What does it take to be a good L & D nurse?

  1. I am currently thinking about leaving ER and trying out my other interest in L&D.

    ER has been a very exciting yet stressful environment for me since you never know what is going to come in the door. My question is for the L&D nurses...what is a "typical" day like?
    How many patients are you assigned too?
    What do you do if more than one patient are fully dilated and ready to push...does another nurse take over?
    What is your typical stress level on average (1-10)?
    What is the best/worst part of your job?
    Do you think an ER nurse could make the transition easily or do you think it is a "whole other world"?
    How long do you think the orientation would be?
    Thanks!
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  2. 25 Comments

  3. by   Natalieboo
    I am curious to hear the answers too! Great post!
  4. by   Energizer Bunny
    I'm bumping this...I'd like to see what L&D nurses have to say too!

    As for my personal experience, I think what makes a good L&D nurse is not questioning what the mom wants.
  5. by   SmilingBluEyes
    Just got off the 2nd 12 hour nightshift in a row. I have MANY ideas as to what I consider a GREAT L and D nurse, as one in practice for 7 years now.

    Will get back to this one later. Suffice it to say, I am strongly opinionated on this one!
  6. by   palesarah
    I agree with CNM2B, I think a good L&D nurse doesn't have her own agenda, and is able to enable her patient to have an empowering birth experience.

    I'm new to the field- I was hired into an LDRP straight out of school last year. We do about 60-80 births a month, but there is no "typical day". You never know what's going to walk through the door, and whether you're going to be out straight for 12 hours or bored silly.

    How many patients are you assigned too? We staff 1:1 for active labor patients and patients on pit. Otherwise we may have 2-3 outpatients (labor checks, NSTs, therapeutic sleepers, etc) or during the day (I work nights) the labor nurse may be starting 2 or 3 inductions, and assignments will be shifted as they become active.

    What do you do if more than one patient are fully dilated and ready to push...does another nurse take over? like I said above, we staff so that doesn't usually happen, but since anything can happen in L&D... that's exactly what we would do. Usually one of the nurses assigned to mom/baby care would cover the other mom/baby nurses patients so one could take over a labor patient.

    What is your typical stress level on average (1-10)? that's tough- maybe a 3? But it's "good" stress. The kind of stress that keeps you from becoming complacent, that keeps the job interesting, the kind of stress that you don't bring home with you. There are bad, stressful shifts where you want to go home and never come back, but you can have those kind of shifts in every field. And every field of nursing has "those" patients that make you want to tear your hair out. My hospital treats its nurses well, and I work in an extremely supportive, team-oriented environment. As a new nurse I have never felt like I was being thrown out to the wolves.

    What is the best/worst part of your job? Best parts of my job- welcoming a brand new person into the world. Being present as families grow. Supporting a woman through an experience she will never forget, and knowing that I helped make it a positive memory. Having a woman grab my hand and whisper "thank you" after the baby is born. And baby baths- I love giving babies their first bath. Especially in the wee hours of the night, after a long labor. And nothing beats the feeling of being so happy with your job that it shows on your face and your patient says "you love your job, don't you"

    Worst parts- things don't always go as planned. Demises are tough on everybody, even the nurses who aren't in the room.

    Do you think an ER nurse could make the transition easily or do you think it is a "whole other world"? I don't think I've been a nurse long enough to give you a good answer! We have several nurses who have transitioned from other fields- I think your level of dedication is the most important factor. It seems like ER is another field where you have to be flexible and be willing to change roles throughout your shift, so I think that would be helpful.

    How long do you think the orientation would be? The nurses who came to my floor from other fields each oriented for about 3 months I think, but that was both to L&D and postpartum.

    hope my answers have been helpful!
  7. by   lgowan
    PaleSarah really summed it up well to only be out of school and in this area for a year! Good Job! :hatparty:

    I think Ob is similar to ER in that it is sometimes an emergency situation. (i.e. prom, abruption, etc.) I think ER nurses do well in OB, as we have several OB nurses that moonlight as ER nurses, and vice versa. The adrenaline rush, and the uncertainty of what is coming through the doors makes for an interesting job in any arena. OB and ER do have this in common. The differences? Well, an ER is generally staffed with nurses despite having patients or not, they also have a doctor in house. OB? Some hospitals even small ones have 2 in house and sometimes float to other areas, and there is not always a doctor in house.

