What could be better than getting paid to snuggle newborn babies all day (or night) long?
This is the most common sentiment shared by almost anyone who hears this job title. While mid-shift snuggles are certainly a job perk, there are many other important responsibilities that come with caring for a new mother and her baby.
Here is a look at a typical night shift for a mother/baby nurse:
1845: Take report from the off-going nurses. On a full-census day, expect to have at least 3 couplets (3 Moms, 3 babies), or possibly 4 moms and 3 babies (with the fourth mom having a baby in the NICU). Report must be taken on both mother and baby, which really forces one to become an expert at organizing their report sheet! Receiving report includes going room-to- room to greet each new patient and introducing yourself as the oncoming nurse.
1930: Time to start assessments. You have already prioritized your plan of care for each patient based on highest need (patients that delivered most recently should be seen first, unless another patient has a need of higher priority). You go to each room and do a head-to- toe assessment on Mom- this includes vital signs, assessment of lung, heart and bowel sounds, palpation of the fundus to assess for position and firmness, assessment of the perineal area and amount of bleeding, assessing the dressing/incision site if there was a C-section, checking for swelling in the lower extremities or signs of blood clots, assessing for any breast issues, such as cracked or sore nipples, assessing voiding status (do they have a Foley catheter that needs to be emptied? If not, have they been able to void since delivery or Foley removal? You’ll need to measure voids for the first 24 hours). Don’t forget to ask about their pain level! At this point, you can start your assessment of the baby. The first assessment is quite thorough, and includes weight, vital signs, assessment of the umbilical cord area, genitalia, spine, skin, mouth, ears- all to check for certain things that mother/baby nurses know to look for. Intake and output is of the utmost importance for our littlest patients, so when the head-to- toe assessment is finished, you will need to check the handy I&O sheet most hospitals keep for newborns to determine the last time baby ate, whether they are breastfeeding or formula feeding, how long or how much they are eating, and how many wet or dirty diapers they have had. This information is part of your documentation for the baby, so you must keep track of it throughout the shift. This is also a good time to ask Mom about any feeding issues, especially if she is breastfeeding. Breastfeeding can be a HUGE challenge for most new mothers in the first few days after birth, so constant education and support is necessary. If there are issues, you should observe a feeding the next time baby is ready to eat and see what you can do to resolve any issues.
2100: This is typically around the time when scheduled medications are due. Of course, medications ordered will vary by hospital and provider, but these are some of the typical medications you will see for postpartum patients:
o Docusate sodium
o Ferrous sulfate
That’s it for scheduled meds! This is one of the perks of this area of nursing.
Most patients are without co-morbidities, so the bulk of medication administration is reserved for PRN pain medications, such as ibuprofen, Percocet, and/or Toradol, and the occasional IV antibiotics for a patient that is experiencing infection. For the babies, there are not usually scheduled medications unless there is suspected infection, in which case, IV antibiotics are ordered.
2200: Better start charting! Now, any good nurse knows that you should certainly be documenting as-you- go, meaning, don’t assess every patient and then sit down to chart everything at once. If your facility has the ability for you to chart in the patient room, that is wonderful. However, nurses know that sometimes time gets away from us, so you do what you can. This is why an organized report sheet is very important for this type of patient load- you want to keep your assessment notes organized, too!
2300: Back to assessments. Typically, patients (and their babies) that have delivered within the last 24 hours are on a q4h assessment schedule. If they are passed 24 hours, it may be q8h. Again, this depends on your facility. This time, you may do more of a focused assessment, including vital signs, fundal assessment, perineum and bleeding, and pain level. For the baby, it’s vital signs and I&O’s. This is usually the time of night when babies decide they’re ready to party, so Mom may need your help with breastfeeding or other baby-related tasks.
0100: Back to charting!
0200: You might wanna grab something to eat. And a coffee.
0230: This part will certainly depend on your facility protocol, but this was the time when routine lab draws were ordered for both Mom and baby. In my state, newborns are routinely screened for phenylketonuria (PKU test) and a number of other metabolic disorders 24 hours after their first feeding, collected via 5 drops of blood from a heel stick. Other baby labs might include bilirubin level, hemoglobin/hematocrit, or C-reactive protein, among others. There is a method to the madness of drawing baby labs, and it can be quite a time-consuming process! These labs are typically drawn in the nursery, so you’ll have to wake up Mom and let her know where baby is going.
0430: It’s that time again! Vital signs and assessments on Mom and baby. Also, if a lab draw was ordered for Mom, this is a good time to take care of that. Most patients will have lab draws ordered simply to check the H/H after delivery, but there can be a slew of other labs ordered for various reasons.
0530: Oh, hello, computer screen. We meet again. Get that charting done, because this shift is almost over! Don’t forget to organize your report for the oncoming shift. The residents typically show up around this time for rounding, so it’s a good time to update them on any issues with patients they are seeing.
0645: Dayshift is here! You give report on each patient, and say your goodbyes.
Remember, this is just a peak into the life of a mother/baby nurse…we didn’t even cover admissions and discharges 🙂 .