L&D vs Postpartum ... literally

klone, MSN, RN · Dec 7, 2015

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

Holy crappity. It hurts my mind to even think about it! In the Denver metro area, I think the highest volume is 5000/year. We have SO many hospitals to choose from for L&D (fifteen off the top of my head?). Can I ask what city this is? Or which hospital is the one that has a bigger volume than yours?

Postpartum RN · Dec 11, 2015

Holy crappity. It hurts my mind to even think about it! In the Denver metro area, I think the highest volume is 5000/year. We have SO many hospitals to choose from for L&D (fifteen off the top of my head?). Can I ask what city this is? Or which hospital is the one that has a bigger volume than yours?

Ipink which hospital or city do you work in? My goodness those are high numbers!

haunani, BSN, RN · Dec 14, 2015

about 20,000 births a year.

Holy moly!! I can't imagine 54+ births EACH DAY!!

On the topic, I think there will always be friction between similar units. When I worked Ortho/Neuro, our main "rival" was the Med/Surg floor. Now that I'm postpartum, it's L&D and SCN (it's a 3-way rivalry, lol).

starry01 · Dec 15, 2015

I work in L&D and there is definitely tension with PP. To start, I work at a high-risk county/teaching hospital. We do recovery for both mom and baby. We do the baby bath, vaccines, skin-to-skin, breast feeding, baby blood sugars, hemacu, and provider communication.

Anyway, when it's time to transfer- I feel like I've been through hell and back with laboring. I've learned to have the basics down for PP- things that seem minor to L&D but important to PP- like delivery type, whether mom has voided, EBL, laceration type, diaper counts, provider who completed newborn assessment, apgar scores, whether mom has started pumping. If it's a c-section give the reason why mom had a c-section (ie repeat, failure to descend, fetal distress).

I also want to add that I also float to PP and notice that each unit has a different work flows and priorities. If you learn what information they're expecting off the bat transferring is smoother.

sltrbovich · Dec 19, 2015

I currently work in LDR and previously worked in postpartum and antepartum in my same facility (we do about 10,000-11,000 births per year). I have noticed the same hostility between units and it drives me crazy!! I think a lot of it is the lack of knowledge of the other areas. The units don't realize how hard the other units work too. This has been one of my biggest struggles with working in different departments within the same facility! Its hard to listen to someone bash your current or former coworkers!! Try to remember how busy and hard working the other units are too!

sltrbovich · Dec 19, 2015

How many beds do you guys have? I'd love to hear more about your facility!! We do 10,000-11,000 births per year and we are known as the Baby Factory of the City.

ashleyisawesome, BSN, RN · Dec 20, 2015

This happens to an extent on my unit, but it's not so pronounced because most of us are crossed trained and bounce back and forth between the units (it is actually all on one floor, just different hallways). A lot of us have our preferences though and the "mostly labor" nurses seem to look down on the "mostly/always postpartum nurses". The old, PP only nurses, especially on day shift, seem to be super nitpicky, and harsh on the new labor nurses, trying to catch them in a mistake somehow. The mostly labor nurses think the PP nurses are lazy and have it easy. This is sometimes true, but sometimes I run my ass off with 4-5 needy couplets and it can be more stressful and physically taxing than an easy labor patient.

I think it helps that a lot of us work in both areas and have seen the crazy of both. We cut other nurses some slack if they make stupid mistakes that don't hurt anything because we know how it can be on the other side.

iPink, BSN, RN · Dec 21, 2015

Ha ha..I don't give my location but I do live in the SE. It's a pretty busy hospital as you can image.

DWelly14 · Dec 22, 2015

I don't feel comfortable giving out the exact city but I'm in the midwest. We are known as the baby factory as well. We have 20 LDRs plus 6 beautiful natural birth suites and 4 ORs (we're finding more and more that patients without a need to are delivering in the ORs because we don't have rooms available). One of our big issues is that the hospital is adding more and more physician groups who are sending us more patients but we are running out of physical space. They have also added about 5 midwives who are also sending more patients. The hospital is exploring ways of expanding our space and getting us more rooms, which is absolutely necessary as we are always full and we've done too many deliveries in triage recently while moms are waiting on rooms (which increases tension with PP as they always act like we intentionally kept the patient in triage for fun until they delivered there).

I appreciate hearing from PP nurses. I completely understand your priorities are totally different than mine as an L&D nurse. As part of my orientation I did do a day shadowing a PP nurse and I tried to pick up on some of the most important things from their perspective, but it still doesn't seem to have helped. Just recently PP nurses have started shadowing on L&D too so hopefully that will help as well. Another tension I've noticed too is that we just recently began working towards Baby Friendly certification and closed our nursery so our moms on magnesium who are staying on L&D for 24 hours postpartum magnesium are rooming in with their babies as long as they have a support person with them. However, there was no training for the L&D nurses about infant care past the 2 hour mark, which is when our usual recovery times end. So we've tried coordinating with PP for help and they treat us like we're incompetent which is frustrating. Just last night, I had a postpartum mag mom and an induction who was starting to get active so I was running my butt off trying to make sure that the induction was going well and that the fetus was tolerating the pitocin (it wasn't so much) and that the mag checks were done and the baby was cared for (did I mention it was a 36 weeker so I had to try to help mom breastfeed a baby who was having difficulties, watch the baby's blood sugars & temps?? yea ... ). So when I call up to PP to see if they could take the baby for it's TCB & hearing test (at least I remembered those needed to be done!!!) they acted like I was lazy and refused to take the baby. So incredibly frustrating!

I just wish that somehow there could be a mindset changes. We all want to take excellent care of these patients, we should be working together, not looking for ways to pick everyone else apart. Everyone at my hospital is overworked, we need more nurses, we need more rooms but somehow everyone thinks it's just them that is feeling the effects of the rapid expansion of our hospital.

JackieShorter · Dec 22, 2015

Yes there was definitely tension at my hospital. They have since started making new hires cross train or shadow. We have also come to more of an understanding with each department. As a pp nurse I understand that the l&d nurses have to get back to a laboring patient and need to bring patients up asap. They give us a courtesy call checking when they can bring a patient up or give us a heads up about issues a patient may be having. Which is great now. We are communicatino better. They realize we don't just sling colaces and it is actually better patient care to medicate a mom for pain before transfer if she needs medicated. I think it comes down to doing things that brings understanding to each department and at the end of the day it's about the patients having the best care

Pinknurse1989 · Dec 26, 2015

I am cross trained to work in PP,NIMC, and L&D. I think that keeps fighting down because we know what the other nurse needs so I think cross training helps. On the down side since we are all cross trained there can be friction when we feel like we don't get on our favorite side as much when other people are there all the time. Especially the more experienced nurses get stuck doing just L&D all the time.