    I have often said L&D is like the emergency room for pregnant women, and in essence I guess it is.

    Just my 2 cents!

    Lisa
  8. by   QTRN74
    Palesarah. Thank you so much for your detailed response! You really helped me out!
  9. by   Tiki_Torch
    Keep in mind that I'm not an L&D or LDRP nurse, but I am a NICU nurse and have worked side by side with these nurses during deliveries and sharing information about undelivered patients that we as NICU nurses need to be aware of.

    I think you'd transition easily considering the aspect that L&D is like a mini-ER... you never know what super-emergency could walk through the door at any given moment. That's a very ER type of existance. I believe only the ER and L&D are pretty much routinely like that.

    Considering the difference between L&D -vs- LDRP (where L&D delivers babies, triages undelivered patients, and cares for critically ill undelivered and delivered patients -vs- LDRP where they do all L&D does along with the Postpartum aspect) The L&D is much like an ER where you "Treat 'em and street 'em"... the street 'em part is when you send the mother and baby to the postpartum/well baby nursery as soon as they are stable, which is usually within a few hours after delivery, unless the mom is very sick and needs to be on a MgSO4 drip for severe PIH after delivery, etc. On the other hand, the LDRP patients do not get the "street 'em" part because they stay with you for a few days while mom recuperates and baby gets used to the world. There would be much more time for teaching and bonding with the patients on an LDRP unit. It would be much less like an ER "in and out" setting. Extra time spent enjoying the new family is very rewarding for nurses. That's what I loved about my years on a Mother-Baby unit.

    If you've never peviously worked in an OR or PACU, that would be a new experience for you since most L&Ds/LDRPs have their very own Operating Room Suites and often do the Recovery Room (PACU) care for their surgery patients. Some critically ill undelivered moms require central lines and other such procedures which you would assist with. I don't know if you do c-lines in the ER much...

    This is all that comes to my mind right now.

    The only other thing I would add is that laboring patients is a very high-risk area prone to law suits (after all, what in the world means more to a person than their child), so they are often very, very good about orientations, safe and proper nurse-to-patient ratios, and other such matters. A good orientation and safe staffing are definate strong points for working with laboring patients.

    I hope the nurses here can help you. I doubt I've been much help but I do wish you the best in your decision. I encourage you to seriously think about stretching and growing as a nurse. It keeps us fresh and passionate about our work. I spent 7 years on a Mother-Baby unit (postpartum-well baby) and got bored with it after I felt I had learned all I could there; I transferred to the NICU and fell in love with nursing all over again. The biggest plus is that my experience helping mothers and babies bond and prepare for going home has helped me tremendously as I work with the parents of these sick babies. I'm sure lots of your ER experience will come in super handy in L&D. After all, all kinds of women get pregnant and in the ER you have been used to seeing patients having asthma attacks, hyperglycemia, seizures, high blood pressure, kidney stones, sepsis, and a host of other things. I actually think you'd be welcomed as an excellent resource for your L&D comrades for the knowledge you would bring to the unit.

    The more I think about it the more I say "GO FOR IT!"

    Warmly,
    Tiki
    Last edit by Tiki_Torch on May 16, '04
  10. by   BRANDY LPN
    You didn't exactly say if you are considering transferring because of the stress or not, but assuming that is the reason you want to transfer then you might want to re-think, OB can be very stressful, you have the same never knowing whats gonna walk through the door as in ER, and there are many life and death complications in OB both for the mom and baby, and like someone else pointed out we don't usually have a MD on the floor if an emergency walks in.

