Labor and delivery vs. Postpartum

klone, MSN, RN · Mar 26, 2011

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.

Oh, I so don't agree.

I prefer L&D to couplet. One of the reasons is because I work SO much harder when I'm in couplet. I'm constantly moving, and the charting on six patients takes forEVer.

I would far prefer one or two patients to six any day.

klone, MSN, RN · Mar 26, 2011

Iwhich is more demanding 4 stable (because they won't accept anything less) PP patients

Nor should they. That's what the L&D nurse is for - stabilizing the patient.

I definitely think attitudes like yours add to the divisiveness, rather than help fix it.

Miranda50 · Mar 30, 2011

It saddens (and angers) me to read comments from Irishobrn and other L&D RNs of like minds. It perpetuates the long-time division that has existed between two units that should be working together to deliver great family centered care. As an RN that has worked on both L&D and MBU, I can appreciate the challenges faced in each area. And I do agree that the skill set is different, but to say that a postpartum nurses are deficient and lazy...not at my facility. We rountinely care for well mom-baby couplets, but we also take antes, post op gyn's and readmits for things like pph and infection. Our patient load can vary based on these groups, and we usually have a total of 8 patient's per shift. Included in this mix are infants that may be on phototherapy or antibiotics and rotations to do newborn transition, which is done for both vag deliveries and c/s in L&D. Multitasking is the definition of a Mother-Baby nurse. How else could one handle routine postpartum and newborn care and all the patient and family education it involves, multiple postops, med-surg patients, PIH and pph complications, and a revolving door of admissions and discharges and still find time to work with case management when needed, initiate successful breastfeeding, draw baby labs, initiate phototherapy, administer blood products, and chart on 8 people, etc. And yes, I do my own IV's and blood draws,too. All this must be accomplished in 12 hours because we can go over on man hours on the unit. Lunch is usually not an option, because there is always something that needs to be done. So keep in mind, when you send your patient from L&D, make sure she is medicated for pain, her bleeding is controlled, her dressing is dry and intact, and there's more than 25cc in her bag (and it's on a pump that's working). Don't tell me she's been firm all through recovery (only for me to find a boggy fundus and heavy bleeding and grapefruit sized clots), that's she's been afebrile (but surprisingly has spiked a temp on the ride down the hall and now I have to start antibiotics), that she's voided (but now has a deviated fundus and heavy bleeding and I have to straight cath), or that as you were helping her into the bed, she suddenly needs pain medication. We often have to fix problems during our admission assessment that should have been solved prior to transfer, while still completing other aspects of the admission process, including the infant's assessment, which often includes blood sugars and feeding assistance, orientation to the room, newborn teaching, and pericare assistance. If the patient's a post op c/s, there's even more to do, possibly even getting all the sets of vs (because our tech has been cancelled). Remember, we still have 6-7 other patient's to care for, and it's time to help another patient with breastfeeding and her baby is scheduled for amp and gent, the 2nd day postop is needing assistance for her first time OOB and also wants help feeding her baby, the ante is vomiting, and the vag delivery has a critical H&H, and she is very upset because her baby is in the NICU. It's not always this bad, but it can be. I'm fortunate to work with many great PP and L&D nurses. We usually can work together, but still there are always the ones that create the tension. It's up to everyone who works in maternal child help to create an enviroment of respect and appreciation for all the RN's who work in these areas.

passionflower, BSN, MSN, RN · Mar 31, 2011

I think that people are more concerned with being politically correct than just telling it like it is. Mother/baby nurses (and I am one) have their own set of unique skills but I still believe that labor nurses are more qualified as nurses. I'm not pulling this theory out of thin air. There is a reason why most of us have to call on labor to start our IV's and although they can come and work on our unit, we can not work on their unit unless the mother/baby nurse has labor experience. Why are nurses so offended when you point out the obvious which is there are different levels of nursing skills. All jobs have this - from secretaries to doctors - do you really think that a cardiologist looks at a plastic surgeon as being in his league? Yes we need ALL forms of nursing and not having the same skills has nothing to do with the level of intelligence of that individual, although I think some people take it that way.

In my opinion not all nurses are created equal. Doesn't make me better or you worse, it is what it is.

klone, MSN, RN · Mar 31, 2011

Mother/baby nurses (and I am one) have their own set of unique skills but I still believe that labor nurses are more qualified as nurses....Why are nurses so offended when you point out the obvious which is there are different levels of nursing skills.

Because saying that labor nurses are "more qualified" as nurses than PP nurses is simply untrue. It's frankly BS.

PP nurses don't have to routinely start IVs the way labor nurses do, so they are quite possibly not going to be as adept at it. That doesn't mean they're inferior nurses.

