Labor and delivery nurse staffing

Units we staff

Labor and delivery, antepartum, postpartum and mother and baby, well baby nursery, NICU across all levels, paediatrics and PICU, and obstetric emergency and triage.

Why L&D is consistently hard to staff

Two patients at once, a physiological process that is normal until it very suddenly is not, and a specialty that does not tolerate a learning curve. Postpartum haemorrhage, shoulder dystocia, cord prolapse and placental abruption all develop in minutes, and the response has to be practised rather than improvised.

The candidate pool is correspondingly small. You cannot cover an L&D gap with a med-surg nurse, and even experienced nurses from other specialties are not a substitute. Facilities that treat L&D as interchangeable with general nursing find out expensively.

It is also a specialty with an unusually high litigation profile, which is why documentation standards and monitoring competence are screened harder here than almost anywhere else.

How we screen

• Fetal monitoring. Interpretation to NICHD categories, and whether the nurse has been formally assessed rather than self reporting comfort. This is the single most important screen in the specialty.
• Certifications. NRP as a baseline, plus AWHONN intermediate or advanced fetal monitoring, ACLS, and RNC-OB or RNC-MNN where relevant.
• Delivery volume at facilities worked, and whether the unit was a community service or a tertiary referral centre with high risk obstetrics.
• Emergency response experience. Participation in haemorrhage protocols, massive transfusion, crash caesarean and shoulder dystocia manoeuvres.
• Scope of practice. Circulating in the operating room for caesarean sections, epidural management, oxytocin titration, magnesium sulphate administration, and newborn assessment and resuscitation.
• Whether they cover multiple areas. Some nurses work L&D only, others rotate through postpartum and nursery. Facilities frequently need the second, and it should be established before submission rather than after.

NICU

NICU is screened separately by level, because the levels are genuinely different jobs. Level II special care, level III intensive care and level IV surgical NICU have different acuity, different equipment and different candidate pools.

We screen on ventilator and CPAP management, umbilical and PICC line care, therapeutic hypothermia where the unit provides it, developmental care practice, and family communication, which in NICU is a much larger part of the role than in adult critical care.

For obstetric nurses

L&D is one of the strongest positions to be in as an agency nurse, because demand consistently exceeds supply and the skills do not have a ready substitute.

Before accepting, establish the delivery volume, whether the facility handles high risk obstetrics, whether an anaesthesia provider and an obstetrician are in house at all times or on call from home, and what the ratio is during active labour rather than on average. Ask what happens when two emergencies occur simultaneously, because the answer tells you how the unit is really staffed.

Then ask about float. An L&D nurse floated to a general medical floor is a poor use of a scarce skill, and one floated to NICU without NICU experience is a genuine risk. Get the float language naming specific units before you sign.