Change is in the air at MCH in Mountain View.  Management has decided the model of care in MCH is going to change to Couplet Care or "Family Centered Maternity Care". The change to couplet care will happen after the RNs and management have developed an appropriate implementation plan, policies and procedures are in place to support the couplet care model, and the nurses have been educated and are fully competent to care for couplets. PRN is involved in the process of change.

Several years ago, management planned to change the model of care to couplets, but did not provide the support and RN education to ensure competent care. This time PRN and management have an agreement that the development process will be completed and RNs will be educated in couplet care prior to the implementation of the new care model.

The Family Centered Maternity Care (FCMC) committee is working on operationalizing the changes required to implement couplet care. The RNs and committee do not have the right to stop the change to couplet care. However, the RNs do have the right to participate in the decision process regarding "how" the change is implemented. With the leadership of PRN, the RNs will be part of the implementation process.

The FCMC committee decided the first step to implementing couplet care is to have babies admitted in L&D rather than in the Admit Nursery. This change was to start last month, until the RNs in Nursery let PRN know there were questions that needed to be answered to ensure patient safety and competent care. The RNs developed a list of questions and PRN let ECH know no change could take place until the questions were answered. This is part of the bargaining process between the union and hospital required by law for management to implement changes in working conditions.

PRN attended the FCMC committee meeting on May 24, 2010. Two issues were clarified between PRN and ECH. First, couplet care will happen. When it starts depends on completion of the requirements for RN education and competency. Just a reminder: Competency can occur prior to an RN feeling comforable with changes. Competency comes from education, both didactic and clinical while comfort comes from experience and time. Also, couplet care will not start until the support procedures and policies are developed and in place to ensure patient safety.

Second, there is no plan to RIF RNs in Nursery. The expectation is that all the RNs in Nursery and Maternity will be needed to staff couplets. Now, to be honest, there is never a time when there is a guarantee of continued work. Staffing is always based on census. If the business in MCH took a radical downturn, there is always the chance that ECH might make a change in staffing (e.g.: a RIF or Layoff). This radical loss of patients is not anticipated. Therefore, the planned change to couplet care does not include a RIF of Nursery RNs or Maternity RNs.

Finally, PRN and ECH have an agreement that the RNs in Nursery and Maternity will be fully educated to care for the "other half" of the couplet. This means each RN's skills will be assessed and learning needs will be identified. This will be the basis for each RN's education needs. This assessment will not be the basis for any employment action. It is very important that each RN get the education she/he needs to care for couplets in a competent manner. Please take advantage of the assessment and education.

PRN is actively involved in the change in working conditions of the RNs. We need experts to support PRN's efforts to bargain effectively with ECH. Whenever it is appropriate or needed, PRN will be happy to attend meetings to share and gather information. Please help the other MCH RNs make the change to couplet care.