L&D vs. Postpartum

RNgonewild · May 11, 2006

Get a grip, the reason you can't get a patient over to post partum as soon as you want to is the bed has to be cleaned. Sometimes L&D does want to send pts over before they are fully recovered, and that includes the babies. Some L&D nurses theory is, placenta out, pt. out. Don't get me wrong, I have worked both ends of the spectrum. So I can understand the stressors you may be under from your managers. Get the pt. out, we have 3 in the waiting room in labor! I have to admit it, last week we were so bombarded I was definately transfering pts. that were not ready to leave L&D, not neccessarily unstable, but not quite ready. And the postpartum nurses were feeling the pressure too, get your discharges out, and now, pts coming! Yes, we should all work together, but you have to understand that there are pressures on both sides of the ward, L&D and postpartum. Don't look down upon the PP nurse as a second class citizen, if she wanted to work L&D, she probably would, but she doesnt want the higher paced stress. Probably the reason the PP nurse wants you to call the doctor is that the doctor will return "your call" faster than the PP nurses and you were there with the doctor during the delivery, so you both have seen the same thing. Some doctors also think PP nurses are glorified "peripad changers" or wetnurses. So be glad your expertice and inside track with the OB is appreciated.

SmilingBluEyes · May 11, 2006

let's keep the language friendly please, in this thread. there is already an "us versus them" tone to it and it will go downhill from here, if we don't keep focused on solutions rather than finger-pointing.

thank you for understanding.

SmilingBluEyes · May 11, 2006

I suggest getting some key members of both units together for a meeting and working some solutions there. That is my best advice.

Fiona59 · May 11, 2006

The only thing I have problems with are receiving patients during shift change. I've never had a report last 15 minutes on any unit I've ever worked, but L&D start sending people down at 0715, 1515, 2315 or they will send them down at 0655, 1450, 2250.

The shift that is finishing is trying like crazy to get the paperwork done, and receiving mother and baby is often the straw that breaks a nurses back.

I've always wondered how five c-sections can come down within 15 minutes of each other along with 3 lady partsl deliveries. I mean we are a busy unit but receiving 8 patients in less than three hours just about does us in....

KellNY, RN · May 11, 2006

Consider also that they tell you to wait 15 minutes because they are in the middle of a med pass. Or dealing with a mama who's bleeding too much, or in the midst of discharging someone and they just need some time to wrap it up, assign a nurse and be ready for a good report.

FWIW-I'm not L&D or PP/MB, I'm antepartum. So I've seen it from both sides (L&D dumping patients and being very impatient with MB, and MB dragging their butts, complaining about how unfair it is, etc...IMO, often they're both right).

But 15 minutes doesn't seem unreasonable to me at all. I often do this when called to get report (from Maternity Urgent Care, the ER, etc), because I'm about to hang a bag of amp to a GBS positive laboring woman. Or about to give her her stadol/phenergan. Or I have a 26weeker who just told me she feels contractions and "some goo just came out of me". Or one of my cervidils just SROMed mec stained water. Or the nurse who'll be assigned the pt is in a room doing something. If I was just sitting there on an off time, I'd take report right away.

I've also been told to wait 15 minutes to give report. Yeah, sometimes it's frustrating, but then I stop and remember. I'm dealing with *humans*, not robots.

Kelly

laborRn01 · May 11, 2006

I am not looking down on PP nurses like 2nd class citizens. I, personally, keep my patients on L&D for close to 3 hours after delivery to make sure that they are stable. And since I am a night shift worker and discharges are usually finished by my shift, only clean rooms are assigned so the wait does not have to do with cleaning a room. I understand that a wait may be necessary some times but it seems that most times when I want to bring a patient over, I have to wait. And, yes we are a busy unit, but not all the time are we just trying to get the patient out to make room for the next on. It is because they are done recovering and the patient wants to get to their PP room so they can sleep for the rest of the night. I did not post this thread for a battle or to point fingers. I just wanted some insight into reasons why I am always told to wait!

