Postpartum Nurses being the Baby Nurse? - page 2

Hi All! My facility is in the process of changing the way babies are handled at delivery and I need your help to find other facilities that do it this way! A little about my facility... We are... Read More

  1. by   holmesln
    Quote from BSNbeauty
    Our hospital has created the neonatel assessment nurse. They are typically NICU nurses who have been cross trained or direct hires. The NAN do all the initial and ongoing treatments for the baby while the baby is in L and D with the mom. The purpose is to decrease separation. The infant will only come to the nursery for monitoring or sepsis work ups.
    Are they also the baby nurse at delivery assigning apgars and resuscitating as needed?
  2. by   holmesln
    Quote from Lulu33
    I'm curious to hear how different hospitals do this as well. I am a NICU nurse but we are cross trained to nursery and have a lot of stress and anxiety of how it is handled where I work. Labor nurses only cover the mother. Some labor nurses are nursery trained, but there is a lot of pushback from the nurses who do not wish to do nursery. There is one (!) or very rarely two nursery nurses on per shift. The physical nursery is not used except for circs/hearing/CCHD testing after baby has been moved to postpartum with mom. The nursery nurse is responsible for attending all deliveries, resuscitating baby, APGARs, assessment, q30min vitals, weight/length, meds, breastfeeding/skin to skin, any blood glucose's, etc. during the two hour stay with mom in labor and delivery. This is for every baby that delivers on your shift. So if three babies deliver within a two hour period you are responsible for this all in a timely manner before sending baby off with mom. If you are lucky, that labor nurse is trained with the babies and can take a set of vitals while you are running to the next delivery. There is a lot of pushback to make any changes to this as labor nurses do not want to take the responsibility of doing both mom and baby.
    I think it's weird to have a NICU nurse doing that role, unless the baby needed special care. The postpartum nurses do couplet care?
  3. by   holmesln
    Quote from ashleyisawesome
    When I first started, we did it like you currently do it. Labor nurse (usually the charge nurse, the moms primary nurse concentrated on mom) did resus/apgars (always straight to the warmer after cord was cut), we grabbed a weight and foot prints in the room, then handed baby to mom for a bit to nurse/hold and then usually around the 2 hour mark when we were ready to move mom to PP, we dropped baby off in the nursery for admission/bath/meds. Baby was returned to mom once it was warmed up after the bath. A lot of our staff is trained in labor and postpartum and we float back and forth, but there are some that only do labor or only do PP/nursery. Our nursery trained nurses could be baby nurse if we were in a pinch and charge was in another delivery.

