well baby nursery RNs... - page 2

What does a typical shift consist of? I am a telemetry/med surg RN of seven years and I have an offer to transfer to the nursery. I will be working nights. Any input would be appreciated.... Read More

  1. by   crissrn27
    Quote from rnin02
    Why encourage the parents to accompany the baby for everything? If one (or both) of the parents wants to come along, I accomodate them in any way possible. However, I sometimes wonder to myself, why can't they trust me with their baby for 30 mins or less? why don't they take those few minutes to take a shower (mom) or run a quick errand or go to the cafeteria (dad)? What do they think I'm going to do to their baby? Just things I wonder sometimes. I certainly understand wanting to have baby room-in, wanting as much time with your baby as you can get, but 30 mins or less (usually less, but doing the weights and changing the linens takes a little bit more time) 3 times a day doesn't seem like that much separation to me. But I haven't had my own baby yet, so I don't have that perspective either.
    I have had a baby (3 in fact) and will tell you, its not that I don't trust the nurses with the baby, its that I don't want the baby to go away-I think its ingrained, back in the caveman days you probably couldn't let them out of your sight for 5 min. without some animal eating them...lol But seriously, not much that has to be done can't be done in the room with the proper layout of the pp and nbn units....which we don't have I too encourage mom to rest IF SHE WANTS TO, most folks just aren't gonna rest in the hospital, at least not at mine, and use this time to bond. Especially at night when all the visitors aren't there. This babe is new to them and it takes a while for them to check them out, etc. Ask them again in a year if you can have the baby for 30 min and they probably will say yes, keep 'em an hour or two.
  2. by   SmilingBluEyes
    Quote from whiskeygirl
    OP: I think you will like it. If you are able to change diapers and be in the same room with occasionally screaming babies you will be fine. It may even be a good break for you.
    Our peds docs want to assess their babies in the nursery to have access to supplies and equipment. If the mother requests it, the docs will do the assessment in their pp room. It just takes longer to do AM rounds.

    Smiling: I totally support babies being with the moms all the time. I want them to bond and be successful at breastfeeding. My main goal in the NBN is for the baby to be healthy and stay safe! I offer the mothers a good nights rest. It's likely they have gone for 24 to 36 hours without a good sound sleep. It is our policy that babies are checked on and charted every 2 hours, even through the night. I encourage moms to get the sleep now while they are in the hospital and have nursing support, to get well rested before going home alone, sometimes to a house with more little ones to care for.
    Our goal is NOT to fix, manage and control. But rather to support mom and baby.
    Mine too; our goals are similiar, but we sure do thing differently apparently. As nurses, we don't "fix" anything. But we do (or should) encourage early bonding and parent experience with their babies. Parents can't learn much about baby care in the hospital if their babies spend all their time in the NBN. Even at night, moms need to learn early cues for feeding, attention and diapering. Giving them a break is one thing. We do that too. Having babies removed against parents' will due to hospital policy, quite another, at least in my thinking.
    Last edit by SmilingBluEyes on Mar 14, '07
  3. by   SmilingBluEyes
    Quote from rnin02
    Why encourage the parents to accompany the baby for everything? If one (or both) of the parents wants to come along, I accomodate them in any way possible. However, I sometimes wonder to myself, why can't they trust me with their baby for 30 mins or less? why don't they take those few minutes to take a shower (mom) or run a quick errand or go to the cafeteria (dad)? What do they think I'm going to do to their baby? Just things I wonder sometimes. I certainly understand wanting to have baby room-in, wanting as much time with your baby as you can get, but 30 mins or less (usually less, but doing the weights and changing the linens takes a little bit more time) 3 times a day doesn't seem like that much separation to me. But I haven't had my own baby yet, so I don't have that perspective either.

    First of all, I would ask you please read the post to which I responded and try to understand the context in which my words were used. In this particular post, the poster states babies are removed, not for their or moms' wellbeing, but due to "policy" . I have to question, why? Why can't a baby be assessed, bathed, weighed and hearing screened in mom's room, if at all possible? Why can't parents have the right to accompany babies for routine testing if they are taken to the nursery? Why can't parents observe what we are doing with their own babies in the hospital? Because "we" say so? I just don't agree this is good reasoning.

