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Running head: Collaborative Project: Mother Earth

Collaborative Project: Mother Earth Birthing Center

Paula Barth, Danielle Bundrent,

Danielle Rogers-Candee, Amanda Golembeski, Kim Schueler

Spalding University

NURS-485
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Collaborative Project: Mother Earth Birthing Center

The labor and delivery sect of nursing has begun to benefit

from the implementation of birthing centers throughout the

country. Many women prefer a birthing center over the

traditional hospital delivery because birthing center usually

provide a more relaxed and natural environment (Vizard, 1993),

women develop a close relationship with their nurses and

midwives (McCartney, 2007), breastfeeding is encouraged ,

episiotomies are not routinely performed (McCartney, 2007), mom

and baby are cared for by the same nurse, and they do not have

to change rooms for the various stages of delivery (labor,

delivery, postpartum)(The birthing center, n.d.). Besides the

preferences of patients, 85% of nurses working in birthing

centers say that they have a “high degree of job satisfaction”.

Birthing centers are also more fiscally sound than the average

labor and delivery unit. On average, they cost 50% less, and the

average length of entire (intrapartum through postnatal care)

stay averages 16 hours (Acton, 2007). Based on these community

and professional benefits, we have created Mother Earth Birthing

Center, which is a tranquil and comprehensive center for women

and their families.

Mission, vision, and values

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Unit description and environment

The Mother Earth unit will be located on a ten acre lot

adjacent to a local hospital. This location will provide the

clients with a serene, nature-filled environment, and will also

be close to the hospital in the rare instance that a client

would need transferred. The unit will consist of 20 client rooms

in a circular arrangement, with one main nurses’ station at the

center. Every two rooms, there will be a large linen/storage

closet and a medicine room. The close proximity of these rooms

will reduce time when a client is in need of an item. Each room

will consist of regular, full size beds which will allow comfort

and movement in the bed for mom, as well as the possibility for

rooming-in for the father or other family member. In addition to

this, each room will have a full-size sleeper sofa to allow for

extra sleeping quarters if needed. The equipment in the room

(lights, optional monitors, vital sign assessment equipment,

etc.) will be discretely hidden in home-like cabinets in the

room. Each of the 20 client rooms will have a private, attached

bathroom and shower that includes a double whirlpool bath.

Whirlpool baths have been shown to reduce the pain of labor and

lowers the mother’s blood pressure (Vizard, 1993). Each room

will also have a balcony off of double-screened glass doors. The

balcony will have a swing that overlooks part of the wooded ten

acre plot.
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The main unit area will have a fully-stocked community

kitchen that each client and her family will have full access

to. Moreover, the birthing center has access to the 24-hour

kitchen and prepared menu at the hospital. During her delivery

experience, the client will never change rooms as in a

traditional hospital setting. Even after her baby(ies) is/are

delivered, the baby(ies) will stay in the same room as mom

(unless she requests private time). At Mother Earth Birthing

Center, we feel that it is important for the new parent(s) to

see and be involved in the primary and initial care of their

child(ren). The main unit will also have an in-house library and

educational center. The center will host all of the prenatal,

intrapartum, breastfeeding, parenting, sibling, family, and

postnatal classes that we offer (free of charge) to all of our

clients and their families. The library will house reference

books, pamphlets, and online education modules that the client

may use to research and discover any additional information that

they feel they need. Also, the library will be staffed during

the day shift by a full-time Registered Nurse that will be

available to answer any of the client’s questions or concerns

about their experience.

As previously mentioned, the Mother Earth Birthing Center

will be in close proximity to the local hospital. This

particular location was chosen because it is on adjacent

hospital grounds. Therefore, all of our clients have rapid

access to advanced medical interventions, should they arise. We

have built a large, underground tunnel that connects the

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birthing center to the hospital. This route is private to our

center, and is used to transport the client, meals if ordered,

medications, and general equipment between the hospital and the

center. Please see the Appendix for the unit and room diagram.

Staff organization and management

Our staff consists of a medical director (an M.D.), 2 on-

call Ob-GYNs, a rotating charge nurse, 20 Nurse Midwives, 10

Registered Nurses, and 5 Registered Nurses in our PRN pool. The

medical director monitors all charts and consults with the nurse

midwives on each woman’s individual plan of care (Vizard, 1993).

