L&D as a separate unit.

nurseob7 · Jun 21, 2006

My unit also delivers about 180 babies a month. The vast majority of nurses are cross trained to all areas. We only have a few nurses that only do postpartum. A few that do labor really hate it, but since they had been crosstrained, they will not allow them to only do postpartum.

We have to circulate for c-sections but have an ob tech to scrub.

I am curious, do you utilize ob techs or cnas? Are they allowed to put pts on the external fetal monitor? Our manager will not allow it because she says the person that applies the monitor must have gone to a fetal monitor class and know how to interpret tracings. I think that is ridiculous. Curious as to what other hospitals are doing? Thanks!

Bibi-OBRN · Jun 22, 2006

Thanks for your reply nurseob7. Yes, we do have techs in L&D but they are not allowed to put pts on the monitors. The surgical techs set up delivery tables, stock L&D rooms, help be a second pair of hands during delivery and of coorifice they are busy when we do CS's. They don't go to postpartum at all. We do not use CNA's in L&D. They are used on postpartum only. They get Mom's vitals and help out there. They do not do babies vitals though.

I did talk to someone who does are statistics today and they said we did just over 2400 deliveries at the end of 2006 and we are full everday and lately we have to overflow to Peds because our postpartum is full. My old unit did around 4000 deliveries a year and it was just so much nicer to have separate units. I guess I just prefer that.

ragingmomster, BSN, MSN, RN · Jun 22, 2006

L&D one unit, PP one unit, NBN one unit. We do our own circulating and have one or two ST's scheduled 24/7.

All new employees in L&D are cross trained for the other two units, but not vice versa, I wish I knew why.

Our CNA's don't put pt's on monitors because - they don't know how to interpret what they find.

JaneyW · Jun 23, 2006

I was trained to do all and have done all at the three hospitals where I have worked. I think it is possible if everyone is on board with it. Our new grads seem to do well, but they get 6 months of training. There is always a unit where you will be most comfortable. I like the nursery where I am now because we have NICU back-up. I was way too nervous working in there at my last place because I was the expert and really wasn't! I also agree that a CNA cannot apply EFM. What if they put it on and the FHR is 60 and they just walk away? I think I have heard of places that certify CNAs to do it.

labor1 · Jun 24, 2006

at our hospital we have to be able to work in at least 2 areas. I work in Labor most of the time but have to work postpartum at times. I can work nursery too but don't have to often. Worst is when we are pulled to a med surg or pediatrics floor. Having the three areas in our own district to staff keeps that pulling to other floors down

Our techs,when we have them, do put pts on the monitors but the nurse comes in pretty promptly to check on the pt or at the least checks the tracing on the central monitoring.

I am interested in how many labor pts each nurse has at other hospitals.

imenid37 · Jun 24, 2006

I am curious, do you utilize ob techs or cnas? Are they allowed to put pts on the external fetal monitor? Our manager will not allow it because she says the person that applies the monitor must have gone to a fetal monitor class and know how to interpret tracings. I think that is ridiculous.

Sorry, I agree w/ your manager. With all of the litigation in OB and w/ EFM anyone who is applying or interpreting the efm should know what they are doing in depth. Your tech could apply the efm, get fh's in the 120's or 130's and it could be mom's tachy pulse-not the fetus. What if they can't find the fh and don't have ths skill to talk mom through things like why it might be difficult because the pt. is...(whatever reason) early gestation, has large pedulous abdomen (tactfully), etc. Besides when pt. first comes in for EFM, they may tell the nurse something important that a tech may not pick up on. The hospital could get slammed if , for example, a mom presents w/ decreased fetal movement and there are fh's of 120 and it is mom's pulse and fetus has passed and then nurse/dr. has to tell pt. that it is not really the fetus. I think AWHONN and Michelle Murray both side w/ your manager. I am sure you are extemely busy, but I hate to see nurses hand this important task over to techs. If techs are needed to apply EFM, then you don't have enough nurses.

fergus51 · Jun 24, 2006

I understand why some people prefer the units to be separate, but I feel differently. I've done it both ways and I think it's best for patients and for the hospital for the nurses to be cross trained.

lalang · Jun 24, 2006

at the hospital where I am working now, we have an average of 10 deliveries for one shift (8Hrs). we're only 2RN,1RM and a Utililty/ shift. we have 4dr table, 1 OR for c-section and a private DR table for private patient. We have 5beds in Labor room and 10 beds for recovery room. we handle an "E" C-section if theres no available room in the operating theater.

photorn · Jun 25, 2006

We do about 350 births a month and have a separate unit. If we float it is to our Perinatal High Risk Unit which is also separate. Rarely do we float to maty, though it can occasionally happen. I floated ther once in the last year and a half. We do our own c/s and recover them. No one has ever floated to peds. I prefer to stay in L&D. Mainly because the paper work is different that it gets stressful trying to figure it out on another unit since we float so rarely.

Only RN's in our hospital can apply the EFM. Too much liability should the RN not look at it right away and there were problems with the FHR.

Jolie, BSN · Jun 25, 2006

I worked on an LDRP unit that was similar to what Bibi-OBRN describes. We had 16 LDRP rooms, and a Level II NICU. Well babies roomed in 24/7, so we had no well baby nursery. If a mom was too ill or tired to care for her baby, it was "watched" in the NICU.

All of our staff was cross-trained to L&D, including circulating and recovering C-section patients, PP, normal newborn care, and high-risk ante-partum. Those of us who had previous NICU experience were also required to work in the NICU. It was OVERWHELMING! I had a 3 month orientation to PP, high- risk ante-partum, L&D, and was no where near ready to work on my own with labor or C-section patients. Fortunately, it was a very supportive unit, so I always had back-up, but the learning curve was sooo steep, even for a nurse with 5 years of NICU experience.

Our hospital also decided to require all of the staff to become ACLS certified, in addition to the NRP that we already had. At that point, it became obvious that there were simply too many demands on the staff, and the decision was made to "trial" assigning nurses to one of2 areas: either NICU and mother baby, or mother baby and L&D.

Unfortunately, hubby was transferred at this time, so I don't know what the outcome was. I, for one, would have welcomed the change, and I doubt that it would have had a negative impact on patient care.

RNfromMS · Jul 4, 2006

I work in a teaching hospital that has separate L&D, antepartum and postpartum/WBN as well as one of the premier NICUs in the country (right now, there are 66 babies in NICU); we do approximately 4900 deliveries a year. We have 15 L&D suites with supposedly a 1:2 or 1:3 nurse/patient ratio, 3 ORs, a triage area and 5 recovery beds (3 of which can be OB ICU beds). We usually handle our own OR cases and recover them unless by some miracle our staffing allows for a floater or two. We are supposed to recover our SVDs and C-sections for 1 hour and then send them to postpartum floor. However, we have a high percentage of tox patients who require 12 or 24 hour mag sulfate therapy following delivery. Also, we have days when our postpartum floor is so full of c-section patients who have to be there 3 days postpartum that they don't have any discharges and we end up recovering our patients almost until they go home.. A lot of our patients are high risk and come from all over a 4 state region. Our L&D nurses are not cross-trained to any other are in the women's center or the rest of the hospital and we are never pulled (of course, we never have that much staffing either...LOL). The postpartum nurses are cross-trained for WBN and are occasionally pulled to the antepartum floor (AP only has 2 nurses per shift so if someone calls in....).

Last Wednesday it was so crazy, we had all 15 rooms full with laboring patients (8 delivered on our shift). We also delivered 2 c-sections, 4 SVDs in our triage area and 4 SVDs in our recovery room. I was never so glad to see a 12 hour shift finish in my life.