Question about being a LD nurse?

klone, MSN, RN · Mar 29, 2015

Many people start into L&D as new grads (such as myself). It can be done, so I would not rule it out as a possibility. The harder part would be finding a job, as L&D is a highly sought after specialty and can be hard to break into without experience (once you have a couple years of experience, though, you will be able to find work ANYWHERE).

Is this process more believable? -> I want to start off as a nursery nurse first, maybe after a year hopefully find a position for mother and baby, after another year (or two if I'm uncomfortable) proceed to LD? Would that "ladder" be believable?

Most facilities are going to couplet care, so they really don't have designated "nursery nurses" anymore. But there is no reason why you couldn't start in Mother/Baby and then possibly transition to L&D. I think facilities are more likely to hire new grads into M/B positions because it's lower acuity/less specialized/less training needed than L&D. But in many places, M/B and L&D are considered totally separate departments, so transitioning to L&D might not be an easy option (luckily, where I started as a new grad, our unit was one total unit, so I was trained on L&D, M/B and special care nursery/level 2 NICU).

Regarding your question - are you sure the person who scrubbed was a nurse? Most places I have worked, the person scrubbing in is a scrub tech, not a nurse. If the L&D staff handle the C/S (some facilities don't have a designated OR on L&D so the patient gets transferred to OR staff for C/S, and the OB department takes over again after the patient has recovered in PACU). For facilities where L&D staff do C/S, the L&D nurse usually transitions to circulating nurse for surgery, and then does the PACU recovery afterwards. But even with circulating, we all had enough familiarity and training to act as scrub tech in an emergency.

Christinajoannne · Mar 29, 2015

Many people start into L&D as new grads (such as myself). It can be done, so I would not rule it out as a possibility. The harder part would be finding a job, as L&D is a highly sought after specialty and can be hard to break into without experience (once you have a couple years of experience, though, you will be able to find work ANYWHERE).
Most facilities are going to couplet care, so they really don't have designated "nursery nurses" anymore. But there is no reason why you couldn't start in Mother/Baby and then possibly transition to L&D. I think facilities are more likely to hire new grads into M/B positions because it's lower acuity/less specialized/less training needed than L&D. But in many places, M/B and L&D are considered totally separate departments, so transitioning to L&D might not be an easy option (luckily, where I started as a new grad, our unit was one total unit, so I was trained on L&D, M/B and special care nursery/level 2 NICU).
Regarding your question - are you sure the person who scrubbed was a nurse? Most places I have worked, the person scrubbing in is a scrub tech, not a nurse. If the LD staff handle the C/S (some facilities don't have a designated OR on L&D so the patient gets transferred to OR staff for C/S, and the OB department takes over again after the patient has recovered in PACU). For facilities where L&D staff do C/S, the L&D nurse usually transitions to circulating nurse for surgery, and then does the PACU recovery afterwards. But even with circulating, we all had enough familiarity and training to act as scrub tech in an emergency.

Thank you so much for your help! I definitely feel more informed now.

My rotation is at Hackensack University Medical Center in New Jersey, and unfortunately my LD units and M/B units are separate. >_

I'm not really sure how my hospital stands when it comes to nursery nurses. I was able to observe this couplet care when I was in the nursery and when I also went to the postpartnum section (My assigned RNs had mothers and babies to deal with) But there was also this other time when I went to the nursery where I observed and shadowed a nurse who stayed there during the entire length of my shift. She didn't have to leave or anything to check on a mom... (So that's why I was a bit confused about the care LOL and if there was only nurses who did "nursery" care)

And about the last question - I'm honestly, not sure if that person was scrub nurse or a scrub tech to be honest. Hackensack University Medical Center has a special designated OR area for their LD. I was able to observe and circulate with my nurse, and do the sponge count and foleys, so I know about the circulation process as a L&D nurse. Our floor also has it's own Recovery room, so the patient didn't have to go to the PACU. I helped her with her post care for about an hour or two. We stayed with the patient during the entire time until we delievered her to the postpartnum floor. We also transfered the baby to the nursery.

My question though is, since my hospital does have these, and since my LD nurse does transition to circulating nurse, do they also sometimes transition to scrub nursing...not as an emergency...but as a full-out position?

klone, MSN, RN · Mar 29, 2015

I'm not really sure how my hospital stands when it comes to nursery nurses. I was able to observe this couplet care when I was in the nursery and when I also went to the postpartnum section (My assigned RNs had mothers and babies to deal with) But there was also this other time when I went to the nursery where I observed and shadowed a nurse who stayed there during the entire length of my shift. She didn't have to leave or anything to check on a mom... (So that's why I was a bit confused about the care LOL and if there was only nurses who did "nursery" care)

She could have been a "transition" nurse - when a woman delivers, the L&D nurse recovers the mom before passing her off to the M/B nurse. There is often another nurse (or nurses, depending on how many deliveries the facility does) that just does the recovery for the baby. They bathe, weigh, do the initial assessment and Ballard, do eyes and thighs, tag, help with the initial breastfeeding, and get the baby admitted into the system. Then, when the q15m assessments are over, baby is totally stable, she will pass the baby off to the same M/B nurse who is taking the mother. If you have several deliveries a shift, the transition nurse can stay quite busy. That nurse will also often "babysit" if the mom wants baby to go away so she can get a nap, or will take care of the babies of the moms who remain high risk after delivery and might be on a different floor, or cannot take care of their own babies (such as a mom on MgSO4), or if the mom is relinquishing the baby and doesn't want the baby in the room with her. That nurse generally doesn't have her own patient load. They will often pull nurses from the general pool of M/B nurses for that role. At one facility I worked, L&D and M/B were the same department. All nurses were expected to do M/B 50% of the time, and the other 50%, chose to either do L&D or "transition" nurse for the babies.

My question though is, since my hospital does have these, and since my LD nurse does transition to circulating nurse, do they also sometimes transition to scrub nursing...not as an emergency...but as a full-out position?

Generally no. Because this role can and usually is filled by a tech, it makes no financial sense to pay a nurse's wages for that position.

Sometimes they will have nurses in first assist positions (that's the person who stands on the other side of the mom during the C/S and is the assistant to the OB doing the surgery). In teaching hospitals, that is often performed by the resident (or, if the resident is far enough along in her training, the resident is the primary and the attending will be first assist). In non-teaching hospitals, first assist can be performed by a variety of people. We had one OB practice where the first assist for scheduled C/S was the CNM employed by the practice (at that hospital, CNMs did not have privileges, so she worked in clinic and just came to the hospital for C/S). An RN can also be in the first assist role, as well.

Christinajoannne · Mar 29, 2015

Generally no. Because this role can and usually is filled by a tech, it makes no financial sense to pay a nurse's wages for that position.
Sometimes they will have nurses in first assist positions (that's the person who stands on the other side of the mom during the C/S and is the assistant to the OB doing the surgery). In teaching hospitals, that is often performed by the resident (or, if the resident is far enough along in her training, the resident is the primary and the attending will be first assist). In non-teaching hospitals, first assist can be performed by a variety of people. We had one OB practice where the first assist for scheduled C/S was the CNM employed by the practice (at that hospital, CNMs did not have privileges, so she worked in clinic and just came to the hospital for C/S). An RN can also be in the first assist role, as well.

Again, thank you so much for all the information. This is fantastic ! I'm really amazed at this first assist position that you explained though. I think I'll google more information about it. Thank you so much for all your help and clearing stuff up for me!

klone, MSN, RN · Mar 29, 2015

Good luck!