Couplet Care
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Nurses' Attitudes and Concerns about Couplet Care Laurie Gnibbs, MSN, ARNP Assistant Professor Barbara H. Cottrell, MSN, RN Associate Professor Florida State University School of Nursing Tallahassee, Florida T he advantages of "couplet care," where one nurse cares for both mother and baby, include continuity of care, facilitation of breast feeding, stronger bonding and attachment, self- regulated interaction and synchroniza- tion of sleep patterns. Staff benefits in- clude enfianced teaching opportunities, less conflict and duplication of effort, a lower patient load, improved commu- nication, increased accountability and VARIATIONS ON A THEME IN MANAGEMENT University of Wisconsin Hospital and Clinics in Madison, is seeking candidates for two key management positions. We're looking for highly motivated, high-energy individuals to help lead patient care, program development and ewluation, and quality assurance and improvement programs. Both positions require a master's degree in nursing with 3-5 years of relevant clinical experience in addition to demonstrated skills in leading staff through periods of re-engineering. Clinical Nurse Manager Urology, Gynecology, ENT and Plastic Surgery As Qinical Nurse Manager of this 29-bed unit, you'll develop, recommend and guide procedures to evaluate the unit's clinical andfiscaloutcomes. You'll assume responsibility for program planning and development of educational and research opportunities for students and staff, develop effec- tive budget guidelines, implement an integrated quality assurance program and collaborate with an outstanding, supportive multidisciplinary team. Oinicetl Nurse Manager Oncology, Hematology, Bone Marrow Transplant This 32-t>ed unit is closely affiliated with the Comprehensive Clinical Cancer Center, one of 28 NIH funded centers for advanced study and treatment of cancer. You'll be responsible for all aspects of our inpatient program — and more too — as you bridge continuity of care from inpatient to outpatient and to the community and home. A thorough understanding of oncology nursing is required here, as is knowledge of the research and clinical thrusts of today's leading centers in the battle against cancer. If you have a track record of success and are driven by the desire to contribute to a highly successful team, we'd like to hear from you at once. Please submit a resume along with a letter of interest to Myra Enloe, D5/408, UW Hospital and Qinics, 600 Highland Ave., Madison,WI 53792, or contact the Nursing Resource Center, (608) 263-8006 or toll-free 1-800-443-6164. DEPARTMENT OF NURSING UNIVERSITY OF WBCONSIN HOSPITAL AND CLINICS WI has an open records law. UWHC is an AA/EEO employer. Circle No. 15 on Reader Service Card autonomy and ultimately increased job satistaction. Why, then, would couplet care be met with enough nursing staff resistance to result in a reversion to the traditional method of care after a six- month trial in a regional medical center in the southca.stcrn United Sates? To understand why the change was not successful, it is necessary to look at the concept of change itself. Change requires growth and with growth comes the emotional process of "letting go" of the past, which requires a type of grieving. Ten stages of emo- tional change were identified by Perl- man and Takacs ("The 10 Stages of Change," Nursing Managetnent, April, 1990, pp.33-38). Difficult periods in- clude the effort to maintain equilibrium, denial, anger, bargaining, chaos, de- pression and resignation. Finally, break- throughs occur in openness and readi- ness that enable administrators to communicate with staff about the de- sired outcomes of the change and to provide feedback and direction. In the last stage, re-emei^ence, empioyees dis- play an emotional and intellectual trans- formation that makes them more proac- tive and helpful as they become more certain of what they are doing and why. It is important to remember tfiat change is a process, not an event, and that cfianges related to knowledge require less time than those that require changes in attitude. Lewin's well-known theory of change follows a similar pattern involving the phases of unfreezing, moving toward a new level andrefreezLng(Field Theory in Social Science, New York; Harper & Row, 1951). That tratisition from tradi- tional to couplet care can be made suc- cessfully has been shown by two hos- pitals. In one, the key factor was a management team who shared a goal and pursued it with TOTAL commit- ment in spite of considerable resistance from senior nurses and physicians. This hospital marketed the concept to the public, thus obliging the staff to imple- ment the changes as publicized. Ac- ceptance was gradual, but the end result was a staff of w^eil-rounded professionals skilled in assessment, planning, evalua- tion, teaching and counseling. This was accomplished while the census grew from 1,100 to 1,800 deliveries annually. 54 Nursing Managemenl / Vol. 27 No. 1
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Transcript of Couplet Care
Nurses' Attitudes andConcerns about CoupletCareLaurie Gnibbs, MSN, ARNPAssistant ProfessorBarbara H. Cottrell, MSN, RNAssociate ProfessorFlorida State UniversitySchool of NursingTallahassee, Florida
The advantages of "couplet care,"where one nurse cares for both
mother and baby, include continuity ofcare, facilitation of breast feeding,stronger bonding and attachment, self-regulated interaction and synchroniza-tion of sleep patterns. Staff benefits in-clude enfianced teaching opportunities,less conflict and duplication of effort, alower patient load, improved commu-nication, increased accountability and
VARIATIONS ON A THEMEIN MANAGEMENT
University of Wisconsin Hospital and Clinics in Madison,is seeking candidates for two key management positions. We're looking forhighly motivated, high-energy individuals to help lead patient care, program
development and ewluation, and quality assurance and improvementprograms. Both positions require a master's degree in nursing with 3-5 years
of relevant clinical experience in addition to demonstrated skills inleading staff through periods of re-engineering.
