[bvb]

Does anyone do cross training between L&D and postpartum? Administration wants us to do it (again). We have tried it 2-3 times in the 17 years I have worked in L&D and it never works very well. It seems that it is fairly easy for L&D to go to PP but (nothing against PP nurses) not reciprocal. We feel that you need to work consistently in L&D to feel comfortable not just a day here and there. What has always happened in the past is this; if L&D is slow, then it's OK for the PP nurse to stay there but as soon as it gets crazy, the L&D needs to go back. Usually they're glad to go back but then what is the point of crosstraining?! We have a 16 bed L&D unit where we also do triage, high risk and antepartum. If anyone does cross training on a regular basis that actually works, how do you get started and then how do you maintain everyone's competencies? We are meeting with alot of resistance among the staff and most of the MD's don't think it's a good idea either. Our supervisor tells us "we're behind the times, EVERYONE else in the country is doing this!?"

[fergus51]

The only way our PP nurses can work in L&D is if they take courses through a university in specialty nursing. BCIT (www.bcit.ca) runs the program. The nurses take one course about high risk moms and babes (via distance), then have to do a six week practicum in L&D (a lot of Canadian universities offer specialty nursing programs which are a great way to introduce nurses to a new area). Only after that is done are they allowed to work there. Most of our staff is not crosstrained, which has never been a real problem. The only place I have been where this was important and actually worked was where the women were in LDRP rooms so the same nurse would care for her in labor and after (so you were always getting time in each area). I see no point in cross training if the units are still staying separate. Why do your administrators want to do this?

[bvb]

I believe they want to do it to downsize staffing. If L&D is busy they could pull nurses from PP then when the pts deliver they could pull the L&D nurses to PP! Our concern is, what if BOTH units are busy? We also feel we should have a minimum number of L&D nurses available no matter what since you never know what's coming in the door or when an emergency situation will occur!

[fergus51]

I'm definitely with you on that. As soon as a L&D staff gets smaller the number of women in labor gets larger! Are there any specialty nursing programs near you?

[Nursz-R-Awsm]

Wow, I work LDRP's, so I had to learn PP, then L&D....pretty much OJT. It really does need to be consistent time in L&D to learn it. I wish we'd been offered specialty nursing courses like that...it felt more like baptism by fire. The only courses we had was a basic fetal monitoring course and I plan to take an advanced course.

[shay]

I cross-trained to L&D when the hospital where I worked decided to renovate and convert to LDRP's. They had all the M/B nurses xtrain to L&D for 6 weeks, then were expected to go back to being M/B nurses and just pop over to L&D on a moment's notice and take a labor patient. After one day of xtraining, I knew that would be impossible, so I asked to be made permanent L&D staff instead.

I just don't think it works well unless you can guarantee that the newly xtrained staff will work in their 'non home-base' unit at least one shift a week. There's just too much to know and technique that needs too much fine-tuning to simply xtrain and float over there once in a blue moon. You need to do it on a regular basis to keep your skills up.

[Angel Baby]

My service cross-trains to a limited degree.

L&D staff are cross-trained to PP and well newborn. The rule is that if L&D is deathly quiet and there is a need in another area then the L&D staff can "help". They must be immediately retrievable, which means they do not take a patient load.

Don't underestimate what Nursery and PP staff can help with. I don't have them interpret monitoring or labor patients, but they can be trained to recover vaginal deliveries (uncomplicated), help perform admission histories, and even monitor a Postpartum MgSO4 patient. Answering phones, lights and order entry are also an incredible help when the bottom falls out in L&D. But, you absolutely must have a core staffing of experienced L&D nurses on each and every shift...........

I think the rules just need to be absolutely clear. If you are not interpreting fetal monitors on a daily basis then competency becomes a real issue--I would not expect that from any other staff other than L&D nurses.

I'm concerned about the respondents who are functioning in L&D with such little training and support--this is incredibly unfair to you. My L&D nurses have a 3 month orientation (which includes 13 didactic classes and clinical with a preceptor) and continue to be supervised by experienced L&D nurses for their first 6 months. This is what the Board of Nurse Examiners says is the standard--any new grad or RN without prior experience in a specialty area needs to be supervised for the first 6 months.

Since L&D is the highest area of litigation and unique in so many other respects I would caution any nurse against taking on the responsibility of managing a labor patient without the appropriate training, supervision, and ongoing competency validation. Know your nurse practice act--it can be your shield!! This may be how you can make your case with Administration--get your Risk Manager involved and look at AWHONN standards. And, lastly, remember that Administration and Senior Nursing Leadership doesn't understand OB nursing unless they've done it.

Good luck.....