    No where did I say *never* should a baby leave his/her mother. In cases of medical necessity, obviously, it has to be done. Also helping out in case of maternal exhaustion, no problem. But taking babies away without allowing the parents a choice, seems a bit unethical and stronghanded to me. *That* is why I would encourage parents in such cases, to be assertive in their desire not to be separated from their (not our) babies in the hospital. I don't think that is all so unreasonable.

    Also, I do say this as a mother myself. So maybe I do have a bit of a different point of view. I did not want my baby taken from me for what was no good reason. I also have experience w/a son who had to be admitted to a NICU immediately after birth (prematurity and a birth defect)---- and I never got to hold him or even touch him, for hours. No breastfeeding him for days. I felt I missed out in those early days. With my daughter, having been through that, I wanted her to room in with me unless medical necessity on my part or hers, absolutely prohibited it. I was lucky; she came out ok and I got my wish. If I had another, same thing; I would not let her out of my room unless medically necessary. Exhaustion notwithstanding, I want to be the one to respond when my baby needs something. So I am guilty of having experience color my opinion on the matter.

    But regardless of how I personally feel, where I work, rooming-in and couplet (not well nursery) nursing care are the standards and I applaud them. Yes, this requires we all be cross-trained, but, that too, to me is a good thing.
    Last edit by SmilingBluEyes on Mar 14, '07
  4. by   SmilingBluEyes
    I apologize to everyone for redirecting the thread in responding to Criss specifically. I realize my input to this one poster has sort of derailed things. Anyhow, to those who need to know what goes on in a well nursery, Arwen provided excellent input. For anyone whose nursery policies are so strict, I would just ask you reflect on why they need be in place at all and who benefits.

    I am out of here. Enjoy the thread.
    Last edit by SmilingBluEyes on Mar 14, '07
  5. by   crissrn27
    Quote from SmilingBluEyes
    I apologize to everyone for redirecting the thread in responding to Criss specifically. I realize my input to this one poster has sort of derailed things. Anyhow, to those who need to know what goes on in a well nursery, Arwen provided excellent input. For anyone whose nursery policies are so strict, I would just ask you reflect on why they need be in place at all and who benefits.

    I am out of here. Enjoy the thread.
    Your right blueyes we kinda got of topic. And your also right about our polices, the only ones they benefit are the nurses and docs and it really ticks me off:angryfire

    Nola, hope we have given you some ideas of how different hospitals do things. One good thing to do is ask the NM about the shift duties and also maybe shadow a nurse for a shift to see if you like how things are done. If you are a "baby person" you'll probably really like it, however its set up. I do, even thought I wish we could change some stuff, and what area of nursing couldn't use some change?:spin:
  6. by   whiskeygirl
    Speaking specifically about the hospitals I have worked in, the only babies that spend all (or even a majority) of their time in the NBN are special care (bilis or unstable temps) or the adoption babies.

    And I respectfully disagree that parents are not learning the early cues that their baby needs attention because they spend a night or 2 away from their parents. By supporting the parents in bonding and breastfeeding we offer basic infant teaching including lactation help.
    Last edit by whiskeygirl on Mar 14, '07
  7. by   rnin02
    Quote from SmilingBluEyes
    First of all, I would ask you please read the post to which I responded and try to understand the context in which my words were used. In this particular post, the poster states babies are removed, not for their or moms' wellbeing, but due to "policy" . I have to question, why? Why can't a baby be assessed, bathed, weighed and hearing screened in mom's room, if at all possible? Why can't parents have the right to accompany babies for routine testing if they are taken to the nursery? Why can't parents observe what we are doing with their own babies in the hospital? Because "we" say so? I just don't agree this is good reasoning.

    No where did I say *never* should a baby leave his/her mother. In cases of medical necessity, obviously, it has to be done. Also helping out in case of maternal exhaustion, no problem. But taking babies away without allowing the parents a choice, seems a bit unethical and stronghanded to me. *That* is why I would encourage parents in such cases, to be assertive in their desire not to be separated from their (not our) babies in the hospital. I don't think that is all so unreasonable.

