Labor and delivery vs. Postpartum

TonieRN · Feb 14, 2011

I saw this also in both the level 3 and level 2 facilities where I worked. Postpartum in many ways felt like the "stepchild" in OB. I was one of the few nurses who worked on both units at both hospitals...the first, starting on PP and crosstraining to Labor...the second, starting on L&D and then upon going PRN, working both units. In defense of PP, labor nurses at both hospitals had an attitude for the most part when they were asked to float to PP...acted like they were the "real" OB nurses...if you could not work labor and del, then you were not really on OB nurse. PP nurses did not like the higher stress of labor...were excellent PP nurses...and labor and del nurses got bored on PP. That was my observations at least. The level 3 hosp was a research facility and the nurses would often help obtain info, blood, samples ect for the docs doing research. Often at the end of research, the doc would buy something for the unit...a new frig...microwave..table for the breakroom..type of thing. Well, pp got our old ones...hand-me-downs so to speak...thus contributing to the resentment.

How do you fix this? Not sure....get as many nurses as poss crosstrained. That may help. Break up cliques. Point out the positives of BOTH units....both equally valued and unique. Dont tolerate openly negative attitudes.

hth

tonie

TonieRN · Feb 14, 2011

BTW...I dont see this as an issue at all in the lvl 1 facility where i now work, BUT we ALL do everything. We each may have preferences and that can change with the day of the week...lol. But the staff works together VERY well.

rn/writer, RN · Feb 15, 2011

We have very distinct units for L&D and PP, with just a handful of people transitioning (long-term) from one to the other. Only our in-house pool staff members go back and forth regularly.

A couple of things that might help are floating and communication.

When people float to another unit, it allows them to see (rather than just hear about) the challenges. And it helps staff members get to know one another beyond the couple of minutes involved in a hand-off. When you work side by side with someone, you develop a more three-dimensional picture of them and start to see how the world looks through their eyes. That alone can make a positive difference.

Communication is also key. We in PP appreciate as much warning as possible that an admission is coming. The L&D folks where I work are usually pretty good, but occasionally we get a call that someone is coming in 15 minutes (normal is at least an hour). I like to make sure my current patients are medicated and feedings are done or in progress. I also look up the patient's profile to get as much info as possible and see what questions I might have for the L&D nurse. Finally, we have to get the room and ourselves ready. Nothing like trying to go through all the admission paperwork with the bathroom calling you.

From a PP point of view, I appreciate having the paperwork complete--the med rec filled out and signed, the orders taken care of, the admission questions asked and answered, etc. I realize this is difficult with someone who just walks in and delivers fifteen minutes later, but gaps should be rare exceptions, and where I work, that's usually the case.

I also am thankful when L&D lays the groundwork for handling special needs. The patient speaks Somali? L&D got an interpreter who will come along for our admission to help us get her settled, sign consents and order meals. The patient had seven people at the birth? L&D made it clear that the patient needs to rest and most of them will have to go home. The patient is fifteen years old? L&D explained that she may not have her 16 yo bff stay the night as they are both minors.

The most important factor in all of this is mutual respect. It's natural for each area to feel that they are the ones who make a difference for the patient, but the truth is we all do.

Instead of feeling like the other department(s) matter less, recognize that if there weren't nurses who preferred that unit, you would have to do their jobs.

birthrevolution · Feb 16, 2011

The units where I am right now get along pretty well for the most part. We have gone through a lot over the last year with the transition to couplet care, which impacted L&D more than expected. I think that people ended up working together a lot during that and our Baby Friendly certification. I think that helped improve the relationship as well. We just had a potluck where each floor provided a course of a meal and then all the nurses traveled from floor to floor, eating, drinking (non-alcoholic of course) and socializing. It was lots of fun! Maybe you could start with something simple like that?

tablefor9, RN · Feb 18, 2011

Cross-training & floating between units fixes this, I think. Also, treating each other well...ex. L&D RNs going out to do vitals/etc when "slow" or PP RNs getting pts transitioned out when they are "slow".

In the smaller unit I work in now, we have 4 RNs on nights, and that is *all*. The calvary isn't coming when the crap hits the air circulating device, so we have to know that we can all depend on each other.