Two rotating midwives attend to each woman’s birth experience.

The client sees one of two (whichever is working that shift) for

all of her visits, and is delivered by one of these midwives

(whichever midwife is on-call during her admission for

delivery). The same nurse works with mother and child, and the

hospital lactation consultant will speak to and educate each

mother as needed. The birthing center uses the main hospital

pharmacy, and the medical director gets frequently needed

supplies from the pharmacy each week. The connecting tunnel is

used to transport any additional pharmacological interventions

that are needed. The two on-call OB-GYNs are hospital employees,

and provide the center with phone consultation services, orders,

and visits/assessments/assistance as needed. Further information

regarding organizational information and structure can be found

in the Appendix.

Staff development and organization, performance reports,

self assessments, and patient surveys/feedback are all based on

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the 14 Forces of Magnetism model. The 14 forces to focus on are

as follows: quality of nursing leadership, management style,

organizational structure, personnel policies and programs,

professional model of care, quality of care, consultation and

resources, quality improvement, autonomy, community and the

hospital, nurses as teachers, image of nursing, nurse-physician

relationship, and professional development (Nursing services,

2008). In order to assess staff nursing competencies, the center

uses the COPA model (Redman, R.W., Lenburg, C.B., Hinton Walker,

P., 1999). It is important to measure staff competence because

it directly affects organizational performance, liability,

ethics, risk management, and recertification of providers (Kak,

N., Burkhalter, B., Cooper, M., 2001). All employees have

modules (based on licensure/scope of practice) that they

complete before their quarterly performance and competency

reviews. These modules may be completed if they do not currently

have a client during their shift, or they may come in outside of

their schedule to complete them. The modules consist of video

demonstrations of the competency skills, a review of the task,

new information and/or protocols, and self-quizzes at the end of

each module. Every quarter (after completion of the assigned

modules), each employee will have a performance and competency

evaluation. This evaluation will be done on our simulation

clients in our education center. They will be assessed by both

the medical director and a charge nurse. If the director, charge

nurse, or employee feels that they need further training in this

area, they will be assigned additional modules as well as one-

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on-one training. After the remedial period, they will be

reassessed in the same manner. Sample performance review and

competency tables (Table 1) are included on the Appendix. As

previously stated, the performance and competency evaluations

will be done quarterly. In addition to these, each employee will

complete a yearly self assessment, and present this to the

medical director and charge nurse. This helps each employee to

mentally review their cases and performance, and communicate any

issues or suggestions to the charge nurse and director. A sample

self assessment is included in the Appendix.

To ensure that Mother Earth Birthing Center employs the

“right person” for our center, we have a potential new-hire

shadow day. An employee that has applied for a position at the

center must first pass the background check and interview

portion. Then, the potential employee comes to the center to

shadow one of our experienced employees. This provides an

environment to sample the “fit” between this individual and the

center. The salary figures and the low patient load at the

center (1:2 nurse-client ratio) leads to a minimal turnover

rate. Also, the birthing center offers stock options after each

annual review. After each positive/passing evaluation, the

employee has additional stock options from the center. Through

the hospital, the birthing center provides paid continuing

education for our employees. In addition to this, the center

offers the option to rotate schedules every 6 months. This is

called the 8 to 12 Program. Every 6 months, this program lets

each employee decide whether they would prefer to work five, 8-

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hour shifts or 3, 12-hour shifts for the next 6 months. This

provides each employee with choices for change, and helps to

reduce shift burnout for our staff. To manage understaffing in

the unit, the center employs a PRN pool of 5 nurses. The center

does not have overstaffing issues. Labor is not usually a

planned experience, therefore we are fully staffed at all times

in preparation for any situation that may arise. As mentioned

above, if an employee does not have a client they work on their

modules, help another staff member, or do their

performance/competency evaluations.

The charge nurses manage all internal conflicts within the

center. The protocol is that the charge nurse will hear each

individual’s account of the issue, and then discuss the

situation together in order to formulate a compromise. Each

employee involved will then sign a “contract” stating that they

agree to participate in the new compromise. Mother Earth

Birthing Center uses a (ENTER LEADERSHIP/MANAGEMENT SYLE INFO

HERE). The center is proud to have an open communication policy

for all of the employees. The chain of command can be visualized

on the organizational chart in the Appendix. In addition to

general open communication via e-mails, phone calls, or set

appointments, the center also has a suggestion box that is

checked monthly by the medical director. Suggestions or comments

in this box can be identified, or can be written anonymously.

