[rnWinn]

Hi,

I have been looking for a travel nursing position in California. I am getting really frustrated though, because my experience is totally in high risk L&D - no LDRP/postpartum experience. I would have thought it would be easy to get a job...but so far the jobs all call for floating to postpartum and gyne. Is it possible to just work on L&D alone? I have spoken with 3 nurses that I know who have travelled and they never floated (2 worked in California). I don't know why I'm having such a problem! Thoughts?

[Selke]

What are you afraid of? Just do it. PP isn't that hard, believe me. Tell them you will need an orientation. You can ask questions of the staff if you are floated. Gyne isn't hard, either. But I've also worked med-surg; gyne may include some sick patients (oncology) or usually postop hysterectomies and such, which are similar to post op c-sections, only the women are older

It is also likely you won't have to float. If the subject comes up you can tell the charge nurse or supervisor that you've never worked PP or gyne before so you'll need to be able to ask for help. Many units will say you need to be able to float, becasue the traveler will be sent to float, but in actuality you won't. Especially during the high birth season I've worked L&D in CA and only had to float a few shifts at one assignment, and the staff were very good to me. (I can work PP, however and am not anxious about it ...) PP is pretty mindless and task oriented if you are a high risk L&D RN. The most important thing you do that requires skill is assisting with breastfeeding and helping new moms with baby care, and you should know this already.

[rnWinn]

Thanks for your quick response...postpartum I would certainly be more willing to float to, but NOT antepartum/gyne (in my hosp they have 10 patients each with no aide a lot of the time and these patients are fresh post ops on PCAs, palliative onc patients etc as well as the antepartums - no way would I float there!!) I would float only IF I was given a good week's orientation to postpartum, because while I know the basics of babycare, assessment and especially breastfeeding, it's the other stuff like bilirubin and wbc shifts and stuff that I'm like *duh* I'm an L&D nurse! But thanks for your input!!

[Selke]

You don't have to know things like bili levels and WBC shifts or whatever to do PP nursing. Trust me on this. You will not be a NICU or nursery nurse, nor a Peds NP. You just have to know how to do basic assessments on mom/baby, hand out pain meds, breastfeeding support, assist at a circ, how to do a discharge (which differs in every place, anyway). Really. It's very simple stuff. You can do it.

[bagladyrn]

Originally Posted by rnWinn

Thanks for your quick response...postpartum I would certainly be more willing to float to, but NOT antepartum/gyne (in my hosp they have 10 patients each with no aide a lot of the time and these patients are fresh post ops on PCAs, palliative onc patients etc as well as the antepartums - no way would I float there!!) I would float only IF I was given a good week's orientation to postpartum, because while I know the basics of babycare, assessment and especially breastfeeding, it's the other stuff like bilirubin and wbc shifts and stuff that I'm like *duh* I'm an L&D nurse! But thanks for your input!!

Your best bet to find positions with minimal to no floating is to look for contracts at larger facilities where the L&D, mother-baby, and antepartum units are completely separate units with separate staff.
What you would be doing in a pp unit though isn't really that much different than what you do in the postdelivery time before they go out to PP. You can tell an interviewer that you lack the PP/Ante experience but would be willing to float as "help" but not to take a patient assignment. (I do this in small facilities for anything outside of OB related). If they agree to this, be sure to have it written into your contract though!
By the way - I'm doing a high risk antepartum unit right now and the patient load is nothing like what you are relating - we max out at 3 pts. a piece. Anything more wouldn't be safe as they are true high-risk!

[CARCAM75]

Hi RNWINN,

I feel your pain I am on my first travel assignment in a smaller L&D hospital than where I trained (a high risk women & baby hospital, with separate units and staff for antepartum, L&D, PP, etc). When I interviewed with the hosp for this assignment, I made it very clear that my experience was in L&D only. They were excited that I came with a high risk background. When I got there, the unit is a small one, so during my 12hr night shift, I can have 1 labor pt, and 1 observation pt - who gets discharged leaving me open to receive either an antepartum pt or labor pt or other observation pt. Just depends on the staffing. I've started a shift as a labor nurse there and when my pt delivers, there weren't enough PP nurses to take her over so I end up being her PP nurse also - still leaving me open to receive one of the 3 other types mentioned above or now leaving me open to take on more PP patients for that shift. It really just depends.