Queen2u · Feb 18, 2011

I don't even know where to begin!!!!!!! I work on PP and I am crosstraining to LD....eventually I want to get experience in nursery, too......anywho, at my hospital, PP nurses aren't "real" nurses in a lot of people's eyes (I think it's because we deal with happy and healthy patients 9 times out of 10).....a friend of mine is working on med/surg and is dying to come to PP...the CNO of the hospital tells her that she could do a one day orientation in PP and she will be able to work there.....a few of the LD nurses like to try to make the PP nurses think we are only busy during the first 30 minutes and the last 30 minutes of the shift, and the rest of the time we do nothing:confused:. I wish this would change and I am open to any ideas as to what I can do to change it! If you think about it, we are all one unit and we all need to get along and think about the patients concerns instead of our egos!!!!! I think PP and LD nurses knowing and working on both units is a GREAT IDEA!!!!!!!!! :nurse: :yeah: :nurse: :yeah: :up:

Irishobrn · Feb 18, 2011

It's very difficult to respect the PP nurses in our hospital when they don't seem to be able to handle anything but uncomplicated patients. Even the doctors make comments like "we better not send this patient over because they will probably kill her". I think it's up to the PP nurses to step up and act like the nurses they were trained to be. Panicking when a patient bleeds, or calling frantically over to L&D for help because they can't do a simple IV doesn't make it any better. Also this we need more time to accept a patient is total crap. When a patient delivers you get notice that you will be recieving an admission of mother and baby...so plan for that admission then, don't get all crazy when we call to say the patient is coming over...you knew that already and most times we have them for at least 90 minutes but most of the time for 2-3 hours. It's also hard for us to hear that the nurse went to lunch so we can't bring someone over...we on L&D don't get lunch we often sneak meals in while monitoring our patients...not that that is right but seriously if we can do that then you should be able to have your tech (which we don't have) set up your room for the patient while you finish your lunch.

Before you think I don't know what PP nurses actually do, I've worked both units and let me tell you PP is infinitely less demanding than L&D, so own that and have some understanding and respect for the nurses that are working harder than you and cut them some slack.

tablefor9, RN · Feb 19, 2011

PP less demanding than labor? How about differently demanding? When I've worked PP, I've been the flipping boob fairy for *hours* of my shift in one room, breaking my back, thanks! While in the next room, there was a late PPH, while in the next room a mom off mag less than 24hrs, seized. Are there lots of times when PP seems like cake? Sure. Are there times when the L&D is dead as Moses and not a soul is in? Sure. Vent all you want, but "own" that PP RNs actually work, too. Let's put the shoe on the other foot...we say all the time that "those PP RNs ought to know that if they are busy out front, those pts had to come from us, so we must be jumping". Well, if we are busy, and need beds turned over, those pts are going somewhere, and where they're going is busy...so cut them some slack.

Queen2u · Feb 19, 2011

It's very difficult to respect the PP nurses in our hospital when they don't seem to be able to handle anything but uncomplicated patients. Even the doctors make comments like "we better not send this patient over because they will probably kill her". I think it's up to the PP nurses to step up and act like the nurses they were trained to be. Panicking when a patient bleeds, or calling frantically over to L&D for help because they can't do a simple IV doesn't make it any better. Also this we need more time to accept a patient is total crap. When a patient delivers you get notice that you will be recieving an admission of mother and baby...so plan for that admission then, don't get all crazy when we call to say the patient is coming over...you knew that already and most times we have them for at least 90 minutes but most of the time for 2-3 hours. It's also hard for us to hear that the nurse went to lunch so we can't bring someone over...we on L&D don't get lunch we often sneak meals in while monitoring our patients...not that that is right but seriously if we can do that then you should be able to have your tech (which we don't have) set up your room for the patient while you finish your lunch.
Before you think I don't know what PP nurses actually do, I've worked both units and let me tell you PP is infinitely less demanding than L&D, so own that and have some understanding and respect for the nurses that are working harder than you and cut them some slack.

