A couple of months ago a reader wrote with worries that since her baby was due at Christmas, her nurse would be a newbie without enough seniority to avoid working the holiday. I assured her that wasn't the way things worked on a labor and delivery unit because: 1). Staff nurses have to take turns working holidays and 2). we'd get our butts sued if we let inexperienced nurses work alone. Gawd, that would be scary—a whole shift of brand-new baby nurses who didn't really know what they were doing. Don't worry, ladies, we wouldn't do that to you.
Most L&D units run with a variety of nurses with different levels of experience. There's the charge nurse who's the team leader for her shift. She decides what our assignments will be (which nurse will take care of which patients), She also runs interference for us, making sure we have what we need to get our jobs done. If we need an additional nurse or two to help out with some particular patient scenario (like in the OR, or when the baby's being born, or if we need to do a resuscitation or move somebody who's totally numb, etc.), she's the one we call on. If there's a problem with a baby, family or doctor, we go to her to help us solve it. We keep her posted on how our patients are doing so she can keep track of what's going on around the unit.
There are staff nurses and on-call nurses. Staff nurses work either full or part time and have guaranteed hours. That's me. On-call nurses (sometimes called per diem) sign up to be available for certain shifts then wait for a call a couple of hours before the shift starts telling them if they're working. On-call nurses get to choose when they want to be available and don't usually have to work holidays and weekends unless they want to. Staff nurses do. If there are more patients on the unit than the staff nurses can cover, we use the on-call nurses.
Some of us are labor trained. That means we've had extra training about all things related to labor and birth. When I go to work, I generally get assigned a labor patient (as opposed to a post partum mother/baby couple). In a best case scenario, I'll work with just one labor patient at a time. Sometimes, we pick up additional patients , if ours doesn't need much care or if the unit is so freaking busy it's an "all hands on deck" shift. It's not unusual to work more than one labor per shift. Say, for instance, I come on duty and my patient is 7 cm. In a couple of hours she's ready to push. A little while later, she's delivered. Once she's recovered, I might have to move on to another labor and she gets picked up by a post partum nurse. On a perfect day, I get to stick with my patient the whole day. Some days, we have so many babies being born, we just go from one birth to the next. I work 12-hour shifts. One day, this year, I attended three births in one shift. That was hectic.
Some nurses do post partums and babies only. They usually take care of three or four mother/baby couples at a time. Yep, that's six to eight patients. It's quite a lot of work. They're your "teach-me-what-to-do-with-this-baby" nurse. They also specialize in, "OMG, what happened to my body." I work "posties" sometimes and spend my shift checking out babies to make sure they're transitioning well, learning to breastfeed (or bottlefeed) and if they're not, we call the pediatrician and we fix them. We're responsible for making sure baby's blood tests and shots are done too. Sorry, we don't like that part either. Sometimes, all that baby stuff gets done by nursery nurses. Our unit is a labor, delivery postpartum unit. One stop shopping.
If one of our babies gets sick, they go to our Level 2 nursery and one of our NICU trained nurses takes care of them. We all know how to draw blood, administer meds and hook up all the devices that measure heart rate, respirations, oxygen and temperature but "nursery nurses" have extra training so they're especially good at it.
We always staff extra nurses to take care of outpatients that need to be evaluated for things like nonstress tests or dehydration. Maybe they've been in a car accident or have some sort of pain. They're generally not in labor but they need us anyway. We also staff "back-up" nurses. On my unit, those of us who are labor trained all work "back-up." When birth is imminent, we call for 'back-up" and an extra nurse comes in, just in case the baby needs help. Not every baby is born ready to breath, beat his/her heart and cry. Some of them need a little encouragement. We call that a resuscitation. Sometimes it's a surprise (even normal labors and births sometimes result in a compromised baby) and we want to be prepared, just in case. If we suspect the baby's going to have trouble, we'll call for a nurse or doctor who's experienced in placing an airway. We use certified registered nurse anesthetists but some hospitals use respiratory therapists or anesthesiologists. If baby won't breathe, these guys place an artificial airway in baby's throat so we can get and keep baby breathing, even if we have to do it for them. Someone trained to do resuscitation is available for every delivery. I work "back-up" quite a lot. Most of the time, there's no problem and I'm just an extra set of hands in the room. Sometimes though, babies put us through our paces.
The unit couldn't run without our housekeepers who clean our rooms, our unit assistants who keep the phones and computers humming and our hostesses who keep the food coming so our patients don't go hungry. There are countless people who work behind the scenes so we can provide excellent delivery service.
I'll be working Christmas Eve this year. Not surprisingly, there won't be any scheduled cesarean sections or inductions because hardly anyone wants to be in the hospital on Christmas and very few want to share their baby's birthday with the holidays. Ever baby born this past week was given a tiny, hand-knit Santa hat. We'll all bring food to share with each other and it'll be kind of fun. I've worked with some of these nurses for years and not only are we a team, we're a family. Next year, when it's my turn to work Christmas Day, I'll be a little sad not to be with my own family but babies born at this time of year are mighty special. There's a rosy glow about the room when these little ones are born. They're our little Christmas miracles. Happy Holidays.
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