    We went "baby friendly" a couple years ago. Now we still have the charge or another labor/nursery nurse catch baby and do resus. Baby goes straight to moms skin after delivery and Apgars/vitals/tactile stim/bulb suction are all done on moms chest. If they need more we whisk them over to the warmer. Weight/prints/meds/assessment are all done in the delivery room by the nursery nurse (we call her when we are ready) after mom has had at least 1 hour of skin to skin and attempted the first feed. Sometimes the labor nurse does the assessment, etc if it's an easy recovery and we have time. Baths are done 12 hours after birth in the PP room by either the PCA or the PP nurse. Baby and mom go to the PP room together and are never separated unless medically necessary or mom requests the baby go to the nursery for a bit so she can rest.
    This is how we are aiming to go, however we will have 2 postpartum nurses assigned to L&D that day to stay down there and be the baby nurse. It makes so much more sense for us to just go down an hour after delivery, in my opinion.
  4. by   Skips
    Quote from holmesln
    Interesting! Where is the baby actually admitted? Like meds, assessment, vitals, etc., in L+D or up on postpartum?
    We admit the baby on L&D and put standing orders in. We do an initial assessment, measurements, growth chart, and two hours of vitals all on L&D. We also give vitamin K and the erythromycin eye ointment in L&D. Essentially, there are two nurses for a recovery. But sometimes there is one nurse to do both Mom and baby recovery if we are busy.
  5. by   Miiki
    I work at birthing hospital with 8000+ deliveries a year. Mother/baby runs the transition nursery. Those specially trained nurses (worked in M/B for a minimum of 2 years and then apply to and train for transition) attend all of the deliveries that NICU doesn't go to. They catch the baby and do all of the initial stuff baby friendly and all that. They admit the baby in L&D or the OR. They handoff to the M/B nurse when mom and baby head to the floor. They have a physical nursery where they can monitor iffy babies for up to 6 hours. At that point they either go back to mom or to the NICU.
  6. by   holmesln
    Interesting. Do they do couplet care on the postpartum floor? Are the transition nurses and the nurses in the nursery also postpartum nurses, depends on the day?
  7. by   Miiki
    Quote from holmesln
    Interesting. Do they do couplet care on the postpartum floor? Are the transition nurses and the nurses in the nursery also postpartum nurses, depends on the day?
    Yes. Couplet care is standard. That's why it's mother/baby instead of postpartum. The transition nurses can work M/B if they are short, but Transition is their job. M/B nurses cannot work transition. While transition is under the umbrella of M/B, it is separate. Transition nursery is more conceptual vs physical. It mostly occurs at the mother's bedside. A healthy baby won't leave mom. The transition nurse will sit at the L&D nursing station. M/B nurses do staff the well-baby nurseries.
  8. by   BSNbeauty
    Our PP do assign apgars and provide resuscitation. We are NRP certified. However , if resuscitation is needed than we also call the NICU nurses and NPs to take over.
  9. by   holmesln
    Quote from BSNbeauty
    Our PP do assign apgars and provide resuscitation. We are NRP certified. However , if resuscitation is needed than we also call the NICU nurses and NPs to take over.
    How does your "flow" work? Do the PP nurses stay in L&D for delivery's or come when needed? Do you do the rest of the admission in L&D?
  10. by   BSNbeauty
    If we are the NAN nurse we do the admission assessment , meds and everything else needed on l and D. We take care of the baby until we are called to another delivery. At that time we quickly report of to the L and D nurse and go to the next delivery .
  11. by   AmberK1026
    I am a PP nurse in a very busy hospital with 6000+ births per year. We have L&D, PP, and Newborn Nursery as 3 seperate units. L&D nurses labor with the mom and at the time of delivery I believe the charge nurse or some other "head/lead" nurse catches the baby and then newborn nursery will come in to transition the baby (give baths, meds, etc). NICU is always on stand-by in case additional help is needed.

    For c-sections the newborn nursery nurse catches the baby, stimulates baby, assigns apgars then will take baby to newborn nursery to transition while mom is still in the OR. Once mom is in recovery and if baby is doing well then baby goes to be with mom in recovery.

    PP nurses take care of mom and baby once baby has been transitioned and is stable. We are cross trained to go to L&D to help recover moms after a normal vaginal birth- recovery time is 2 hours.
  12. by   Ashes172
    The postpartum nurses at my hospital are the ones who train and do transition nursery, Which means they go to all deliveries of babies over 37 weeks. Not every PP nurse is trained in transition nursery though. We have one "primary" transition nurse who spends the shift in L&D and one back up who usually has a smaller assignment on PP but can go to L&D to help if need be. The L&D nurses really don't do much with the baby at all.
  13. by   not2bblue
    Ldrp only one unit. There are a few pp only nurses and a few nursery only nurses from when they first opened but now everyone hired needs to be able to do everything. You might be ld, pp, or nursery at any given time. Although TYPICALLY one nurse is assigned to catch baby if it is busy everyone miat pitch in. Yep catch a baby when you have 3 couplets. But the mom and baby are rarely seperated (circs, procedures, and nightly weights only) and they are trying to limit that but we only have 4 scales for 50 room so it is easier to do it in a central location. Baths are done in pt room under warmer whenever as long as not on blood sugars and the baby must have successfully fed at least 2 times. I like it this way a lot better. Mom stays in same room whole time. We might labor and keep her. Or give her to pp nurse and get another labor. It is super easy because we are one floor, one unit (although we are an entire hospital floor lol) and so there isn't a whole lot of conflict amongst labor and pp that I experienced in hospitals where they were different separate units.