If someone asked me to suction a trach, I'd have NO CLUE how to do it, because I don't do it as part of my job. That does not have anything to with my skills or qualifications as a nurse. It just means that it's not something I routinely do, therefore my skills at that particular task are rusty (which is an understatement).

Miranda50 · Mar 31, 2011

but I still believe that labor nurses are more qualified as nurses. I'm not pulling this theory out of thin air. There is a reason why most of us have to call on labor to start our IV's and although they can come and work on our unit, we can not work on their unit unless the mother/baby nurse has labor experience. Why are nurses so offended when you point out the obvious which is there are different levels of nursing skills. All jobs have this - from secretaries to doctors - do you really think that a cardiologist looks at a plastic surgeon as being in his league? In my opinion not all nurses are created equal. Doesn't make me better or you worse, it is what it is.

It's naive to think that choice of a speciality makes one professional more qualified than another. It's true that not all doctors and nurses are created equal. But do you really think you can so easily sum up the abilities of a doctor or a nurse based on their area of expertise. After working in hospital, I sure you know the difference between an outstanding cardiologist and one with a less than stellar track record. Would you still say then that every cardiologist in this spectrum is still a better doctor than a top notch plastic surgeon, who may specialize in highly complex microsurgies to correct severe congenital deformities? The same can be said about nursing professionals. I work with some fabulous L&D nurses and have a lot of respect for their skills and abilities. However, there are some that I would never want to care for my daughter. Also, the ability to place an IV, while an important skill, does not define a nurse's capabilities or level of expertise. Do you think that an experienced postpartum nurse that manages a postpartum hemorraghe until the MD can arrive in house is any less than the novice L&D that's just started taking patients on her own. There is a wide spectrum in nursing knowledge and a long road to travel before one gains proficiency in their specialty. It's unfair to make generalizatons about how qualfied or skilled any nurse is based on the unit they work on. I'm not sure sure where you pulled your theories from, but right now, thin air does not come to mind.

punkydoodlesRN, BSN, RN · Mar 31, 2011

This has been an interesting read.... I see very little of this at my facility, but it's there. You RN's think it's bad - Try being the PP LVN - Red. Headed. Step. Child. Even the RNs on my own floor sometimes treat me like a total moron. Just because I have three letters behind my name instead of two doesn't make me any less inferior. I can give insulin just like you. I can start an IV or program a pump, I can even read and chart a PCA. And don't even get me started on how the L&D RNs act....

I have a suspicion that some of the posters in here are the very ones that I speak of. I seriously don't understand why nursing has to be such a ******* contest.

AnnaBSN · Dec 19, 2012

I work in postpartum couplet care, also antepartum/ob gyn, also intermediate nursery. Thankfully our L&D unit and us get along for the most part. I have great respect for them, it's not really my thing to carefully watch a moniter, run in a room to intervene and then prepare for a crash c/s. They do their job well. My job is just so different. I have seen c/s pts develop an illeus because L&D thought it was ok to give food so soon. Rarely is it reported to me that the fluid was mec stained. I sometimes see complications that develop hours sometimes days later when the baby codes or requires o2, etc. I get report that mom has GDM but that it was very well diet controlled therefore there was no glucose done on baby, only to have to put him on a D10 drip later for sugars in the 20-30s. Or when L&D wants to bring a patient an hour or more early because she wants to see her baby whom we are resuscitating, only to have her hemmorhage in the nursery. Just some things that will help me do my job better. Some complications that you dont see within 2 hrs after birth.

melmarie23, MSN, RN · Dec 20, 2012

I work both...we are a LDRP unit. I wouldnt want to work in any other setting. I like the fact that one shift I can do labor, and the next PP. Things never get boring that way and everyone works as a true team.

but I agree with others, if transitioning to LDRP isnt an option, then crosstrain as many as you can.

standardprecautions · Dec 27, 2012

I used to work in postpartum but I requested for a transfer to L&D and fortunately, I got the transfer. Both units have their own challenges but I'd have to say that so far I feel better working in L&D because it's what I've always wanted. It wouldn't be fair to compare both areas though since the work is so different. There will always be friction among units that work closely together like PP and L&D but I think this is normal and healthy. The important thing is to do each our jobs the best way possible and think of our patients first. :)

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losbozos · Jan 1, 2013

Always worked at places where we worked all areas. No prob at all!

allene24 · Jan 4, 2013

I am a newer L&D nurse and had to rotate through a PP unit as part of my orientation. The nurse I was with kept telling me "THIS IS SUCH A BUSY DAY" and it was the slowest day of my life! L&D is MUCH faster paced. The PP nurses had time to sit down and chit-chat with each other, love on their patients and newborns, have a snack in the break room. A day on L&D- I NEVER have a chance to sit down, managing two labor patients. The L&D units see the PP nurses as having an "easy job- just giving pain meds" There is definitely tension between the two units- Like previous posters said- it would be good to float between the two.