Questionable staffing in L&D vs Nursery

miss81, BSN, RN · Oct 25, 2011

This is what we do at our hospital. We don't really have a nursery, just an area with a few isolettes for sick babies. Our babies are taken to there mom as soon as the admission assessment is completed on the baby. With the exception is after a c-section, in which case we will watch the baby in the isolette for a few hours only. The mom's have a support person stay with them to help her care for the baby. I mean the care that the baby needs is not nursing care... changing diapers and feeding... no reason a family can't do it with some teaching!

new2manage · Oct 25, 2011

So do your L&D nurses admit infant as well as take care of recovering patient and possibly other laboring? Or is there a designated nurse that assumes care of infant at delivery?

cayenne06, MSN, CNM · Oct 25, 2011

Hmm. Babies should stay with their parents if everything is normal, so i think that is the rationale behind what your facility does. What do you think the facility should do differently? As long as the baby is normal and healthy, it seems like it would be a waste of money and disruptive of bonding to have the baby go to the nursery.

serenity1 · Oct 25, 2011

This is how we do it on our unit too. Usually, a nursery nurse catches baby, does initial assessment and any bloodwork if necessary. After that, mom and baby bond for about 2 hours in L&D before both are transferred to post partum. The only time a baby goes to our nursery is if there is a problem. And, yes...L&D nurse does recovery while attending to another laboring mom.

Mec_Happens · Oct 25, 2011

This is how it is done on my unit as well. Once our laboring patients are in active labor they become a 1:1 assignment (sometimes we'll carry 2 laboring patients if they both have an epidural and stable, but the assignment is split as soon as possible. There is another nurse present in the room for delivery just in case the baby needs resuscitation, otherwise baby goes directly on mom's chest skin-to-skin and stays there undisturbed for an hour or so. We also have NICU nurses that will come to delivery if there are any risks that warrant having them present for delivery (ex - any time there is mec or a crappy strip or a vacuum delivery we always have them present for delivery), but most of the time the baby is vigorous at delivery and they are dismissed. So, most of the time with a normal uncomplicated delivery it is the L&D RN recovering mom and assessing and admitting the baby. Sometimes on the rare occasion that there is a free RN with nothing to do they will help out with the baby assessment/admission. Once mom is recovered and baby is admitted they go up to post partum together :)

DebblesRN, ASN, BSN, RN · Oct 26, 2011

Our hospital is also having a big overhaul on how our unit is run. Currently, we have a L&D unit, PostPartum unit, and a Nursery (divided into a newborn nursery, special care nursery, and a 3 bed NICU). The plan is to convert our nursery unit into a ten bed level II NICU, discontinuing the nursery altogether, and L&D will be responsible for recovering mom and admitting baby for the first three hours. Mom and baby will then come to PostPartum and the nurses there will provide couplet care.

Our shut down date is set for next June. Everyone is anxious, especially the nursery nurses since some of them have never done anything but neonatal nursing in their entire careers. We also have a higher risk population, so there is concern that some issues will get missed with our newborns, as we have issues now with our L&D nurses missing things in the first hour that we have to address and fix. At this point they are keeping infants in resp distress for an hour and trying to get them to breastfeed. They are crashing and burning by the time they get to us.

Not sure about all the particulars on how the unit will run, we currently have a team making decisions on all the Particulars so we will be ready to make the change in June. Good luck to you, and I would love to hear how things are going with the new guidelines.

Bottom line, this is how MOST hospitals run their departments. L&D to postpartum with couplet care, or they have LDRPs. Three separate units--L&D, Nursery, and PP is a dying trend.

souprflyhony · Oct 29, 2011

I work in a small rural hospital and this is how take care of our patients. Our L&D nurses wear all the hats when they clock in. We may be working L&D/antepartum/post partum and nursery all during the same shift. During deliveries we will have the delivery nurse present in the room and the only other L&D nurse working will come in and work the warmer alongside the house supervisor. We utilize skin to skin in our hospital, so unless the newborn is having problems, then the newborn is placed on the mothers chest and is transitioned there by the delivery nurse. This free's up the other L&D nurse to manage her patients, whether it be additional Pt's laboring or post partum patients or nursery of previously delivered newborns. After the transition is completed, our hospital immediately begins to utilize rooming in. We do not have the staff or the budget to staff a sole nursery nurse. The only time we have a nurse designated for the newborn solely is when we have a comprimised newborn and then staffing is adjusted accordingly.

I know that it probably does seem like a lot right now, but this is a managable scenario. It just takes some getting used to and getting used to juggling it. Hang in there and good luck in your transition to the new staffing trend!

CEG · Oct 31, 2011

As far as baby not going to the nursery- that is consistent with evidence and is best practice. Going to a nursery is not good for anyone- detrimental to breastfeeding, bonding, increases infection risk and security risk, etc. It is recommended however that a second nurse is available at delivery to be responsible for neonatal resuscitation. So if you mean truly alone, that is a concern.

shortstuff31117 · Nov 1, 2011

We are all LDRPs where I work. Core staffing on nights is 3 nurses, at least one of whom is a nursery nurse. We have 2 NRP certified staff at all deliveries. The baby nurse does all the baby things, then leaves the couplet to the labor nurse. Baby never goes to the nursery unless there is a problem.

luv4nursing · Nov 1, 2011

We are all LDRPs where I work. Core staffing on nights is 3 nurses, at least one of whom is a nursery nurse. We have 2 NRP certified staff at all deliveries. The baby nurse does all the baby things, then leaves the couplet to the labor nurse. Baby never goes to the nursery unless there is a problem.

what do you guys do when there is a c/s? Our minimum staff at night is 5 and a c/s takes 4 of them off the floor, leaving 1 person to watch the whole floor.

new2manage · Nov 2, 2011

Let me clarify. We have been doing couplet care for 2 years now and typically this works well and I do agree that this is best for mom and baby. My concern is that the nursery nurse is not being staffed at all on Sundays and placed on call whenever the House Supervisor sees fit- if there are not any designated special care babies. Nursery nurses placed on call have a 30 minute window on average to get to the hospital. If a laboring patient goes bad (and we all know they do without warning) you have a 30 min delay getting specialized care to that infant other than what the the trained NRP/L&D nurse provides. I want a trained nursery nurse in house at all times whether she's bedside at delivery or not- she/he should be available. Am I being unreasonable?