ORLANDO, Fla. — HCA Florida Osceola Hospital’s decision to eliminate its nursery — which prompted dozens of nurses, who argue the change will create unsafe conditions for newborns, to stage a protest last week — is part of a growing trend around the country.
In recent decades, it’s become standard to leave healthy newborns in rooms with their mothers as much as possible — a practice called rooming-in. It’s also referred to as the mother-baby model because one nurse typically cares for both of them. HCA Osceola has embraced this model.
There’s disagreement about whether removing the nursery unit is necessary and whether the same standard of care can be provided without it, however.
“Rooming-in has been around for many years. But you always had that one person that was an expert in her field that you could count on that was watching the babies that were out on the floor,” said Nancy Duckworth, who worked as a nurse for decades before becoming an associate instructor at the University of Central Florida College of Nursing.
Keeping mothers and babies together can improve the well-being of both and encourage breastfeeding, research suggests. Breastfeeding is linked to a lower risk of asthma, Type 1 diabetes and sudden infant death syndrome, also known as SIDs, according to the Center for Disease Control and Prevention.
Organizations such as the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the World Health Organization endorse the mother-baby model used by HCA.
“HCA Florida Osceola Hospital has a decreased need for nursery services because healthy term babies are typically cared for in the room with their mothers and our preterm or vulnerable babies are cared for by our specialized team in the NICU,” HCA Florida Osceola Hospital Chief Nursing Officer Michelle Farris said in a statement to the Orlando Sentinel.
This mother-baby method does not require hospitals to get rid of nurseries, however, and AWHONN advises nurses to “be flexible” in allowing mothers breaks.
Orlando Health Winnie Palmer Hospital for Women & Babies, for instance, practices rooming-in but currently has no plans to phase out its nurseries, said spokesperson Alayna Curry in an email.
At least one of AdventHealth’s hospitals, AdventHealth Celebration, lacks a traditional healthy-baby nursery. It’s a nationwide trend, too. Emory University Hospital Midtown in Atlanta and Dartmouth-Hitchcock in New Hampshire have gone without traditional nurseries for years, according to the Boston Globe.
Three HCA Osceola nurses told the Orlando Sentinel they believe that nursery unit nurses are crucial. They argue nursery nurses have more experience than other nurses at certain tasks, such as performing a standard newborn assessment, in which babies are checked for potential problems with breathing, skin color or other warning signs.
“When you do something over and over and over again, you get good at what you do,” said HCA Osceola nursery unit nurse Virginia “Ginnie” England.
HCA spokesperson Trip Farmer said through the mother-baby model that HCA Healthcare employs, other nurses do have the requisite experience already and can handle all the responsibilities that were historically given to nursery nurses.
Cassandra Concas, a labor and delivery nurse at the Osceola hospital, is concerned in part because she has previous experience at a different hospital that lacked a traditional nursery unit.
The battery of newborn assessments babies need was still getting done, but not as well, she said.
“Babies were being born and they weren’t being admitted properly. We didn’t have measurements done; the pediatricians would get upset,” Concas said. “Things were being missed. Babies that should have been getting blood sugar checks because they were too small or too big weren’t getting them and it became a very, very big problem.”
Thorough newborn assessments are especially important at the HCA Osceola hospital, which serves a high-risk population of moms who don’t always advocate for themselves, Concas said.
“A lot of our patients are really low-income immigrants that are fresh to the country,” Concas said. “Patients that will come in, they don’t have insurance, they don’t have prenatal care, or they have very limited prenatal care. They don’t speak English, so they just kind of stay quiet and they don’t ask questions.”
Short-staffing — prevalent across the nation — compounds these concerns, said Marissa Lee, vice president of the National Nurses United union and a nurse at HCA Florida Osceola Hospital. Lee has helped organize pickets regarding low-staffing at this hospital before.
HCA contends high-quality care will continue to be provided without a nursery.
In addition to mother-baby nurses and NICU nurses, HCA Osceola has a group of experts who are available to assist with newborn assessments 24/7, including neonatologists, neonatal nurse practitioners, and board-certified OB/GYNs, Farmer said.
“Newborn assessments and care are of the utmost importance,” Farmer said. “That is why we have multiple experts onsite to assist from when the mother checks in to when the mother and baby leave from our hospital.”
Another common concern surrounding rooming-in is whether it puts an undue burden on mothers.
“Rooming in has gone on for a number of years, but the mother always had the option to say, ‘I need to sleep,’” Duckworth said. “Once they go home, they don’t have the option to say, ‘I need my baby to go to a newborn nursery.’”
A 2017 study published in the Journal of Perinatal Education found 60% of surveyed postpartum mothers had a positive experience rooming-in at a hospital that closed its newborn nursery.
If a mother wants a break from her baby for any reason, the baby can be admitted to the neonatal intensive care unit at nursery status and cared for there, Farmer said.
“There are no restrictions on when a healthy baby can be cared for in the NICU. A mom may request this at any time, for any reason,” Farmer said in an email.
England and Concas said they feel pressured to deny moms’ requests for time alone because of the hospital’s rooming-in philosophy.
The hospital is hiring more neonatal intensive care unit nurses to make up for the lost positions, and nursery nurses have the option to train to work in the NICU or other departments, Farmer said.
Nursery nurses have already begun training alongside NICU nurses in anticipation of the Dec. 12 transition.
