Workflow of Labor & Delivery Nursing

ragingmomster, BSN, MSN, RN · Oct 7, 2012

Work flow? There is no work flow in L&D. You need to have your clinical standards for L&D down pat, but the clearly regimented days of CSICU will be gone. The whole picture changes on a dime and you have to be thinking about all the possibilities as you go along. And more than anywhere else I ever worked...document your butt off.

Cottontop365 · Oct 8, 2012

Thanks for the input, ragingmomster. So, are you saying that a nurse with icu experience wouldn't be a good fit for L&D? BTW, I've never heard of ICU being labled as "regimented", LOL! Do you enjoy L&D?

HeartsOpenWide, RN · Oct 9, 2012

Work flow? It's "Ebb and Flow" you have to be able to go from zero to sixty in no time flat. When your busting at the seams and another labor walks in the door, there is no transferring them to another hospital.

I like how one nurse put it: in L&D you are caring for two patients, one of which you can't even see!

Cottontop365 · Oct 9, 2012

"Work flow" was apparently the wrong phrase! :down: Geesh! I do, however, appreciate your input. :up:

Fyreflie · Oct 9, 2012

Sometimes it's slow--until it's not!! I work on a unit that averages 15-25 deliveries in 24 hours. I have worked shifts where 13 of us have sat on our duffs all night and had 1 delivery. I've worked shifts where we've had 18 nurses running their butts off for the entire shift, no breaks. I've even worked a shift where we had 8 sections in 12 hours (16 in that 24 hour period). I've had shifts where we have started the night with one room full and only had one room empty four hours later, and vice versa!

It's so hard to compare L&D to any other type of nursing. I think your closest comparison would probably be Emerg. There are no scheduled meds, and we are often looking up policies and procedures to learn how to deal with something we've never seen before (ie withdrawing from alcohol who had retained product and a general anesthetic followed by IV push sedatives to keep her from seizing). A medically risky person can deliver with no complications and a perfectly healthy young primip can hemorrhage after a quick and easy labour and delivery and lose her uterus. You might care for both these women in one day, and then resusc a baby who had a perfectly normal tracing. You have to be prepared for any or all of these situations to occur within minutes and you have to be able to act quickly when they do, all the while reassuring dad and grandma and staying connected to Mom so she feels trust enough to let you preoxygenate her for an emergency c/s with general anesthetic without panicking, even if you met her 5 minutes ago.

You will learn to mistrust full moons, yell at people who say the Quiet word and firmly believe that pressure changes cause waters to break. You will teach more than you thought you knew and grieve with perfect strangers when something perfect goes wrong. You will learn to hold your tongue and put your judgement on the back burner. You will learn to trust your intuition--sometimes over your experience or common sense. You will never let a first--or even second--year resident check a patient without checking after them just to see how good they are.

You will learn that your work flow has more to do with your personal karma or run of luck than anything else. You will want to call in sick when that flow is kicking your ass!

If you're lucky, you'll love it, and if you're not, you'll switch out pretty fast :)

Cottontop365 · Oct 10, 2012

Thanks for answering my question, Fyreflie! This was exactly what I was looking for.

sugarbee · Oct 11, 2012

Sometimes it's slow--until it's not!! I work on a unit that averages 15-25 deliveries in 24 hours. I have worked shifts where 13 of us have sat on our duffs all night and had 1 delivery. I've worked shifts where we've had 18 nurses running their butts off for the entire shift, no breaks. I've even worked a shift where we had 8 sections in 12 hours (16 in that 24 hour period). I've had shifts where we have started the night with one room full and only had one room empty four hours later, and vice versa!
It's so hard to compare L&D to any other type of nursing. I think your closest comparison would probably be Emerg. There are no scheduled meds, and we are often looking up policies and procedures to learn how to deal with something we've never seen before (ie withdrawing from alcohol who had retained product and a general anesthetic followed by IV push sedatives to keep her from seizing). A medically risky person can deliver with no complications and a perfectly healthy young primip can hemorrhage after a quick and easy labour and delivery and lose her uterus. You might care for both these women in one day, and then resusc a baby who had a perfectly normal tracing. You have to be prepared for any or all of these situations to occur within minutes and you have to be able to act quickly when they do, all the while reassuring dad and grandma and staying connected to Mom so she feels trust enough to let you preoxygenate her for an emergency c/s with general anesthetic without panicking, even if you met her 5 minutes ago.
You will learn to mistrust full moons, yell at people who say the Quiet word and firmly believe that pressure changes cause waters to break. You will teach more than you thought you knew and grieve with perfect strangers when something perfect goes wrong. You will learn to hold your tongue and put your judgement on the back burner. You will learn to trust your intuition--sometimes over your experience or common sense. You will never let a first--or even second--year resident check a patient without checking after them just to see how good they are.
You will learn that your work flow has more to do with your personal karma or run of luck than anything else. You will want to call in sick when that flow is kicking your ass!
If you're lucky, you'll love it, and if you're not, you'll switch out pretty fast :)