    We had a pt brought in seizing a while back, the nurse on duty was a new grad and the other nurse was gone and on-call. The only thing that really saved the day was the fact that pts family called on the way in (yes, they drove) and new grad nurse was able to get MD, on-call nurse, and OR crew in all before pt showed up, which prob saved baby and possibly moms lifes.

    But the critical thinking skills you have learned in ER would be a great bonus to an OB floor.
  11. by   PCGrad06
    Once I make it out of RN program L&D is my goal!
  12. by   SmilingBluEyes
    BINGO Brandy. OB is often considered "easy street" by other nurses. It can be in a way, I guess. WE are ESSENTIALLY dealing with alert/oriented women who are most often healthy. But when OB's "go bad" they go REALLY REALLY BAD FAST!!!

    It is NOT easy when you have moms who appear healthy suddenly go bad, somehow, babies born still, babies who develop severe distress right after birth when you think they are ok, moms who seize, PP hemorrages in the middle of the night when there is no physician around to call right in, women who come in w/o any doctor or history who are almost too hot to touch (Read: SUPER HIGH RISK), Psychiatric problem cases, drug abusers, etc. We are the primary triage point for ALL women over 20 weeks' gestation and we see it ALL as would any ED seeing adults. I have seen countless women sent up to us for NON obstetric complaints, as well, which can be a major time-eater.


    Often, too staffing is cut and in many units, OB nurses "floated" to other "busier" floors. Yet rarely is this reciprocated when the need exists for OB. (too specialized). This is a HUGE point of frustration for many OB units that are not closed.


    SO NO ONE thinking she/he "needs a break" need apply.

    I see some really good definitions of a "good L and D" nurse already above. I think you guys are SOOO SMART!
    Last edit by SmilingBluEyes on May 25, '04
  13. by   Energizer Bunny
    The more I read, the more I still think OB is for me, even though I have been questioning it. Can I ask what do you guys consider the pros and cons of your specialty area?
  14. by   BRANDY LPN
    Quote from SmilingBluEyes
    BINGO Brandy. OB is often considered "easy street" by other nurses. It can be in a way, I guess. WE are ESSENTIALLY dealing with alert/oriented women who are most often healthy. But when OB's "go bad" they go REALLY REALLY BAD FAST!!!

    It is NOT easy when you have moms who appear healthy suddenly go bad, somehow, babies born still, babies who develop severe distress right after birth when you think they are ok, moms who seize, PP hemorrages in the middle of the night when there is no physician around to call right in, women who come in w/o any doctor or history who are almost too hot to touch (Read: SUPER HIGH RISK), Psychiatric problem cases, drug abusers, etc. We are the primary triage point for ALL women over 20 weeks' gestation and we see it ALL as would any ED seeing adults. I have seen countless women sent up to us for NON obstetric complaints, as well, which can be a major time-eater.


    Often, too staffing is cut and in many units, OB nurses "floated" to other "busier" floors. Yet rarely is this reciprocated when the need exists for OB. (too specialized). This is a HUGE point of frustration for many OB units that are not closed.


    SO NO ONE thinking she/he "needs a break" need apply.

    I see some really good definitions of a "good L and D" nurse already above. I think you guys are SOOO SMART!

    Well what Deb said is a definate "con" you get every pregnant women over 20 weeks even if their complaint is NOT ob related in any way. For example once got a women in L and D where I used to work, she was in because she had a laceration on her hand that she got while washing dishes it needed to be stitched, now why in the world didn't the ER just sew her up and send her packing? Another time got a girl with a sprained ankle, no fall, no ob problems/complaints. again more of a ER kinda thing. Stuff like that irritates me, as well as when they send me girls who are less than 20 weeks, I mean what am I supposed to do they aren't viable there isnt anything that I can do that ER or MS can't do and then this girl who may possibly be losing a child won't have to hear the happy sounds of an OB unit. Okay so that is my major pet peeves, well some of them anyways, I have millions lol.

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