Clinical Nurse ManagerUrology, Gynecology, ENT and Plastic Surgery
As Qinical Nurse Manager of this 29-bed unit, you'll develop, recommendand guide procedures to evaluate the unit's clinical and fiscal outcomes.You'll assume responsibility for program planning and development ofeducational and research opportunities for students and staff, develop effec-tive budget guidelines, implement an integrated quality assurance programand collaborate with an outstanding, supportive multidisciplinary team.
Oinicetl Nurse ManagerOncology, Hematology, Bone Marrow Transplant
This 32-t>ed unit is closely affiliated with the Comprehensive ClinicalCancer Center, one of 28 NIH funded centers for advanced study andtreatment of cancer. You'll be responsible for all aspects of our inpatientprogram — and more too — as you bridge continuity of care from inpatientto outpatient and to the community and home. A thorough understandingof oncology nursing is required here, as is knowledge of the research andclinical thrusts of today's leading centers in the battle against cancer.
If you have a track record of success and are driven by the desire tocontribute to a highly successful team, we'd like to hear from you at once.
Please submit a resume along with a letter of interest to Myra Enloe, D5/408,UW Hospital and Qinics, 600 Highland Ave., Madison,WI 53792, or contactthe Nursing Resource Center, (608) 263-8006 or toll-free 1-800-443-6164.
DEPARTMENT OF
NURSINGUNIVERSITY OF WBCONSINHOSPITAL AND CLINICS
WI has an open records law. UWHC is an AA/EEO employer.
Circle No. 15 on Reader Service Card
autonomy and ultimately increased jobsatistaction. Why, then, would coupletcare be met with enough nursing staffresistance to result in a reversion to thetraditional method of care after a six-month trial in a regional medical centerin the southca.stcrn United Sates? Tounderstand why the change was notsuccessful, it is necessary to look at theconcept of change itself.
Change requires growth and withgrowth comes the emotional process of"letting go" of the past, which requiresa type of grieving. Ten stages of emo-tional change were identified by Perl-man and Takacs ("The 10 Stages ofChange," Nursing Managetnent, April,1990, pp.33-38). Difficult periods in-clude the effort to maintain equilibrium,denial, anger, bargaining, chaos, de-pression and resignation. Finally, break-throughs occur in openness and readi-ness that enable administrators tocommunicate with staff about the de-sired outcomes of the change and toprovide feedback and direction. In thelast stage, re-emei^ence, empioyees dis-play an emotional and intellectual trans-formation that makes them more proac-tive and helpful as they become morecertain of what they are doing and why.It is important to remember tfiat changeis a process, not an event, and thatcfianges related to knowledge requireless time than those that requirechanges in attitude.
Lewin's well-known theory of changefollows a similar pattern involving thephases of unfreezing, moving toward anew level and refreezLng (Field Theoryin Social Science, New York; Harper &Row, 1951). That tratisition from tradi-tional to couplet care can be made suc-cessfully has been shown by two hos-pitals. In one, the key factor was amanagement team who shared a goaland pursued it with TOTAL commit-ment in spite of considerable resistancefrom senior nurses and physicians. Thishospital marketed the concept to thepublic, thus obliging the staff to imple-ment the changes as publicized. Ac-ceptance was gradual, but the end resultwas a staff of w^eil-rounded professionalsskilled in assessment, planning, evalua-tion, teaching and counseling. This wasaccomplished while the census grewfrom 1,100 to 1,800 deliveries annually.
