Purpose for the Program
Perinatal units are challenged with providing the nurse-to-patient ratios recommended by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). For uncomplicated births, one nurse should be assigned to the mother and another to the newborn. Healthy mothers and infants belong together, and separating them can disrupt early mother and infant interactions and affect breastfeeding. Our goals to align with Healthy People 2020 and the Baby Friendly Hospital Initiative's Ten Steps to Successful Breastfeeding motivated us to develop a program that would allow us to meet these goals.
To promote early skin-to-skin contact between mother and newborn, eliminate or reduce separation of mothers from healthy stable infants, and promote early initiation of breastfeeding, we proposed to pilot a role for select nurses in our department called the float nurse. The float nurse acts as an advocate and liaison between the family, labor and delivery staff, mother–baby staff, and healthcare providers. The float nurse is present at uncomplicated vaginal deliveries and meets the AWHONN standard of being the nurse assigned to the newborn. She provides initial breastfeeding and newborn education as well as performs the initial physical assessment. The float nurse transitions the mother and infant together from the labor and delivery unit to the mother–baby unit.
Implementation, Outcomes, and Evaluation
A departmental task force consisting of leadership, clinical specialists, healthcare providers, and nurses met to develop the float nurse pilot. They obtained a baseline survey of current patient satisfaction, breastfeeding initiation rates, and quality of breastfeeding assistance. The department task force then determined the skill set required and identified potential float nurse participants. The 2-week pilot enlisted six registered nurses with 24-hour nurse coverage. The float nurse carried a cell phone and was contacted by the labor and delivery nurse when a birth was imminent. Despite a much higher than average birth rate during the pilot period, participating nurses were able to survey each participating mother. Preliminary survey results showed improved patient satisfaction, breastfeeding initiation rates, and quality of breastfeeding assistance. We proposed that positions be budgeted for FY 2013 to continue with this model of care.
Implications for Nursing Practice
This model of practice has the advantage of meeting the AWHONN staffing recommendation as well as promoting early nursing interventions that promote maternal–infant attachment and breastfeeding success. It also has the potential to provide other avenues of practice for the obstetric and neonatal nurse.