RNgonewild · May 11, 2006

ahh, its just nursing, we are always running around crazy. no matter what area you work. and i have worked all areas. now you have some reasons, but I'm sure there are tons more. Peace.

rn/writer, RN · May 12, 2006

I am not looking down on PP nurses like 2nd class citizens. I, personally, keep my patients on L&D for close to 3 hours after delivery to make sure that they are stable. And since I am a night shift worker and discharges are usually finished by my shift, only clean rooms are assigned so the wait does not have to do with cleaning a room. I understand that a wait may be necessary some times but it seems that most times when I want to bring a patient over, I have to wait. And, yes we are a busy unit, but not all the time are we just trying to get the patient out to make room for the next on. It is because they are done recovering and the patient wants to get to their PP room so they can sleep for the rest of the night. I did not post this thread for a battle or to point fingers. I just wanted some insight into reasons why I am always told to wait!

This sounds like something you need to work through at your particular hospital. There are lots of generic reasons that might cause PP to ask you to wait 15 minutes--shift change, something going on in that unit, etc.--but what exactly is happening between your units is hard to say.

If this is an ongoing concern, you're probably not the only one feeling out of sorts. And I'd venture a guess that PP has its own gripes. Communication can go a long way toward helping clarify what the policies are/should be and WHY the requests are being made. The unit managers need to be involved in this as well.

I work PP and have seen this situation up close and personal. We try not to ask for delays unless they're really necessary, but our charge nurses will draw the line when we get called five minutes before shift change. That's not fair to anyone as it means the receiving nurse has to stay late, report needs to be made twice (L&D to noc nurse, noc nurse to day nurse) in a very short time, or the patient has to wait for most of her cares for a half hour or so. None of these is a good choice.

Another problem I have seen from our end is that L&D will not always give us a timely notification about a delivery. Vag moms stay in L&D 1-2 hours. Section moms stay 2-3 hours. Of course, these time frames are always subject to the mom's stability. What causes problems is when we get a half hour's notice of a new admission. If you're just starting to hang blood or you are in the middle of getting a section mom up for the first time, that can crash the rest of your night's organization. L&D says they forgot to call us and they apologize, but it puts everyone at a disadvantage. With the proper amount of notice, you can prioritize your tasks, work with the other nurses to help out if need be, make sure all the kiddoes in the nursery have been fed, etc. Without that notice, you spend the rest of the night playing catch-up and hoping you haven't forgotten anything. We're supposed to get a minimum of an hour's notice and it makes a big bad difference if we don't. Fortunately, our units usually work together well and this is a very occasional occurrence. If it weren't, you can bet we'd be discussing a solution.

I keep coming back to communication. Talk to your managers and each other before this becomes a real flash point between units. And before the patients pick up on this bone of contention.

ADN 2002 · May 13, 2006

I am a PP nurse.

Our patients do not recover in L&D - as soon as the episiotomy is sewn up, they're out the door to us. The biggest problem I have with the labor nurses is that they'll sit on a patient in recovery after a c/s or take a while with a vag delivery (neither of which really need the extra time in L&D, in many cases..some do, though) and they'll drop the patient on me all of 15-20 minutes before shift change...long enough that I have to open a note and do all the paperwork/orders/recovery VS, etc. Meanwhile, the labor nurse in question gets off on time (one is worse than the others, but they've all been known to do this).

The worst case I've had is a labor nurse that came out and put the patient in a room (the patient, a grand multip) and fail to give any kind of report or even let me know I had a new patient. I just happened upon the patient, was thankful she was not hemorrhaging, went and read the labor nurse the riot act and then went to the nurse manager about it.

Our labor nurses (ours, not everybody's) tend to forget that for every patient that gets sent out from L&D, PP gains a patient.

SmilingBluEyes · May 14, 2006

Actually PP gets TWO patients, the mom and baby!

Back to the original topic, since I have digressed....

rn/writer, RN · May 14, 2006

Actually PP gets TWO patients, the mom and baby!
Back to the original topic, since I have digressed....

Excellent point, Deb.