Postpartum Nurses being the Baby Nurse?

[holmesln]

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 a 775 bed hospital in NJ, right outside of NYC. We have about 6,500 deliveries a year, with 50 postpartum beds. The postpartum nurses do couplet care with typically 10-12 nurses for the unit on the floor. We also have two charge nurses and two nursery nurses in the main nurseries to admit babies, assist with circumcisions, handle lab orders and phototherapy babies, as well as feedings for any babies not in the rooms with the mothers and more.

Currently, the L&D nurses are the ones being the Baby Nurse at delivery and in charge of the initial resuscitation and assigning APGAR's. They assist with the skin-to-skin and breastfeeding immediately following. About one to two hours after birth, the L&D nurse will bring the newborn to the nursery for the postpartum nurse to officially admit the baby. We will do the weight, measurements, admission medications, vitals, head-to-toe assessment, bath, and any monitoring that needs to occur. Typically the mother comes up to the postpartum floor shortly after and as soon as the baby is done, we will send the baby out to the mom. Separation time is typically one to two hours.

Right now we are in the process of changing all of that! They would like for a postpartum nurse to attend the delivery and be the Baby Nurse. She would do the initial resuscitation, assign the APGAR's, and then do the whole admission process (except the bath, which will occur later during their stay), in the L&D recovery room. Babies that need closer observation, such as respiratory distress babies, as well as all c-section babies, will still go to the main nursery after delivery for admission. The "goal" or "purpose" of this new change is to keep the mother and baby together. However, there is a lot of push back from the postpartum nurses about not wanting to be the Baby Nurse.

We have been given the opportunity to find a hospital that does it the same way or similar as described above, so that we may do a site visit to better understand the process. I am looking for that hospital!

The key changes are:

-Postpartum nurses being the Baby Nurse and doing the initial resuscitation and APGAR's

-Admitting the baby in L&D

-Once mom is stable and ready for transfer to postpartum, mom and baby would travel together, never being separated

-Decreasing the staff in the main nursery (ours would go from four RN's to two RN's)

I'd like to hear how your hospital handles babies at delivery! I'd love to find a hospital that does it the same way as above so that we could possibly do a site visit!

Thanks for your help!!

[Ashes172, BSN, RN]

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.

[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.

[LibraSunCNM, BSN, MSN, CNM]

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.

Wow 50 rooms! I've never heard of a hospital doing LDRP with such a large unit, that's awesome. I agree that there's often a lot of needless conflict between L&D and PP, I always wished I could work in a facility that did LDRP.

[jenrninmi, MSN, RN]

I work in a level II LDRP and we are baby-friendly designated. Baby never leaves room unless absolutely necessary and for circs. All of our nurses have specialty of L&D or special care nursery nurse but we all do m/b. Any of our nurses can transition the newborn as we are all NRP certified. If we're busy sometimes we have a second RN in the room just to make sure baby is stable and then the l&d RN will finish up with mom and baby. That includes all meds, assessments, footprints, measurements... No bath until at least 12 hours (I had no idea hospitals still gave baths so soon after delivery). Even nightly weights , cchd, tcb, newborn screens and hearing screens are done in mom's room.

[JackieShorter]

We have a NAN on postpartum. Its the newborn admission Nurse. They go to the delivery shortly after the baby is born once called. They admit the baby in the labor and delivery room. This involves assessment, meds, weights, length, growth chart and help with feeding. Some are OR trained and attend c-sections in which they assign the apgars as well and are in right before delivery occurs. Moms are not separated from babies unless the baby goes to nicu or once on the floor the mother requests baby be in the nursery or for circumcions. We no longer have a nursery nurse. The nurse of the couplet is responsible for all lab work and testing for baby. The Nan does not take an assignment on the floor. She just admits the babies in ldr. On daylight their is an OR NAN and a regular LDR NAN.

[Leader25, ASN, BSN, RN]

"ight now we are in the process of changing all of that! They would like for a postpartum nurse to attend the delivery and be the Baby Nurse. She would do the initial resuscitation, assign the APGAR's, and then do the whole admission process (except the bath, which will occur later during their stay), in the L&D recovery room. Babies that need closer observation, such as respiratory distress babies, as well as all c-section babies, will still go to the main nursery after delivery for admission. The "goal" or "purpose" of this new change is to keep the mother and baby together. However, there is a lot of push back from the postpartum nurses about not wanting to be the Baby Nurse. "

I can understand why you are concerned and you should be ,but I am afraid they are trying this experiment in other places - now the so called Happy areas are full of overworked, unhappy nurses.

Their claims that it is good for the patients are bogus - as parental complaints are up and many unhappy MDs -ob/gyns,peds etc.

It is such a unfair unilateral change akin to being bullied.

They are planning to change visitation policies ito more open ,... even in light of statistically increasing numbers of nurses being assaulted, shooter incidents.

May all nurses be safe and well with these changes.

[Just-floored]

I work at a baby friendly LDRP and all of our nurses are both labor and postpartum trained. As the labor nurse I will do all the care for baby and mother including the admission and assessments. We have standing orders that we can input but need to call physician for sepsis, glucose or chorio protocols. We don't encourage bathing of the baby right away unless Hep B or Hep C positive mother. At delivery there is a second pair of hands who help with NRP if necessary, assisting the physician and clean up afterwards. We get about 2-3 hours for recovery. Mother and baby are never separated unless medically unstable. We even do skin to skin in the OR and mom and baby travel together back to the room for recovery. We do not do circs at the hospital at all.