L&D vs Postpartum ... literally

klone, MSN, RN · Dec 4, 2015

Yep, in my experience, this is a common occurrence when L&D and postpartum are completely separate departments. The only place where I didn't find this attitude was at a place that was LDRP, or that L&D and pp were one department and most of the nurses were cross-trained and did both (this was a smaller hospital, only 1400 deliveries/year).

7000 deliveries a year?? Wow! That's crazy! I'm curious, how many LDR rooms do you have? Can I ask what suburb this is? I've just never heard of such a huge volume before.

xxdiscoxxheaven · Dec 4, 2015

It's the same way at my job lol. I'm on the PP side of things. My problem is the same as yours except the labor nurses are so clique-y and don't associate with PP. I try to smile or make jokes and they just stare blankly. Frankly, I don't care anymore. Just give me report and leave lol

**LibraSunCNM, BSN, MSN, CNM** · Dec 5, 2015

I worked as a postpartum nurse in a large urban hospital for 3 years and I definitely felt friction between the L&D nurses and PP. We did about 5000 deliveries per year, and I think the extreme volume and high pace definitely contributed to the rift. It makes everyone a little more on edge all the time when there is a never-ending revolving door of patients.

The commonly encountered vibe from L&D was that the postpartum nurses had a cakewalk of a job compared to them, which really wasn't true at that hospital. If we couldn't take report the second they wanted to give it, we were "dodging" report on purpose to make their lives more difficult. Meanwhile, if we dared question or ask for clarification of any info given in a sloppy, third-hand report, we got serious attitude.

Now where I work as a midwife, it is at a much smaller hospital, doing only about 1000 deliveries per year, but I witness similar dynamics between the two units. Here, however, I feel that the L&D nurses' beef with postpartum is totally warranted, as I have never in my life seen a group of nurses complain so much about a job they barely put any effort into! The level of care I witness is really quite bad compared to where I worked in PP.

I think a lot of issues could be resolved by cross training or at least shadowing on the opposite unit to walk in their shoes, but I also think nurses can be a territorial group in general, so there always will be passive aggression in some capacity.

srvjamz · Dec 6, 2015

I think a lot of issues could be resolved by cross training or at least shadowing on the opposite unit to walk in their shoes, but I also think nurses can be a territorial group in general, so there always will be passive aggression in some capacity.

I float alot to different departments and quite agree with LibraSun. There are battles between ICU and Med/Surg.. battles between Med/Surg and ER... battles between OR and General Surgical...battles between units and house supervisors and so on... ANY time you are bringing a patient to another unit you are bringing more "work" to that nurse. It takes alot of emotional maturity to try to look at all the things the delivering (no pun) unit has done RIGHT and focus on teamwork to quietly amend the missed items that may have been missed. Cross training not only helps with gaining perspective.. it also puts a personal relationship barrier to the easy complaining about someone you only know as a person who brings you more "work".

obrn2 · Dec 6, 2015

POC! In PP, there is a LOT to do so the plan is r/t teaching, vaccinations, breastfeeding, pain control, post-op care, baby weight gain/loss, screenings, etc. However, for L&D it's the immediate SAFETY of mom/baby and getting baby OUT - we couldn't care less at the time about Tdap or flu (I mean, we care...but talk to me about HIV, Blood borne disease, HSV, etc and THEN we're talking the same language)!

Someone said cross-training makes it easier. Yes. I WANT to give a full report, but been consumed with POCs no longer relevant in the handover. The PP nurse may only be considering things needed from that moment on.

As a previous Mother/Baby nurse I can say that my biggest pet peeve was floating L&D nurses blowing off the work I was doing. Oh, you think my entire shift revolves around water and colace?! That's insulting to anyone. Don't complain about a heelstick, then! Say a nice word, don't put down the postpartum unit and you will be in a good spot. When they get snippy about small details (I sometimes did) just say so sorry I was worried about the decels/contractions/pitocin/whatever and couldn't get to it. I swear, it wasn't something I understood until I cross-trained! If they brought it to my attention I realized it and backed off.

The other thing I've noticed is RNs tend to have a Type A attitude, so each one thinks they're always right! LOL. We just do the best we can...

iPink, BSN, RN · Dec 6, 2015

I am a PP nurse at one of the top largest women's hospital in the nation with about 20,000 births a year. So everything is separated. Before going into OB, I worked critical care but the nurses in L&D had to quickly realize I absolutely know my stuff when they give me report and I question things that should have alarmed the L&D nurse during the recovery phase. They seem to want to push a mom who is septic to our unit and will not medicate a mom who's in pain. Some telling the patient, your PP nurse will medicate you. I don't tolerate that. Every single floor has a major complaint with the lack of knowledge some of the L&D nurses have with their own patients. Due to the volume of births L&D has one of the highest nursing turn-over rates over all the units. Also because of the volume in L&D, some of the nurses forget to chart, frustrating the MDs because as you know if it wasn't documented, it wasn't done. If a unit has a bad reputation even with the MDs that's saying a lot.

There are some fantastic L&D nurses at my hospital but we PP nurses know the incompetent ones too. It's not about messing up a few times, we are all human. It has to be more than just labor, deliver. These moms also have comorbidities and issues besides hemorrhaging can occur during the recovery phase and the critical thinking skills must be on at all times in whatever unit you're working.

klone, MSN, RN · Dec 6, 2015

POC!

Products of conception? :)

I don't know what POC means in this context.

klone, MSN, RN · Dec 6, 2015

I am a PP nurse at one of the top largest women's hospital in the nation with about 20,000 births a year.

DAYUM!

obrn2 · Dec 6, 2015

Plan of Care :)

iPink, BSN, RN · Dec 6, 2015

DAYUM!

You can say that again. And we aren't the largest.

obrn2 · Dec 6, 2015

If my charge is hounding me to move a patient and she's stable, sometimes I move a patient when her epidural is wearing off and has not gotten PO meds. For the most part I try to give all my patients decent pain control, but sometimes unit needs dictate other things.

If patients are sick, it puts this discussion on a whole different levelâ€¦I was only referring to things that can mitigate tension during a normal and stable transfer of care.

There's no easy comment re the other issues you mention at your hospital. Perhaps the high nurse turn over means there is something going on other than incompetentâ€ nurses, but obviously I have no idea. The nice thing is with your background you are able to care well for mothers who do get sick PP and that is invaluable. Hopefully the other RNs you work with appreciate that, too.