) 1-3, 4-6, 7-12 and >12 hours. At the end of our 6 weeks, we proved that 67% of all the newborns delivered during that time needed to be in the nursery for greater than 4 hours. Down to 48% after 6 hours. We prepared several cases to Management showing the potential for lawsuits that would be far more costly than keeping the Nursery open. They never were able to close the nursery and we still are rotating nurses from couplet care to staff it. But it is back in the budget and here to stay. Nurses working together is how this was accomplished. Good Luck to You.
1. How many deliveries?
450/month, low & high risk
standard "regular nursery"
staffed w/ minimum of 3 nurses...
postpartum/maternity nurses do 'couplet care' but patients do NOT have babies at the bedside unsupervised, i.e. when sleeping, etc.
We had a baby die in its crib while mom napped! So, never again!
-with IV's and antibiotics? YES
-less than 37 weeks gestation? YES
-being monitored for withdrawal? NO--NICU
-receiving phototherapy treatment? NO-NICU OR LEVEL II
-that are apprehended by a child welfare agency? YES
4. Are your patient rooms single or double? 3/4 DOUBLE
Is there room for a cot or fold-down chair for a support person to stay, and sleep? ONLY IN PRIVATE ROOMS
5. Do you admit babies in the room with the mothers when they are transferred from the labour floor?NOPE..
ANOTHER REASON WHY WE HAVE A NURSERY! MULTIPS CONSIDER THIS THEIR ONLY BREAK FROM REALITY!
COUPLET CARE IS SUPPOSED TO BE 4 MOMS/4 BABIES...OCCAS IS 6+ (yuck)
hope this helps!
I am not an OB nurse, but I pick up shifts there frequently when the unit is short-staffed, but have oriented for a few weeks to the unit. I do Post-partum and gyn surgeries only.
1. Deliveries...between 35 to as many as 60 (small town).
2. The unit does have a nursery, but only in use when there is a baby that needs monitoring for some reason, has unstable sugar levels, low O2 sats....
The nurses that work the unit have to be flexible. In every shift there is a nurse staffed that is NICU trained to handle a less than perfect scenario. A typical shift has 4 day shift nurses and 3 night shift nurses. Although, the nursery is only used when needed and is never regularly staffed.
3. We do have babies with IV's and antibiotics. They remain at bedside as well as in nursery, depending on what the problem is.
Yes, we have babies under 37 weeks all the time. I think the youngest, I have personally seen is 34 weeks delivered.
Not too sure if the unit monitors for withdrawal, I guess it depends on how bad the babies are after delivery if they get shipped out or not. But, there is the occasional crack/cocaine baby at this facility.
Phototherapy--since our facility is primarily low risk, we move the lights to an actually room and count baby in as part of census.
When baby is a CPS hold, the infant does go to nursery.
4. Our rooms are all single rooms and the unit does have cots for them to sleep in
5. I am not sure how the admitting process goes since I only do post-partum. The nurses doing labor also does recovery. I have seen them enter "Baby boy ____" into the computer for admitting. Labor nurses also do meds and assessments on baby here, but often when they come out of recovery, I will go and do another assessment if I am picking that couplet up.
6. What do we do if mom needs a break. We get creative. I had a smoker mom yesterday that would give me baby once an hour to go smoke. I would take baby into the report room and sit with my charting. At the time, I had only two couplets and other couplet had no needs. If I was busy, I told smoking mom, she would either have to wait or have her husband come to the hospital (he had the other ID band) to watch the child.
7. Our primary ratios are lighter compared to many I see here. 2-3 seems to be the norm. We do surgerys at this facility too, so if you have two couplets, then you get a surgery too. We do primary care on this unit. If there is a C-section that needs the frequent vitals, the load may be lightened (although this totally depends on what else is happening on the unit...by the end of my day yesterday, I had three PP, and then got a C-section couple due to babies being born left and right)
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