Hi from SFl,
I had to get on this posting about transitional nurseries.  I really see the
transitional nursery for all deliveries as a way for departments to hurry moms
from the delivery areas/ recovery to postpartum areas and free up labor room
nurses.  I had worked previously in a true LDRP where I as the RN labored,
delivered, and recovered Mom and Baby and sent the happy family into Postpartum
without moving anyone about. By four hours post delivery everyone was bathed,
cleaned up and snuggling in and breastfeeding had no interruptions.  It was
Camelot. And for almost 9 years it worked well... we had a new nurse-manager who
wanted to increase the numbers and as the numbers went up the unit became a
LDR and we who started it were saddened to see the change. Only on the weekends
or slow times did we get to revert to our LDRP roots.  When we closed down our
unit it was a very difficult thing. A few of us went to a near by hospital
that was LDR and had a transitional nursery.  If we didn't get our babies over
to the nursery within an hour we were reminded that it was slowing down the
system.  On days when we had to hold our babies only those of us who enjoyed the
LDRP concept were happy.  If they can get Mom Baby nurses to transition babies
in the room in such times its all in the favor of the LD nurses.  Our
transitional nursery is manned by one RN and an aide it is busiest in early am when
babies who have gone back to the nursery at night at mom's request are being
assessed and returned to mom before breakfast. It is steady throughout the day
while deliveries and cesareans are being transitioned. We have been known to
deliver up to 19 to 20 babies in a 12 hour day shift.  Then a extra RN may be
pulled to assist the nursery RN.  Babies come out usually within 3-4 hours and
will not be fed prior to this unless they need to be; at that time we will
advise Dad or Mom that it is medically necessary. Babies can fed prior to going to
nursery and my breastfeeding taskforce recently mandated that it be recorded
if a baby had the opportunity to breastfeed prior to admission and if not why
not.
About a year ago someone in Labor management wanted to have all deliveries in
the transitional nursery within 15 min of delivery. I went bonkers....I
enlisted the RN who is the chief nursery nurse to help me tell them that it
interfered with bonding and breastfeeding.  I got a few choice people and we enlisted
a few choice labor nurses who felt breastfeeding was important and we got
that idea killed.  So now all the SVD deliveries can breastfeed and then go to
transition and cesareans come over straight from the OR.
Our taskforce is working on trying to keep the babies in the rooms at night
as much as possible to encourage breastfeeding, but with our high cesarean rate
>60% and the Latina population that is an ongoing struggle.  We are trying to
get the babies to be at least taken out for feedings....the cultural concept
of being a patient is an uphill struggle.  But we are still trying to address
it.
My feelings about transitional nurseries are mixed.  Its nice to have a
reliable nursery for some transitions but I still love the idea to transition the
baby at the bedside. Have Mom breastfeed and do the first bath with the family
watching.  Bedside transition is an opportunity for family teaching and
bonding.  But if you have a busy unit and need to free up maternal beds and keep
things flowing then I suspect that a transitional nursery is a necessity.  I
think if families want the bedside transition perhaps allowing  them to have a
designated nurse who could transition a couple of deliveries over 4 hours might
be an option.  But there needs a policy of how to address when does a baby need
to go to the more advanced area of observation.  Just like in our
transitional nursery when a baby needs to be moved to NICU.  Management and nursing
shortages and increasing the numbers will forever keep LDRP transitioning as a
rarity.  Our chief nursery nurse and Neo team try to keep the babies in the
nursery for as short as time as possible.  Hope this helped.
Our biggest problem then is getting the baby out to all the enthusiastic
family members and having to deal with 20 minutes of excuses while everyone holds
the baby and gets their photos in, and we are trying to get the baby to Mom
for breastfeeding and we have to either send them out or we get Mom well we'll
just give a bottle THIS time I don't want to send them away.  It's a mystery
how they think.
Got to go...
Leanne Jewell, RN, C, LCCE, FACCE

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