The center also applies a democratic system with new policies

and communications. Regarding new policies, the director/charge

nurses meet with each employee individually to discuss the

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policy and their feelings/opinions about the situation. After

meeting individually, the staff meets as a group during each

shift to discuss these policies and their implementation and

impact. Staff communication about meeting times will be

distributed by the director, and always have at least a 24-hour

notice (except for cases or extreme urgency). To motivate the

staff during normal work hours, there will be a Kudos board

located at the nurses’ station. When a staff member or client

sees a staff member doing something exceptional, they are free

to put a star with that person’s name on it on the Kudos board.

The board will be cleared at the end of each month, and the

employee with the most stars will get to draw a gift card out of

the center gift card bucket as a special treat for their

exceptional work habits.

Licensure and fiscal management

In order to license the center, there are many steps to

take. First, it is essential to obtain the land and finances to

construct the center. Second, we need to obtain our business

license and work on licensure. According to similar centers,

licensure consists of: background checks on employees,

organizational structure, business license, code/ordinance

compliance proof, proof of building occupancy, number of beds,

average daily patient census, and contact information for the

director, administrator, and one additional employee (Child

birth center application checklist and instructions, 2008). To

obtain the finances necessary to build and run a functional

birthing center, we sent our grant proposals to several

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celebrities and private companies. Our grant proposal included:

history, mission, purpose of grant, steps, public needs

assessments, staff information, and evaluations (Blue Cross Blue

Shield Foundation planning grant proposal, 2006). Based on the

funds we received from initial grants, we were able to purchase

the land and build the facility. From the funds from more recent

grants, we are able to sustain our payment plans and employee

salaries for the next 100 years. At that point, we will reassess

for new grants or sources of additional funds.

The Mother Earth Birthing Center accepts all types of

insurances including Medicaid for services rendered. No one is

turned away due to lack of insurance or inability to pay. If

they can pay, the full cost of the average birth at the center

is $5000. If they cannot pay that full amount, we offer a

sliding scale payment plan based on previous W-2 income

information. The salary range information is as follows: R.N.

$100,000-$150,000; Nurse Midwife $150,000-$200,000; Director

(M.D.) $500,000; and OB-GYN consultant $200,000. These ranges

vary based on experience and educational levels. Also, these

salaries are exclusive of any malpractice coverage. The center

covers malpractice insurance for all employees. More detailed

client census information and fiscal can be found in our annual

report located in the Appendix.

Conclusion

5 and 10 year goal for our facility

forseeable problems
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References

Acton, K. (2007). The birth center model: As good as it gets.

British Journal of Midwifery, 15, 10.

Blue Cross Blue Shield Foundation planning grant proposal

(2006). UMN Regional Partnerships. Retrieved on January ,

2009, from http://www.bcbsm.com/foundation/grant.shtml.

Child birth center application checklist and instructions (2008)

. Washington State Department of Health. Retrieved on

January 3, 2009, from http://www.doh.wa.gov/hsqa/fsl/HHACS

Kak, N., Burkhalter, B., Cooper, M. (2001). Measuring the

competence of healthcare providers. Quality Assurance

Project, 2, 1.

McCartney, M. (2007). How are birth centers different? AABC.

Retrieved on January 5, 2009, from http://www.birthcenters

.org/birth-center-faq/bc-difference.php

Nursing services (2008). American University of Beirut Medical

Center. Retrieved on January 5, 2009, from

http://nursingservice-lb.aub.edu.lb

Redman, R.W., Lenburg, C.B., Hinton Walker, P. (1999).

Competency assessment: Methods for development and

implementation in nursing education. Online Journal of

Issues in Nursing, 4, 2.

The birthing center (n.d.). Our benefits. Halifax Regional.

Retrieved on January 5, 2009, from

http://208.11.4.47/benefits.html
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Vizard, M. (1993, September 5). Inside the country cottage, a

hospital birth center. The New York Times. Retrieved

January 3, 2009, from http://nytimes.com

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Appendix:

organizational chart

unit diagrams

patient satisfaction survey

employee self assessment

performance evaluation

competency table structure

fiscal report