....Irishbrn, maybe it's difficult to respect nurses who think other nurses in their hospital look down on them for enjoying having happy healthy patients to care for. Let me tell you something, honey; I am a PP nurse, and I ROCK!!!!!!! I absolutely ENJOY what I do, and for nurses who want to look down on me and think as ignorantly as you do, kiss this!!! I DO deal with unstable patients! How about the patients who come over full of clots because you guys did not do your jobs and massage my patient's fundus adequately.....how about the patients who come over with a boggy fundus bleeding all over the place, but you told me she was firm, contracted and midline with minimal lochia? How about the patients who you KNEW were in absolute pain prior to transfer and you did nothing to comfort her. How about the patients who complain about you guys being nurses with attitudes? Girl, I DO step up and perform like a nurse! When I know a patient is on her way, you can call me and give me an admission report and I will tell you to bring her on and which room she will be admitted to, and when you come to wheel her over, you will notice that her room is READY and has been ready for over an HOUR!!!!! I stay a couple of steps ahead. Have I had very few times where I asked for 10 minutes? Sure! Was I sitting on my behind, NO! I was tending to the needs of my PP patients who needed and requested things BEFORE I was called with an admission report. There are PP nurses who take forever admitting patients to the unit, but don't bunch us all together! And you want to talk about EATING?! There are times we don't get to sit down to a meal as well!!! But trust me, I have seen PLENTY of times where LD nurses at my facility didn't have patients FOR THE WHOLE SHIFT and took naps, went out to eat, etc...I'm sorry...no ACTUALLY I AM NOT SORRY, but I LOVE what I do, and I refuse to allow other nurses to make me feel dumb!!!! And you and all other nurses who look down on PP nurses can take that to the bank and CASH IT!!!!!.....THANKS! :rolleyes: :heartbeat:redbeathe:D:):redpinkhe:lol2: :nurse: :w00t::hug:

Irishobrn · Feb 19, 2011

I have no doubt that some PP nurses are up to the challenges they are supposed to be up to. Those nurses however are severely in the minority in the hospital that I work in. They only have 4 patients at a time and we do not do couplet care...so you tell me which is more demanding 4 stable (because they won't accept anything less) PP patients or two active labor patients? If you didn't choose active labor then you don't know what Labor and Delivery is like. I stand by what I said, PP is less demanding than L&D and that is a fact. If you want to compare helping a woman breastfeed to helping her push for three hours you are have never been in a demanding delivery, where as I have helped women breastfeed for hours. As for transferring them in pain, we medicate them before transfer but often do not have the time to wait for the medication to take effect...when we have women laboring in the hallways waiting for that room. As for L&D being slow...it's a rare occaision where I work with all the scheduled inductions and c/s everday. The PP unit where I work is the dumping ground for L&D nurses who couldn't make it in L&D...so no their skills are not on par with ours. That is not looking down upon them, that is a fact where I work sorry to say. We can be pulled to help them when needed, but when we need help there is none for us so we make due. They also have the ability to pull from Med/Surg which we can't do. Again when even the doctors are hesitant to transfer patients there for lack of good nursing care there is a problem. Maybe this is specific to the hospital I work in but it's been that way for as long as I've been doing this...10 years now. So don't lecture me on the few good nurses, I am speaking on the PP nurses as a whole, and where I work specifically.

Elvish, BSN, DNP, RN, NP · Feb 19, 2011

What the post before me describes sounds very facility-specific. My mother/baby floor does couplet care as well as high-risk antepartum and GYN care. We also deliver fetal demises under 20 weeks. From the time we get to work til the time we leave 12 hours later, we work. There are not just a 'few' good mother/baby nurses on my floor. There are a lot of good mother/baby nurses there, on all shifts.

Is the skill set different? Yes. But inferior? No. This is not a contest of whose skills are more advanced, whose nursing care is more intense, nor whose job is harder. I've worked med-surg, community, and on my current floor. I have come home physically, mentally, and spiritually exhausted working all three, and my skills have been stretched in all three as well. I coded more people working in a community health center(!) than I ever did working med-surg, and I can now say that I really hate coding babies, which I've done as charge nurse in the nursery. If everyone were good at L&D or postpartum, no one would be able to talk therapeutically to actively hallucinating people with schizophrenia, nor start IVs on a preemie, nor teach people with diabetes how to manage their insulin. And we need people who can do all those things too, so please....let's not turn this into any sort of war.