I was TERRIFIED when I first had to take on a non-labor pt. But the other nurses were more than helpful (which I was grateful for because I came from a paper charting environment into a computerized QS system style charting - which was a nightmare trying to learn but now I can function ). I say all of that to say this: Antepartum pts aren't so bad (high-risk or not) because most of the time the babies aren't on continuous monitoring (like labor pts) - leaving you to just monitor mom's condition/ meds (which is mostly Mag anyways) q 4hrs vitals (unless on mag- then it 's hourly), q 2hr charting on baby (if they are on continuous monitoring or q shift if not) leading to an "easier" night most of the time once the assessments are completed.....

Postpartum pts aren't so bad either cause once you do the admission assessment (extended recovery checks I call it) on mom and check baby's vitals (TPR), bathe baby (sometimes the techs like to do this - which is a help to you), and decide on moms baby feed schedule (breast q2hrs, bottle q 3rs), take care of whatever baby tests are required for your state (I'm in FL so that includes the PKU test, bilirubin test, etc.) you basically have an "easy" night cause you don't have to touch mom again for the shift unless there is a bleeding issue or she has more going on, and as for baby, you just have to do TPR q2 hours for the newly born then I believe it's every 4hrs (I've only had to take care of the newly delivered pp pt. thus far not the day 2 pp pt. so I don't really know what happens with the care after that). Triaging is ok too, because you basically see the pt and then send them home or to the respected unit - ante or labor per the MDs orders. (Treat em or Street em they say).

I still will not trade L&D for any of those areas no matter how much "easier" my night may go. But being on this assignment has reduced my "fear/discomfort" of leaving my L&D comfort zone if needed. Since they know that my specialty is labor, it is VERY rare that I have to take a non-labor pt unless the census is just low. Even if the census is low and there are only 2 labor pts on the board, they'll give me the 2 labor pts and use the staff in the other areas. I think you'll be more than fine. Just be sure to reiterate to your charge RNs at the start of the shift that your specialty is L&D. Be sure to follow that with "I am more than CAPABLE of handling Antepartum or Postpartum, but because my experience is L&D, I'll spend more time inquiring on how to care for the ante and pp pt than I will for the labor pt".

I didn't get a "formal" orientation to the postpartum or antepartum area, but the need arose a couple of nights, I was the available nurse on shift and so I was it. Again, my fellow nurses were more than helpful in filling me in when I had questions. They've also reshuffled staffing on the shift a couple of nights - giving me someone's labor pt so that they could assume pp or antepartum duties. So, as long as you speak up - not in the I JUST WON"T DO IT tone, but in the I'm more than capable,but I"ll require more training if you give her to me tone - you'll be ok. I'm sure of it. The charge RNs for the most part are so appreciative to have your help that they'll be more than happy to place you where you're comfortable than to have you go where there may be a liability issue for them. Another example that I have is that 2x there have been pts with demises that I should've gotten but the assignment was shuffled so that I could assume care for a labor pt and that nurse received the demise pt because I - the traveler would not be as familiar with the hospitals processing for that type of case. Again I feel you'll be fine. Happy Traveling!

[suzanne4]

CA has ratio laws so you are not going to find any assignment in any hospital that has 10 patients per nurse. Just not going to happen.

When you work as a travel nurse, you are there to fill in gaps that the facility has in their scheduling and in most facilities are expected to float to other areas that are covered in the same area, such as post partum, antepartum, and even gyn in some facilities. Depends also on how busy that the facility is and how many deliveried per month. Some may get floated once a week, or even two shifts per week, and others may float more, and some neve get floated. Things can change also from assignment to assignment in the same facility, depends on their needs.