The "Float Nurse": Promoting Safety and Support At Delivery and Beyond

Purpose for the program:

Perinatal units are challenged with providing AWHONN recommended nurse to patient ratios. For uncomplicated births, one nurse should be assigned to the mother and one to the newborn. Healthy mothers and babies belong together, and separating them can disrupt early mother and baby interactions and impact 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 which would allow us to meet these goals.

Proposed change:

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 advocate and liaison between the family, Labor staff, Mother Baby staff and providers. She 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 performing the initial physical assessment.  The “Float Nurse” transitions the mother and baby together from Labor and Delivery to the Mother Baby Unit.

Implementation, outcomes and evaluation:

A departmental task force consisting of leadership, clinical specialists, 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, then determined the skill set required, and identified potential “Float Nurse” participants. The two week pilot enlisted six RN’s with 24 hour nurse coverage. The “Float Nurse” carried a cell phone and was contacted by the Labor nurse when a birth was imminent. Despite a much higher than average birth rate for the pilot time period, participating nurses were able to survey each participating mother.  Preliminary survey results show improved patient satisfaction and breastfeeding initiation rates as well as quality of breastfeeding assistance. We proposed that positions be budgeted for FY ’13 in order 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 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.

Keywords:

Skin to skin, breastfeeding, maternal infant attachment, nurse patient ratios