L&D Nursing Advice PLEASE HELP!

Theworldisourspot · Nov 29, 2015

Any thoughts??

lavenderskies, BSN · Nov 30, 2015

I have been offered a position in L&D at Northside. Anyone have advice? This is the business L&D hospital in the nation. I am excited but nervous at the opportunity and would love some "real life" feedback from L&D nurses...do you love it? What parts do you least enjoy? Any input in Northside as an employer? Thanks!

Congrats on the job offer! To answer your questions....

I like it not love it most days. :)

I least enjoy the hideous amount of documentation necessary to cya. Next up would be the unnecessary interventions. Pretty much everyone has more intervention than they need. It's hard having patients that are less than stellar parent candidates.

I'm not familiar with the facility you've been offered a position, sorry :) I hope someone chimes in that does.

Theworldisourspot · Dec 2, 2015

Thanks! Why is cya? What unnecessary interventions? Thank u!

JustBeachyNurse, LPN · Dec 2, 2015

CYA = cover your ass aka thorough defensive documentation as opposed to charting by exception

Annachu512, BSN, RN · Dec 3, 2015

I have been offered a position in L&D at Northside. Anyone have advice? This is the business L&D hospital in the nation. I am excited but nervous at the opportunity and would love some "real life" feedback from L&D nurses...do you love it? What parts do you least enjoy? Any input in Northside as an employer? Thanks!

Did you ever take the job? I was offered an interview at Northside as well however it comes right after I will be starting at L&D at Kennestone. While Northside would be a fantastic opportunity, I just don't know if I could make such a nasty move right after starting elsewhere.

cayenne06, MSN, CNM · Dec 3, 2015

I agree with the comment about unnecessary interventions. The facility where I work prn as an L&D RN seems to actively discourage uninterrupted S2S (no one does bedside assessments but me, and there is a huge rush to get weights/measurements done within the first ten minutes or so because "we can't admit the baby without a weight!" Sigh. Vacuum extractions after an hour of pushing and good fetal descent, the OB who refuses to deliver in any position but semi-fowlers with stirrups, continuous monitoring across the board (our IM protocol is 20 minutes on, 40 minutes off- more of a pain to the patient than just keeping the straps on all the time. IA is not allowed.), no VBACS because anesthesia is not in house 24/7, similac "breastfeeding support bags" for every patient.... yuck. I also hate assisting in circs.

I loooooove providing labor support, I love helping a new mom develop confidence in her skills, I love spending time in the OR. I love the autonomy, I love the adrenaline of successfully managing complications. I love placentas, and blood, and cuddling squishy noobs while mom takes a nap. I love that my patients are almost always healthy and independent. I love working in a low volume unit so that I almost always have all the time in the world to educate my moms and give them extra TLC. I dislike working in a low volume unit because we can go from 0 to unsafe staffing levels in an instant.

I dislike PACU with a passion (our new EHR doesn't "talk" to our vitals machines, so I have to manually transcribe q5m vitals into the EHR- I hate this so, so, so much. And when things go wrong in LDRP, it just seems so much more tragic. And no matter how good you are at your job, you will have bad outcomes, and that sucks. I dislike the crappy partners who treat their laboring partner disrespectfully, or the dads who are scrolling through facebook on their phones while they are holding up mom's leg while she's pushing. Or the family members who bring a large pepperoni pizza into the room, while mom is subsisting on ice chips because of our outdated NPO rules, and who act put out when I tell them they must go eat in the waiting room.

I hate that our small hospital was recently taken over by the local Catholic hospital system, so now we cannot do BTLs or inpatient IUDs/implants.

I have always worked in women's health ( I spent 6 months doing pedi home health, that is my only non-OBGYN experience lol). I couldn't imagine doing anything else. I love it so much, and the pluses definitely outweigh the negatives in my opinion. But you have to *love* the specialty or else it can be a sucky job.

Theworldisourspot · Dec 4, 2015

Did you ever take the job? I was offered an interview at Northside as well however it comes right after I will be starting at L&D at Kennestone. While Northside would be a fantastic opportunity, I just don't know if I could make such a nasty move right after starting elsewhere.

I turned down Kennestone. Northside and other hospitals offered more money and were closer to home...and potentially more room to learn, though I think Kennestone would be great as well. I do think they typically require a signed work agreement for two years after the residency ends (assuming you're a new grad), so changing after starting could be a really expensive thing to do to buy out a contact