54 Nursing Managemenl / Vol. 27 No. 1
with no increase in FTEs.A second hospital credited its suc-
cess to having a comprehensive plan.They established a philosophical frame-work, selected a steering committee,identified key resource personnel, de-fined new staffing patterns, formulatednew methods for evaluating patientcare, client and staff satisfection and rit-ualized the change through inviting staffto a ceremonial dinner to formalize andcelebrate their commitment to thechange. A "buddy system" was intro-duced in which a nursery nurse and apostpartum nurse cared jointly for fourmother-baby couplets. Not only didnurses learn the necessary clinical skillsbut also cooperation increased betweenthe two groups and the social climateon the floor improved.
An analysis of our unsuccessful effortto establish couplet care may assistthose currently considering this change.After reviewing the literature, nursingadministrators made the decision to im-plement couplet care in a 38-bed ma-ternity unit with a 30-nurse staff. For-malized planning began four monthsbefore implementation through bi-monthly meetings at which both staffand nurse managers gathered for brain-storming and problem-solving. Througha "comment poster," staff could recordanonymously their thoughts and feel-ings about the upcoming change. A fec-tor that should have made this transi-tion easier is that upon initial hiring tothe family care unit, staff were cross-trained for at least two weeks in eacharea.
The director of maternal-child nurs-ing and the head nurse of the familycare unit consulted with nursing facultymembers at a local university to developa survey that assessed the nursing staff'sattitudes and concerns about coupletcare. The survey contained 40 state-ments with responses on a 5-point Iik-ert scale. Categories included teaching,professional behaviors, work satisfac-tion, attitude toward change and pa-tient care. Advantages and disadvan-tages of couplet care, why they did ordid not want it and advice they wouldgive to assure a smooth transition tocouplet care were covered in four open-ended questions. Content validity w asestablished by three external reviewers
CLINICAL NURSE SPECIALIST
The North Carolina Baptist Hospitals, Incorporated, an 806-bed tertiary care hospital,which serves as the teaching facility for The Bowman Cray School of Medicine of WakeForest University, announces an opening for a Clinical Nurse Specialist in Oncology.
As a Clinical Nurse Specialist, in our comprehensive cancer center, you have the op-portunity to provide nursing leadership in a facility ranked in the JCAHO's top ninepercent of hospitals nationwide. Our service areas and affiliations provide you with theideal environment for challenges and professional growth.
We seek a dynamic individual to identify ways to support and improve patient care,and ensure an efficient and cost-effective patient stay. Through development, implemen-tation and monitoring of an individualized clinical path and coordination of care, youwill match human and material resources to patient care needs. You will collaboratewith physicians to develop case management strategies to optimize patient care. Youwill also work with nursing management to identify and implement goals for nursingpractices.
Your qualifications must include:
-MSN/MS (Oncology]- Clinical Nurse Specialist experience with an emphasis on case management- Expertise in specialty area based on patient age and developmental needs- Demonstrated skills of communication, mentoring, organization and planning- Flexibility to work in a changing environment- Specialty certification is preferred
Send resume to:
Nurse RecruitmentThe North Carolina Baptist Hospitals, IncorporatedMedical Center Boulevard, Winston-Saiem, NC 27157-1185(910)7-16-3339An Equal Opportunity Employer
The North Carolina Baptist Hospitals, IncorporatedCircle No. 10 on Reader Service Card
tversitJoin a team whose strength lies in its variety.
As a dynamic 700+ bed center of health care excellence, Pitt County Memorial Hospital isable to meet the needs of 29 counties through a diverse range ol sen/ices. From the highestquality care in Medical/Surgical and Cardiology to an OR with 14 subspecialties, a newlycompleted critical care tower, and the Children's Hospital of Eastern Carolina, they're all partof the reason we're so highly regarded.
NURSE MANAGERLabor & Delivery, Birthing Center
BSN, MSN preferred with previous management experience required.
Our location offers the enviable lifestyle of Greenville, North Carolina, a family-orientedcommunity, just a short drive from the capital city of Raleigh and within close proximity to theCrystal Coast and the Blue Ridge Mountains, in addition, we offer a highly competitive salaryand attractive benefits that include tuition reimbursement, retirement and a stimulatingenvironment that's geared for ongoing growth. To learn more, call for an application:Director, Nursing Resources, PITT COUNTY MEMORIAL HOSPITAL, Inc., 2100Stantonsburg Road, Greenville, NC 27835-6028, (Toll Free) 800-342-5155. An EqualOpportunity/Affirmative Action Employer.
Pitt County Memorial Hospital, Inc.a constituent of
Univergtv Medical CenterOf Eastan Carolina-rat County
North Carolina's health carepaeesefJer
Circle No. 11 on Reader Service Card
January J996 / Nursing Management 55
EMORYUNIVERSITY
HOSPITALDEPARTMENT
DIRECTOR• Peri Operative
You will provide leadership forselected areas within a clinical ser-vice line.
