well baby nursery RNs...

Elvish, BSN, DNP, RN, NP · Mar 13, 2007

This is what night shift is like from 7p-7a where I work. I'm sure it differs depending on where you are....

1900-2300 consists of:

scrubbing x3min.

getting report

admitting newborn babies (bath, vitals, assess, vit K, eyedrops, then back out to mom); calling NICU/peds resident if babe doesn't look good

taking care of what we call our OBNers (not sick enough for NICU but not well enough to go home...bilibeds, methadone babies. This also includes babes of prisoners who have gone back to prison but baby hasn't been taken home by whomever is getting him/her).

Feeding/changing/holding whoever else is in there at the time.

Meds/IVs for whomever has them ordered

If you are charge you also:

Order HepBs from pharmacy

Obtain circ permits if this isn't already done

Audit charts if not already done

Make out night sheet -- lists names of all babies & what they need in terms of HepB, O2Sat check, a recorded pee/poop, bilichek in AM, Tylenol for circs. Also space to write weights.

2300-0700 consists of

helping to assess/bathe/weigh all babies (primary responsibility is with couplet nurse but we help as we can)

still admitting newborn babies

still caring for OBNers & whoever else is in there

fighting whatever fires need fighting, if you are charge in NBN

NBN charge also is responsible for communicating with pediatricians prn & ordering total bilis for babies c high bilicheks

making sure everyone gets fed on time...or gets sent back to mom for BFing.

Meds etc.

We do our best to keep babes with moms but it doesn't always happen.

I love being in NBN, but I am usually very glad to see 0645 roll around.

SmilingBluEyes · Mar 14, 2007

WOW things vary by place.We don't have a wellbaby nursery where I am. Babies stay 24/7 with mom, if they are well. IF they are not well, then they are special care babies, different rating, and are generally 1:1 or 1:2 in our SCN.

Well babies belong with their families all the time, unless medical conditions prohibit, either for moms or babies. Sometimes, for maternal exhaustion at night, we do take babes out to the nursery for a few hours for rest. But we are not always able to, if things get crazy on the unit.

Rooming-in is a great concept, most of the time. I just wish we had staffing for when moms are truly exhausted, that did not make it necessary to watch babies in addition to caring for other couplets and surgical pts on the unit.

But for the most, part, moms want their babies in with them at all times----which is a good thing for everyone.

Jme2007 · Mar 14, 2007

Arwen, Great list and you covered a lot! I too work in a well baby nursery on nightshift. Most of the duties you listed are the responsibility of the either the post-partum nurse (couplet care) or their unit secretary. When a baby comes into the nursery at night, it is still the post partum nurses assignment but I am there basically to "babysit", if you will. Whenever a baby comes into the nursery, I first assess the little one, change his diaper, and linens and maybe feed, if bottlefed. When the AM rolls around before change of shift, I will also do any heelsticks for labs that were ordered. Unfortunately, a lot of night PP nurses encourage their moms to get rest and offer for the baby to go to the nursery. This a lot of times makes my shift very busy. Last shift I had, I had 7 babies the whole night, by myself. I dont mind that so much, but I thought our hospital was supposed to encourage the "family environment". Oh, that is another subject.. We do have a "transition nurse" whos primary job is to go to each delivery and "catch" the baby and do assessments, Vit K, eye oint, measurements, etc. I think our hospital is the only one who has this position because everywhere else I know of, the L&D nurses transition their babies. Okay, WOW, too much info! Hope it helps someone....

crissrn27, RN · Mar 14, 2007

Hi, I work in a well baby nursery, we actually go to all deliveries, usually take turns or whoever is not the busiest at the moment, we usually have aroud 1200 del. a year. Ok so my normal shift (7p-7a) is 1. change into scrubs (OR type cause we go to c-secs), 2. scrub for 3 min.3. get report,

assess all babies, change diapers, linen, etc 4.take out to mom and help with BF, bottle feeding, baby care (we don't do couplet), 5. bring babies back in to nursery for assessment, weight, bath, and test at 2300 6. bottle feed at 0100, take breast babies out for bf'ing during night, then pick back up after bfing, (we don't encourage moms keeping babies), assessments at 0300, bottle feed at 0500, end of shift stuff at 0600, and during "down time" we do babes pictures, hep b's, PKU's, hearing screens, etc-also don't know if ya'll have a level II but we do so we might have a NICU kid to do (thats usually 1:1), and we take premies with OG/NG feeds, monitors, etc so we might have a couple of them-kind sounds tiring but I love it! Just wish we were more "family oriented"

