What is a shift like for a PP/mother/baby nurse?

QTBabyNurse, BSN, RN · May 13, 2008

first of all, congratulations in your new unit! you will enjoy mother/baby, i am sure.

i've worked 10 years in l&d, nursery and mom/baby--sometimes all three areas within the course of one 12 hour shift!! when i worked mom/baby, i would start off my shift getting my assessments done and preparing patients for any surgical procedures that they were having done--i.e., postpartum tubals. as i was doing assessments, you would find out if anyone needed pain meds which is one of the few meds given in mom/baby. hardly any of our patients had scheduled meds except for the occassional insulin or b/p med. the rest of the day is assisting with baby care, breastfeeding/breast care and lots of education. you will also be checking to make sure that bonding is going well between your mom/baby. in between you will be accepting newly delivered moms/babies...so they get assessments and vitals signs more frequently for awhile. you will also get back your post surgical patients from the morning tubals. unless your unit has nurse assistants (ours didn't)...you will also be getting patients set up for showers, changing linens, passing and collecting meal trays, doing vital signs, i&o's on your surgical patients, and making sure your patients are ambulating, etc. in between all those things, you will also document!

some people say that mom/baby is a "cake walk" job...i beg to differ...you will bust your butt!! :chuckle

momma/babyrn · May 14, 2008

Thanks for your reply, QTbabynurse. How frequently does your PP unit monitor vitals after a tubal? Also, do your pts ever come back to the floor w/ a PCA? Do you frequently have blood transfusions on PP? When a PP pt starts to hemorrage does it happen suddenly?

I delivered my 2nd son two months ago and noticed that one of my PP nurses did not assess me at all. I had nothing other than a vital sign check during her shift. Is it a possibility that some units don't require an assessment if the pt has been stable for a certain amount of time? I would guess not. I think my nurse that shift knew I was a nurse myself so she figured I could handle things on my own.

Again, thanks so much for your input.

rn4babies63 · May 14, 2008

I have done L&D, postpartum, nursery for 12 years. I'm now doing Mother/Baby nursing and L&D. A typical 12 hour day shift for me is assessments, most meds are at 10 AM (mostly prenatal vitamins, stool softeners). We also take gynes on our floor so maybe some HTN meds, insulin, etc. I just did a blood transfusion last week. Fortunately, we don't have to do them often. Docs don't jump quickly do do them unless H/H is very low (hers was 6.9) AND symptomatic. Usually a PP hemmorhage is managed in the labor room with Hemabate or Methergine before things get too out of control. Our postop vitals, including tubals are q4 hrs x 24 hours then q shift. PP patients get vital signs AND complete assessments, including fundal checks q shift. Lots of breastfeeding assistance and teaching (We have a 90% breastfeeding rate), and other mother/baby education. We also have to take our babies to the nursery and stay with them during circs, do bilichecks, labwork as ordered, etc. Mother/Baby nursing is quite exhausting. We usually have an aide for linen changes, bathroom assists, sitz instructions, trays and water passes, but, if not or if we're particularly busy (which we usually are) then we do that also. I personally prefer the separate assignments to Nursery, L&D, or postpartum on a shift.

QTBabyNurse, BSN, RN · May 14, 2008

thanks for your reply, qtbabynurse. how frequently does your pp unit monitor vitals after a tubal? also, do your pts ever come back to the floor w/ a pca? do you frequently have blood transfusions on pp? when a pp pt starts to hemorrage does it happen suddenly?
i delivered my 2nd son two months ago and noticed that one of my pp nurses did not assess me at all. i had nothing other than a vital sign check during her shift. is it a possibility that some units don't require an assessment if the pt has been stable for a certain amount of time? i would guess not. i think my nurse that shift knew i was a nurse myself so she figured i could handle things on my own.
again, thanks so much for your input.

our post op vitals routine for sections and for tubals was q15min x 4, q30 min x 4, then q8h for the duration of their stay. yes, section patients have a pca, not tubals though. blood transfusions happen from time to time, not too frequently though thank goodness! the very best preventative to a full blown hemorrhage is frequent fundal checks~~never forget that!! if you catch it early, you can prevent many problems....also remember that a full bladder can prevent a uterus from staying firm, so get momma to pee!! :twocents:

momma/babyrn · May 14, 2008

How long do sections stay on their PCA? When are they able to get up and walk... is it soon after anesthesia wears off or do they need longer?

Thanks for answering all my questions!! :rcgtku:

rn4babies63 · May 14, 2008

Most of our sections don't need PCA's. Usually they get Astromorph spinal and Toradol IV for 14 hours. If they need a PCA (increased pain or general anesthesia), they are usually d/c'd the next morning. They aren't allowed out of bed until the next AM either (usually to chair after foley is pulled). It's not always 24 hours, usually less than that if they delivered later in the day.

cassioo, RN · May 14, 2008

How long do sections stay on their PCA? When are they able to get up and walk... is it soon after anesthesia wears off or do they need longer?
Thanks for answering all my questions!! :rcgtku:

If our patients get a PCA because they didn't get astro/duramorph they PCA, IV, Cath come out the next morning and they don't usually get up. If they have a baby in NICU no matter what they have (PCA or astromorph)they might get up later in the day to go to the nursery...at a hospital I worked per diem at they were up the evening of surgery if they had a morning section...similar to what other post ops would be.

cherokeesummer · May 14, 2008

Let me see if I can recall LOL! I work PP and have been on Mother/Baby for six months approximately. I will say this our day is super busy and I never sit still unless I'm very lucky! :):):):)

0700 - get assignment, get report, get pager

0730-0830/0900 - 8-10am meds out for patients, see all moms - which entails getting vital signs since we don't get an aide usually, pass trays, pass meds, assess moms.

whenever finished with moms (hopefully by9ish) go see babies to assess but if we are lucky someone in the nursery can start assessing babies but not always.