    Also, I do say this as a mother myself. So maybe I do have a bit of a different point of view. I did not want my baby taken from me for what was no good reason. I also have experience w/a son who had to be admitted to a NICU immediately after birth (prematurity and a birth defect)---- and I never got to hold him or even touch him, for hours. No breastfeeding him for days. I felt I missed out in those early days. With my daughter, having been through that, I wanted her to room in with me unless medical necessity on my part or hers, absolutely prohibited it. I was lucky; she came out ok and I got my wish. If I had another, same thing; I would not let her out of my room unless medically necessary. Exhaustion notwithstanding, I want to be the one to respond when my baby needs something. So I am guilty of having experience color my opinion on the matter.

    But regardless of how I personally feel, where I work, rooming-in and couplet (not well nursery) nursing care are the standards and I applaud them. Yes, this requires we all be cross-trained, but, that too, to me is a good thing.
    I suppose to me it wasn't clear you were responding to a specific post, it seemed more like a general comment. I am in favor of couplet care, I think it will work well if done properly. In my particular hospital we all try to be supportive of whatever decision the mothers/parents make. I think rooming in, if parents are not 100% exhausted or other serious issues are going on, is a very good thing. I sometimes wonder how the first few nights go at home, for the moms who send their babies in to live in the nursery for most of the night, and we end up spending the shift trying to console a screaming, fussy baby that the parents have sent in to us to "fix".

    Somewhat back on topic:
    We bathe babies in the nursery because our policy is to bathe under a warmer. We do have one warmer that can be rolled into the rooms if the parents desire, or we can do it in L&D if asked. We also usually do our labs in the nursery in case you need extra supplies (ie, a second stick, another bandaid, etc), its hard to remember to bring duplicates of everything. Or triplicates But we do have parents come to the nursery and watch things, if they want too. Sort of unnerving to do a PKU for the first time with a Dad watching, but not too bad after you get used to it.
  8. by   mitchsmom
    I'm with SBE.. we also don't have a well-baby nursery and frankly I would be bummed if we did. Nothing against well-baby nursery nurses!

    If a mom needs us to take the baby for a while we do it. But, overall we do not find this necessary. And it is not supported by the literature (for maternal rest or other reasons). Our moms get plenty of rest (ummm, most newborns sleep most of the time KWIM?!)... and if moms don't - it's because they are allowing too many people to visit them, not because of the baby.

    We do everything in parent's room as far as baby goes, no special setup needed, just regular rooms, and it's fine. Well, it's better than fine (Actually it's probably *easier* come to think of it, no shuffling babies around back and forth- that would probably take more time!). It's all very valuable teaching time for parents and everyone is usually really into it!! Pictures, questions, etc.

    I strongly feel that the best place for healthy new babies and mommies is with their new family In most cases, the whole time. I didn't even realize that that many places still separated moms and babies for that stuff! Wah!

    On the other hand, if we have to do anything not routine, like getting a baby IV or whatever, the nurses generally take baby to the nursery.
    Last edit by mitchsmom on Jul 12, '07
  9. by   crissrn27
    quote In most cases, the whole time. I didn't even realize that that many places still separated moms and babies for that stuff! Wah!quote



    Your right, I got a shock when I started at this hospital, at all the pressure on the parents NOT to be involved/present for care.........we don't allow parents in the nursery at all, unless their kid is really sick, our docs would die if we asked them to do bili tx in moms room, or if we didn't have baby in nursery promptly at 0700 for them to examine........and most of the nurses, well everyone except me, is FOR this to continue. I love being in the nursery, but I sure would like to see some change!
  10. by   DebblesRN
    I work in a well baby nursery, and we also have a level II NICU.

    We start the shift with the 3 minute scrub. We have 8PM rounds, where we chart a mini assessment, midnight rounds where we do weight, VS, and a full assessment, and 4AM rounds, where we do another mini assessment.