NURSEPRACTITIONER• Same Day Surgery
You will assist in the development,implementation and evaluation ofall aspects of care for patients insame day surgery. You must be aGA'licensed/eligible, certifiedRegistered Nurse Practitioner witha Master's degree in Nursing.Requires 3 years' RN experienceand current CPR certification.Prefer at least a 2-year backgroundas a nurse practitioner.
CLINICAL NURSESPECIALIST• Neuroscience
You will provide leadership inthe development and mainte-nance of nursing practice stan-dards, policies and procedures.Serving as a consultant for issuesregarding clinical practice, edu-cation and research will also beamong your responsibilities.
Salaries are commensurate withexperience and our excellent ben-efits include paid time off andtuition-free enrollment at EmoryUniversity. For more information,please call (404) 712-5750 or(800) 727-4949. TDD: (404)712-4270. EOE/AA.
EMORY UNIVERSITY HOSPITALEmory L/niversity System ofHeabh Care
Circle No. 2 on Reader Service Card
and reliability to the questionnaire, us-ing Cronbach's alpha, was .94. Thoughall nurses currently working in the nurs-ery or on the postpartum floor wereasked to participate, only 19 of 30nurses completed the pretest survey,and 16 completed the posttest surveysix months later Only nine nurses com-pleted hoth.
Analyses of mean scores showed thatfor 36 of 40 survey items, nurses' atti-tudes and concerns were unchanged af-ter six months. Statistically significantdifferences indicated that even moredisagreement existed about (1) ade-quacy of equipment, (2) improvednurse-patient communication, (3) im-proved nurse team spirit, (4) more au-tonomy for nurses and (5) choice ofthis center because of couplet care.
Though nursing staff initially had ap-peared enthusiastic about the new pro-gram, the pretest revealed only 50% ofthe nurses were in favor of the change.Many of the full-time staff had been em-ployed for over five years on this unit,and thus had a great deal of power, par-ticularly over newer and part-time staffAlso, they had weatliered a previouslyfailed attempt to implement coupletcare under a former administration.
After implementing the program, thestaff immediately began bai^aining withadministrators, convincing them thatthe new program could work onlywhen there was adequate staff present.On each shift they were given thechoice of whether or not to use cou-plet care, based on staffing and patientcensus. Since staffing rarely came closeto the recommended 1:4 nurse to cou-plet ratio, the resistors could negotiatethemselves right back to the status quo!Perhaps less autonomy and some in-centive or reward may have helpedbring about the desired change.
A key problem vras that even underthe best of circumstances, six monthsis not enough time to evaluate the ef-fects of a new program. Another disad-vantage was that this change occurredduring some of the busiest months thehospital had ever seen in terms of num-bers of deliveries.
Prior to implementation of coupletcare, the nurses identified the very prob-lems that occurred. Clearly, nurse man-agers should listen to staff when
changes are being anticipated and in-corporate them into the planning pro-
Nurses' Attitudes AboutFloatingDaniel J. Nicholls, EdD, RNAssociate Professor, College of
NursingWinona State University—
Rochester CenterRochester, MinnesotaEdward A. Duplaga, PhDAssistant Professor, Department of
ManagementBowling Green State UniversityBowling Green, OhioLinda M. Meyer, BSN, RN, MBAStaff NurseSt. Marys HospitalRochester, Minnesota
Although the practice of floating isusually viewed as an efficient, cost-
effective strategy for responding toworkload and unplanned staffingchanges, it can negatively affect overalljob satisfaction, staff turnover and thequality of patient care. This study askednurses to identify the positive and neg-ative aspects of floating to other unitsand receiving float nurses on their unit.
A two-page questionnaire was sentto 319 registered nurses (RNs) and li-censed practical nurses (LPNs) at St.Francis Medical (Center in LaCrosse, Wis-consin, a private, non-profit, 315-bed,acute care hospital. A complete listingof names and regularly assigned unitswas obtained from the institution. Asample of 175 RNs and LPNs was drawnfrom this population using a table ofrandom numbers.
Demographic information includedcurrent position, initial education, high-est level of education completed andnumber of years working as a nurse.The remainder of the questionnaire con-sisted of open-ended questions in twosections: describe positive and negativeaspects of floating to other units and toreceiving float staff on their unit. Twopanels of experts examined the ques-tionnaire for face and content validity.Anonymity and confidentiality of indi-vidual responses was assured with theexplicit promise of reporting onlygrouped data.
5 6 Nursing Management / Vol. 27 No. J