Theworldisourspot · Dec 4, 2015

I agree with the comment about unnecessary interventions. The facility where I work prn as an L&D RN seems to actively discourage uninterrupted S2S (no one does bedside assessments but me, and there is a huge rush to get weights/measurements done within the first ten minutes or so because "we can't admit the baby without a weight!" Sigh. Vacuum extractions after an hour of pushing and good fetal descent, the OB who refuses to deliver in any position but semi-fowlers with stirrups, continuous monitoring across the board (our IM protocol is 20 minutes on, 40 minutes off- more of a pain to the patient than just keeping the straps on all the time. IA is not allowed.), no VBACS because anesthesia is not in house 24/7, similac "breastfeeding support bags" for every patient.... yuck. I also hate assisting in circs.
I loooooove providing labor support, I love helping a new mom develop confidence in her skills, I love spending time in the OR. I love the autonomy, I love the adrenaline of successfully managing complications. I love placentas, and blood, and cuddling squishy noobs while mom takes a nap. I love that my patients are almost always healthy and independent. I love working in a low volume unit so that I almost always have all the time in the world to educate my moms and give them extra TLC. I dislike working in a low volume unit because we can go from 0 to unsafe staffing levels in an instant.
I dislike PACU with a passion (our new EHR doesn't "talk" to our vitals machines, so I have to manually transcribe q5m vitals into the EHR- I hate this so, so, so much. And when things go wrong in LDRP, it just seems so much more tragic. And no matter how good you are at your job, you will have bad outcomes, and that sucks. I dislike the crappy partners who treat their laboring partner disrespectfully, or the dads who are scrolling through facebook on their phones while they are holding up mom's leg while she's pushing. Or the family members who bring a large pepperoni pizza into the room, while mom is subsisting on ice chips because of our outdated NPO rules, and who act put out when I tell them they must go eat in the waiting room.
I hate that our small hospital was recently taken over by the local Catholic hospital system, so now we cannot do BTLs or inpatient IUDs/implants.
I have always worked in women's health ( I spent 6 months doing pedi home health, that is my only non-OBGYN experience lol). I couldn't imagine doing anything else. I love it so much, and the pluses definitely outweigh the negatives in my opinion. But you have to *love* the specialty or else it can be a sucky job.

This is SO helpful-thank you! What is S2S? Is the unit you're on only L&D or also postpartum? I want some postpartum experience too but most hospitals here it sounds like they transfer about 2 hours after delivery.

cayenne06, MSN, CNM · Dec 5, 2015

S2S is skin to skin. A minimum of an hour of uninterrupted skin to skin (for stable newborns) is very beneficial for temp/resp stabilization and breastfeeding success, not to mention the fact that it just forces us to leave well enough alone, and makes it easier to facilitate delayed cord clamping- no pressure to get the baby off mom for weights and measures. And amazingly, it IS possible to admit a baby without a weight and length, no matter what anyone says lol.

Our unit only does about 250 births a year, so having a separate PP unit would not make sense. In larger facilities, a dedicated PP unit often makes more sense, staffing wise.

kdkout, BSN, RN · Dec 8, 2015

L&D at night is much more fun & 'normal' than L&D during the day. During the day, the MDs want that mom on pitocin and baby blasted outta there within "normal" hours so they can run from clinic patients, catch the baby, and back to the clinic during daytime hours.....

At night, you can help women with positioning, let them get in the tub, and actually let them "labor down" instead of forcing that kid out before he's ready......

I believe L&D/OB is the most "litigious" area of nursing, so that's why you're seeing the "CYA" comments.

Side note - I loved the book "Baby Catcher" by Peggy Vincent when I was an L & D nurse.

Dont take your first OB job at a teaching hospital & get off of orientation in June/July when the med students are students one day and Drs the next, & at a place where you rarely do vag exams because there's already too many resident hands in there. I believe more than 5 vag exams greatly increases the risk of chorioamnionitis, but I havent done this area in a while....

Hope to work with Midwives as well as OBs so you can see how each does certain things better....or worse.....

And I agree about the tubal ligations and consequences of getting bought out by a Catholic hospital....but if you are pro-life at least then you dont have to be working at a level 3 hospital assisting with terminations in one room, & caring for the G6P0 IVF patient in trendelenburg in the other room.

Word of cautious advice:

For everyone wanting to do L&D nursing, IF you get a job at a non-Catholic hospital that gets sick patients (Level 3-4), find out if assisting with terminations will be part of your role. Every hospital has it's own name for this part of the job, & it's not an obvious name.

If it is part of your role and you are not comfortable with it, then find out if you can "opt out" of this part of the job, and then get it in writing. This is a very difficult thing to discuss at an interview, and I did get passed over for jobs because of it (not that I can prove it). I had no idea this would be part of the expectation of my role as an L&D nurse at a big city job ....and this information was kept from me on purpose. Seems like they dont mention it in nursing school, either.

I dont want comments about pro-choice or pro-life because I have so much empathy for mom's who are in this position....as have been friends and relatives of mine....all I'm saying is that when you interview for a job, you should be told that this is part of your role. If you already have the job & refuse this patient, it can be seen as "patient abandonment" in some cases. Not to mention you may really piss off your charge nurse, not exactly a good idea when you are new at a job. Yes, I am speaking from experience.

If you know you would never be comfortable helping with this, then dont apply to non-Catholic hospitals that are level 3, unless you KNOW from people already working there that they have a policy in place for you to "opt-out" of this part of your job. I could've really used this advice 15 yrs ago.

NBSAlvarez · Dec 9, 2015

I love to hear how much you enjoy your specialty. I think it is wonderful. I really enjoy Labor & Delivery and still have so much to learn but I feel like it is time to move on to something new.

It was refreshing to write your post