This was the best post I have ever read.

PeepnBiscuitsRN · Oct 12, 2012

I work in Postpartum, but L&D and PP are sort of buddy buddy, so when they're getting spanked so are we. At our hospital we end up on divert...I want to say 5/7 days a week, so what the previous poster said about going from zero to like...well.. full house in the span of 8 hours isn't really unheard of. I think the patient ratio in L&D is 1:1 or 1:2. Depending on the patient, if she's on Mag, if she's got PIH, if she's a teenager or 44 year old. I actually worked in cardiac/prog care for a little over a year before switching to OB, and it does take some getting used to. There's a LOT of charting. Yes, you'll learn to hold your breath coming in to work on a full moon night, you'll notice it get's really dull in November, and then around oh...July/August BAM! You might deal with disgruntled, estranged babydaddies, or disgruntled new grandma's to be, you'll look at a 5 paged, detailed birth plan and ready the patient (mentally) for a section.

Not saying it's no fun, I like it, it's just that it's sometimes like watching a dark, twisted comedy...and you're a player in it.

Cottontop365 · Oct 25, 2012

I work in Postpartum, but L&D and PP are sort of buddy buddy, so when they're getting spanked so are we. At our hospital we end up on divert...I want to say 5/7 days a week, so what the previous poster said about going from zero to like...well.. full house in the span of 8 hours isn't really unheard of. I think the patient ratio in L&D is 1:1 or 1:2. Depending on the patient, if she's on Mag, if she's got PIH, if she's a teenager or 44 year old. I actually worked in cardiac/prog care for a little over a year before switching to OB, and it does take some getting used to. There's a LOT of charting. Yes, you'll learn to hold your breath coming in to work on a full moon night, you'll notice it get's really dull in November, and then around oh...July/August BAM! You might deal with disgruntled, estranged babydaddies, or disgruntled new grandma's to be, you'll look at a 5 paged, detailed birth plan and ready the patient (mentally) for a section.
Not saying it's no fun, I like it, it's just that it's sometimes like watching a dark, twisted comedy...and you're a player in it.

Thanks for your response, PeepnBiscuitsRN!

I took the leap and applied for a job on the maternal/child unit which is postpartum, I think. I am crossing my fingers and toes, to be able to transition to this new position! I'm hoping it will give me more a leg-up to transfer in to L&D. Not sure if they do cross-training, but hoping that they do.

I enjoy my job now, for the most part. It can be very physical, sometimes and we don't have a lot of help (tech's or CNA's). On a typical day, I have 3 patients (1 or 2 IMC level) and I am responsible for bathing them (which they need a lot of help with after open-heart sx), and ambulating them 2 or 3 times per day. Not to mention all the transfers to the bathroom, the chair and the bed, LOL! Of coorifice, all the nursing stuff also (my favorite part).

Like I said, I came in to nursing because I wanted to be a L&D nurse. I dreamed about it since I was 13 years old. Then, after having preeclampsia with both of my daughter's, I knew that I needed to go back to school and make it happen!

So, I feel like after putting my family through the hell that is nursing school, they deserve and I deserve, to be where I feel I am most passionate about!

Thanks again for the great responses from everyone! :)

jenrninmi, MSN, RN · Oct 29, 2012

Good luck to you, Cottontop365, this will be a piece of cake for you in comparison to ICU!

Cottontop365 · Oct 30, 2012

Thanks :)

Good luck to you, Cottontop365, this will be a piece of cake for you in comparison to ICU!