SmilingBluEyes · Mar 14, 2007

Why, pray tell, do places still discourage mom/baby couplet care and rooming-in?

rnin02 · Mar 14, 2007

We currently are set up so the mom has a postpartum nurse and baby has a nursery nurse. Supposedly that is changing come May, but we still have a lot of cross training to finish first! At our hospital, we tell moms (and dads!) they can keep their babies all night and we will "borrow" them briefly for weight & assessment, they can send them babies into the nursery between feedings, and/or we can give bottles to the bottle babies during the night. It seems that the majority of our parents send the babies in, at least from 11-4. They seem to keep them after the 4am feedings frequently. It will be interesting to see how things will work out after we make the transition to mother baby nursing. My typical shift is this:starting at 7p:report, check my charts, meet "my" parents and check up on "my" babies, try to get any forms we may still need (hep B consent, circ consent, security), follow up on any leftover issues that may delay discharge. By 11p, start my assessments, including weights and chart checks. Hopefully finish assessments by 1 or 2am. Depending on how many labs I have, start them around 5am. In between all of this is going to deliveries and admitting new babies, helping with breast feeding, feeding the bottle babies that are hanging out in the nursery. Sometimes we have middle of the night circs to assist with, teaching the new parents baby care, working nights we usually stock the supplies, sometimes the nurses do this, sometimes we have a tech that will do this. I think that about covers the major things. Its busy, but a totally different busy then working tele/med-surg, which I used to do. I say make the change, its worth it! My last year on tele I really dreaded going to work every night, I don't have the same feeling of dread.

coco18 · Mar 14, 2007

My mother/baby unit has the nursery open on night shift 2330-0630ish.. our postpartum (couplet care) nurses rotate being in the nursery. The limit is supposed to be 8 well-babies, but sometimes 9 or 10 if you've got a good group and breast-fed babies are always going in and out. Sometimes we have so many moms wanting nursery we need two nurses there. The nursery nurse is responsible for assessments, bottle feedings or paging the primary RN when breastfed babies need to eat, weights, bili-checks, ordering labs if needed, hep B's if ordered, calling the ped or NICU if needed, and chart checks. We also do initial assessment and bath for new admits when able to help out the primary RN. We are only a postpartum unit and never attend deliveries. Some mom's wouldn't dream of sending their newborn to the nursery, even for a few hours, but other mom's are very happy that we offer this service and say so on our feedback forms. It's all up to mom, and I try not to encourage or discourage either way, just support mom's decision. I love the nursery when I'm there and happy to rotate, but we do have nurses who only want the nursery, and those who never want it!

crissrn27, RN · Mar 14, 2007

Why, pray tell, do places still discourage mom/baby couplet care and rooming-in?

I don'twant to get to specific, but I will say in NC.........some of the other nurses actually want to make mom sign a wavier to keep her baby in her room during the night, all the babies "have" to come to the nursery at shift change and the docs absolultey will NOT assess babes in moms room.........it is very frustrating to me, but I seem to be the only one that is bothered by this "old" way of doing things:uhoh3:

SmilingBluEyes · Mar 14, 2007

Evidence-based practices surely are lacking among many of us (where I work we have problems too---just not this one). All in all, in light of these things, I can see why some people really do not want to have babies in hospitals. I cannot understand having to sign a waiver to have a baby room in with his/her own mother. Unbelievable to me.

SmilingBluEyes · Mar 14, 2007

I would encourage parents to refuse to allow people to remove their babies without their accompanying them unless there exists a true medical urgency or necessity whereby they must be separated. They have this right; they just don't know it. How revolutionary to have moms actually assert their rights are parents!

whiskeygirl, LPN · Mar 14, 2007

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.