    We also recieve newborns after delivery within one hour of birth. The infant is given meds (vit k and eye ointment), measurements done, assessment, bathed, and a security photo is taken. If infant is unstable, all the NBN nurses are trained to stabilize, and a neonatologist is on call 24/7.

    We go to all c-sections, and occasionally are called to Labor and Delivery if there is a preterm infant being delivered, if an infant is having problems in the Delivery room for unknown reasons, If there is thick Meconium stained fluid, or if the baby's strips look bad.

    All labs, or any technical procedures (IV's, circ's, hearing screens, etc.) are done in the nursery. Any baby on a running IV, Phototherapy, or oxygen stays in the nursery.

    Parents are welcome in the nursery at all times to observe unless the infant is not stable, and then for obvious reasons, they are not allowed in. The only time people are barred from entering the nursery is if there is a bad baby we are working on, and between 7 and 9 AM, and 7-8 PM for report and pediatric rounds.

    We encourage rooming in, but I have to say, about 60% want their babies in the nursery all night, and another 30% want them brought to the nursery between feedings, so they can sleep. Makes for a hard night when you have 6-7 babies, that are either all in for the night and bottlefeeding, or all have to go out to BF every 2-3 hours.
  11. by   ElvishDNP
    I should add...we usually have 30-40 babies at a time. Of those, about 10 are in the nursery all night on any given night. The rest are either out c mom or in w/ us between feeds. 2 RNs.

    These are some barriers I have found to 24/7 rooming-in: (which, I must say, I like -- rooming in, not the barriers)

    -grandma or somebody else saying, "You are so tired, you need to send the baby to the nursery for the night." after we've already gone through how we're going to get through the night w/ baby in the room, how I am going to help them, blah, blah, blah. Gone right out the window.

    - fresh c/s moms whose help leaves them for the night. Now that I can understand why Mom just might not feel up to having babe in c her all night. But I have helped many a fresh c/s mom room in, by her preference. It can be done.

    - Our nursery is hugely prominent on our floor, i.e., a big fishbowl right in the middle of our unit. The power of suggestion.

    - As some others have suggested, having visitors traipsing in & out all day for the new family to entertain. Can't they see the huge circles under everyone's eyes?? Come 2230, they are wiped out.

    - Where I am we have a lot of nurses (on every shift) who don't believe in couplet care & so will encourage families to send babe to the nursery @ night. This really gets under my skin.

    - The floor set-up. I wish we had a scale & supplies in every room, or at least a place stocked with said supplies for every foyer (group of 4-5 rooms). As it is, all supplies, and the ONE scale for our unit is in NBN.

    Ok, all that was OT. Sorry.
  12. by   nolaRN
    Thank you everyone for the input! I have officially submitted my transfer application. :wink2:
  13. by   zahryia
    Quote from mitchsmom
    I'm with SBE.. we also don't have a well-baby nursery and frankly I would be bummed if we did. Nothing against well-baby nursery nurses!

    If a mom needs us to take the baby for a while we do it. But, overall we do not find this necessary. And it is not supported by the literature (for maternal rest or other reasons). Our moms get plenty of rest (ummm, most newborns sleep most of the time KWIM?!)... and if moms don't - it's because they are allowing too many people to visit them, not because of the baby.

    We do everything in parent's room as far as baby goes, no special setup needed, just regular rooms, and it's fine. Well, it's better than fine (Actually it's probably *easier* come to think of it, no shuffling babies around back and forth- that would probably take more time!). It's all very valuable teaching time for parents and everyone is usually really into it!! Pictures, questions, etc.

    I strongly feel that the best place for healthy new babies and mommies is with their new family In most cases, the whole time. I didn't even realize that that many places still separated moms and babies for that stuff! Wah!

    On the other hand, if we have to do anything not routine, like getting a baby IV or whatever, the nurses generally take baby to the nursery and they are (I think) bad about not letting family in for that stuff (like a 180 from our regular routine above!). I think they are too strict about not letting family in the nursery, and that is not supported by the literature either (denying family presence for procedures or whatever).
    [FONT="Century Gothic"]Totally agree with you and SmilingBluEyes.

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