How does your hospital do this? Newborn Assessment Nurse

[burritoexpert]

Curious about how other hospitals do this--

At my hospital, every shift a postpartum nurse is assigned to be the Newborn Assessment Nurse (NAN) for the shift and will see every baby that is born on their shift within the first hour or two of life for their birth measurements, footprints, admission meds, any bloodwork if needed (our L&D nurses aren't trained in infant bloodwork), & a very thorough assessment to identify any birth defects/babies that need blood sugar monitoring or tox screens based on mom's history etc. & you might have to teach mom how to breastfeed and help get baby latched for the first time, if she hasn't fed yet.

We have trouble keeping nurses agreeing to do this job because it can be really grueling when, say, 5 babies pop out all within a couple hours and regardless of how many babies are born, it is just one nurse doing it.

So I want to know how other hospitals do this--- do you all just have one NAN for the shift? Or are these tasks divided up between the L&D and postpartum nurses? Something else? I'm curious!

[klone, MSN, RN]

Hi there and welcome to Allnurses! My first question would be, how many deliveries do you do a month/year? That would help in determining whether it's reasonable to have one baby assessment nurse/baby catcher/transition nurse (every place calls it something different). The place I've worked that has done the most deliveries (about 300/month) generally had one nurse in that role, and another nurse (the NICU break nurse) as backup if there were more than one delivery happening at a time. This nurse did a bit less than what you are describing, though. She would stabilize the infant after delivery, the first couple sets of vitals, measurements, sugars if needed, and meds. And then she would pass the baby back to the labor nurse, who would then finish the recovery of mom and baby (unless mom was unstable). Admission assessment was done by the pediatric provider.

At another place I've worked, the charge nurse was the baby receiver. This facility did about 100 births/month. 

The first place I worked, we would tag another L&D nurse to be the "baby catcher" and she was truly just there to make sure NRP was not needed, and then the primary L&D nurse would take over care of mom and baby (again assuming mom is relatively stable).

But by and large, most places I've worked that has done higher volume typically had one nurse in that role, and that's all she would do during her shift. But whether that's reasonable to just have one nurse or more than one really depends on your hospital's birth volume.

[Michellelizz]

I work L&D at a hospital that does around 400-500 births/month. Our charge nurse attends all deliveries with the primary L&D nurse just to make sure any resuscitation isn’t needed. The primary L&D nurse does all immediate baby care including assessment and meds. 

[RUNBNursing, BSN]

Like the previous poster said, it depends on average deliveries per month. The hospital I work for has on average 400 to 450 deliveries per month. On day shift there are generally 3 nurses in the nursery that do everything you described. On night shift there are usually 2. I've had nights were I have 1 or 2 deliveries to attend all night and nights where I have 3 or 4, have never had 5 but I know it happens. We are required to show up for csections immediately after delivery and for lady partsl births no more than 45 minutes after delivery so sometimes if we have too many births close together the charge nurse will go to one. We find this works well and allows a good balance. We are trained in both postpartum and nursery so we could be assigned to either although there are nurses who have preferences and are more likely to be assigned to one or the other, I personally don't mind either way.

[moongoddess9301, BSN]

So, my hospital does this, but there is not always a NAN nurse scheduled or available. So it is the L&D nurse's responsibility to assess the patient if the NAN nurse is too busy or if there isn't a NAN nurse that day. Kind of like an additional resource. The NAN nurse tells the L&D nurses how many babies they can handle, and the L&D nurses pick up the slack. 

[NICUmiiki, DNP, NP]

So our (high volume, it’s normal to have 20-30 births per day) hospital has a transition nursery. There is a physical location, but it’s more of a home base for the transition nurses. Occasionally, well-babies who are teetering the line will be observed here for up to 6 hours and then either return to mom or go to the NICU. 

There are a handful of transition nurses on each shift (4-5). The transition nurses are called to all non-NICU births. They attend the birth, and assume care of the infant until the couplet is transferred to M/B. The transition nurse gives report directly to the M/B nurse. If all of the nurses are assigned to a baby, then the one with the oldest baby goes and will have 2 babies at the same time for a short period.

The transition nursery is run by and staffed by the M/B department. They have dedicated nurses who were MB nurses for at least 2 years, applied (competitive), and received additional training. 

[RhandaH, ADN, RN]

We have this- neonatal admission team (NAT). Same exact thing you explained. And yes its soooo hard keeping this role filled. At times the nicu nurse will have to fill in and we DREAD doing it because it is so grueling.

[NICUmiiki, DNP, NP]

On 6/4/2021 at 9:10 AM, RhandaH said:

We have this- neonatal admission team (NAT). Same exact thing you explained. And yes its soooo hard keeping this role filled. At times the nicu nurse will have to fill in and we DREAD doing it because it is so grueling.

Our hospital actually doesn't have a problem keeping it staffed. It's got a waiting list of M/B nurses who'd like to train into the role. 

[motherbebenurse]

So glad to find this thread as the unit I work on is having similar issues transitioning! I work in a large volume/fast turnover hospital. We average about 600 births per month and rapidly growing. Our ratio on the unit is typically 1:3-4, and 3 nurses in the nursery. We are far from baby friendly as we care primarily for a population who favors babies spending most of their time in the nursery. For about 5 years now our process has been that of the 3 nursery nurses, 2 are in charge of going to L&D to admit babies, and one RN in the nursery. This has become a safety issue lately with the increasing number of births and higher turnover. Our pediatricians (3 primarily) see all of the babies in the nursery first thing in the morning. So if the shift starts with multiple admissions, the 2 admission nurses are in L&D and 3rd nursery nurse is left alone in the nursery to give report to all pedis, and there could be up to 35-40 babies in the nursery. Not to mention keeping track of orders, circs, bills, blood draws, etc. We do couplet care so the floor RN's are technically in charge of the care of their babies, but the nursery nurse is the main communicator between pedis and RN's. 

Recently management has decided to change the process. Our ideal situation would be 4 nursery RN's, 2 to stay in nursery and 2 to admit newborns. But the increase in staffing will never happen. So management solution is one nurse stationed on L&D for the day in charge of admitting babies. 2nd backup admit nurse who stays in nursery to assist nursery nurse with tasks, and assists in L&D when needed. Our process was typically that the two admit nurses would admit together, one assessing baby and one charting assessment in real time and placing orders. Of course when we are at our busiest, the 2 would separate and do admissions independently. But the process is so much faster and smoother when done as a team. 

We have accepted that the change is being made, but we want to come up with some compromises to streamline the process. Is there anyone who works on units with a similar volume that has any suggestions??