900/930ish pick up breakfast trays from patients, address needs and attempt to chart if possible.

Work on any discharges

10/11ish - meds/noon vitals, then pass lunch trays

12ish - pick up lunch trays, make beds if time allows, get things for patients, etc. etc. constantly running seriously.

try to sneak a few bites for lunch.

2 to 3ish try to start second round of assessments for the afternoon, vital signs on all patients again, assessing again, moms and babies. meds if needed, getting things, charting, doing pku's as needed throughout the day.

4-5ish - pass dinner trays, same as above doing things as needed for moms and babies, you'd be suprised how many needs new moms (and previous moms) have...from breastfeeding to burping to help walking to i need a t-shirt for baby, oh then I need diapers, and oh can I have some soap, oh wait I forgot to tell you I needed nipples for the bottles and I need some more milk. Yes those are true conversations. I try really hard to tell them to make a list and give it to me at once. Or if they are vag deliveries and not cs delivery days, then I will tell them where the stuff is so they can walk and get exercise. I'm still "too nice" as viewed by some b/c I do tend to do more for the patient than I probably should but it keeps them happy and sometimes off the buzzer so thats nice.

6pm pick trays back up, start prepping for last rounds when they always need something else or some pain meds. Prep for report.

7pm - give report to nurse coming on.

All day long we also get new admissions which is what takes up a bulk of the time b/c new admissions require lots of time - vag deliveries are recovery vitals q30 mins x 2 hours then q four hours for 24 hours. C-section deliveries are recovery vitals q30 mins for 2 hours then q1 hour for 2 hours then q four hours as long as they have epidural pca.

So yeah its a BUSY day!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! :banghead: :heartbeat but I do like what I do! :heartbeat:nurse:

cherokeesummer · May 14, 2008

How long do sections stay on their PCA? When are they able to get up and walk... is it soon after anesthesia wears off or do they need longer?
Thanks for answering all my questions!! :rcgtku:

I wish our patients used something different, I've heard that they are trying to go with duramorph - I don't know anything about that but will look it up!

Anyway our sections have PCA for a little over 2 days. They come over with it and a catheter, then we try to get the cather out the same day, later on. on Day1 (the day after delivery day that is) we do lower the pca usually (when anestheisa comes around) then on day2, we generally remove the epidural if the doc says its ok. Then day3 they go home. We are trying to pilot seeing how many ppl want to go home a day early. So that means pca out a day early too.

When I had my section for my son I wanted pca out the same day but they encouraged me not to b/c of the pain. I do think I got it out the next day tho LOL. I walked about 6 hours post op (was in reovery for a few hours), had cath removed and went to the NICU to see my son. I was determined LOL! :):):):)

cherokeesummer · May 14, 2008

some people say that mom/baby is a "cake walk" job...i beg to differ...you will bust your butt!! :chuckle

thank you!!!!!!!!! i'm so tired of hearing..."you are so lucky you get to hold babies all day" um no i wish! very rarely do we even get to hold them longer than to hand them to mom or than to assess them. on the rare occasion that i have a few mins of quiet i have been known to hold a baby while charting lol! :heartbeat:heartbeat

cherokeesummer · May 14, 2008

Thanks for your reply, QTbabynurse. How frequently does your PP unit monitor vitals after a tubal? Also, do your pts ever come back to the floor w/ a PCA? Do you frequently have blood transfusions on PP? When a PP pt starts to hemorrage does it happen suddenly?
I delivered my 2nd son two months ago and noticed that one of my PP nurses did not assess me at all. I had nothing other than a vital sign check during her shift. Is it a possibility that some units don't require an assessment if the pt has been stable for a certain amount of time? I would guess not. I think my nurse that shift knew I was a nurse myself so she figured I could handle things on my own.
Again, thanks so much for your input.

Wow I would be very suprised about that! I assess all my patients regardless of nurse or not...if they are nurses I tend to be very laid back but still give them the same attention, but I kind of assess their level of comfort. Most will say I'm a nurse but I'm new to this (mommyhood).

To answer the tubal question, I've only had a few myself so far, but when we do get them back we monitor them like a regular recovery, q30 mins x 2 hours, and so on. My last tubal, she came back and jumped up to go to the shower, she was such a trooper LOL!

I've been blessed to not have witnessed a hemmorage yet but I understand that they can come on super quick. I think I almost did, my patient was in the bathroom with my help and she went pale and dizzy asap, and felt very spacey so I called for help and charge nurse and another nurse came in and helped me, massage fundus and we ran pit and got her sitting up and back to bed once she kind of came back. But that was a scary thing for me! So I'd say keep up on fundal checks and checking bleeding as checking fundus. :nurse: