My name is Sarah and I have been a postpartum nurse for about a year. I work on a 36-bed labor, delivery, recovery, and postpartum unit in the Seattle area. We take care of a variety of postpartum patients and babies on our unit, and see gestational diabetes, preeclampsia, small- and large-for-gestational-age babies, late pre-term babies, etc. I work three 12-hour shifts per week, and I am currently working night shift.
Typically, I have three to four couplets each night, all needing vital signs, assessments, medications, 24-hour newborn screenings and much more. I am lucky enough to work at a baby-friendly hospital where we encourage breastfeeding, so I spend about 30% of my time as a postpartum nurse educating and assisting my patients with breastfeeding. The rest of my time is spent delivering hands on nursing care (about 40%) and charting (about 30%).
It would be nearly impossible to write about the many things I do during my 12-hour shift, but I will try to describe a typical day as a postpartum nurse:
17:00: My alarm goes off. I snooze for another 15 minutes while I cuddle with my cat.
17:30: Shower time. Once I am squeaky clean, I eat a bagel and cream cheese and drink my English breakfast tea. I always make time to sit down and eat before I go to work so that I can fuel my body and mind.
18:10: I braid my hair, do my makeup, and put on my scrubs.
18:45: I say goodbye to my cat and she meows in protest. I head to my car and listen to NPR during my 10 minute drive to the hospital.
19:00: I clock in, grab a work phone, drop off my bags in my locker, fill my pockets with my essential nursing supplies, and sit in the break room to hear the unit’s announcements and safety concerns.
19:10: Out on the floor I am greeted by the day shift nurses, who are extremely happy to see the night shift nurses. I have been assigned three couplets tonight. Two are vaginal deliveries and one is a caesarean section. One of them is an experienced mom, and the other two are first-time moms. All have chosen to breastfeed their babies (yay!).
19:15: I find the day shift nurse who has my patients and we go into their rooms to get SBAR report, introduce me to the patients, and write my work phone number on their white boards. As I congratulate each set of parents and ask about their baby’s name, I scan the room and patient to make sure all my emergency supplies are available, tubes and drains are functioning properly, and the bed and bassinet are locked and safe.
19:40: After getting report, I sit down at a computer to gather additional information on my patients and plan my night. For each patient, I look at their history, orders, medications, and labs, and chart a Braden skin assessment and Morse fall scale. I plan out when vital signs, medications, and other tasks need to be done during the night.
20:15: Feeling organized and ready to take on the night, I visit each of my patients to tell them their plan of care. While I’m in the room, I restock supplies, take out trash or dirty linens, and tidy up the room.
20:30: I get a call from one of the dads. Baby pooped for the first time and they need help with the diaper change. I enter the room to find a screaming baby and panicked dad. Dad hands me the baby and I proceed to change the diaper while I educate the parents on diaper basics. The parents look at me with wide eyes as they see the sticky black meconium. I reassure them that this is completely normal as I swaddle baby and hand him to dad.
21:00: It’s time to do the first set of vital signs on my cesarean section patient and her baby. I get blood pressure, temperature, and do a full assessment on mom. Her belly is distended from the c/s and she hasn’t passed gas yet, so I talk with her about taking a medication to help relieve the gas and other alternative therapies she can try. She agrees to take the medication and try walking the halls, so I grab the gas pill, simethicone, as well as her Advil and Tylenol that are due. I assess her pain and give her the medications. I then listen to baby’s heart and lungs and do a full assessment. Baby has a wet diaper, so I quickly change it and swaddle him.
21:30: Spotting my charge nurse in the hall, I stop to give her an update on my patients and ask a few questions. She tells me there are cookies in the break room from a thankful patient, so I make a mental note to grab one later in the night.
22:00: I take my 15-minute break and scarf down an apple with peanut butter, pretzels, and cheese. I drink some jasmine green tea on my way back to the unit.
23:00: More vitals and medication administration. While in one of the rooms, I notice that baby has managed to wiggle out of his swaddle, so I wrap him up and spend a few minutes cuddling and cooing at him until mom has returned from the bathroom.
00:00: I get a phone call from one of my dads and he expresses concern about baby being fussy. I go into the room to see if I can help soothe baby. I educate the parents about the many reasons baby might be crying: hunger, wet/poopy diaper, wanting to be held, etc. The parents soak up the information like a sponge and begin to discuss what baby might want. They decide that baby needs to be re-swaddled and might want to be held. I watch and give feedback as mom swaddles the baby. It takes her two tries, but she is thrilled to have done it by herself.
01:00: It is time for the 24-hour screening, so the tech and I gather our supplies and head into the patient’s room. The baby is sleeping, so we take advantage of the quiet time to do the CCHD heart screening and jaundice check. Baby passes the CCHD test, but the jaundice level is higher than average. I explain to the parents that while I do the metabolic screening, I will also be gathering a small tube of baby’s blood to test the serum bilirubin level. The parents are asking questions about why baby’s bilirubin is higher, so I sit down to explain and educate them about newborn jaundice. While I’m discussing this with the parents, the tech is weighing baby and warming baby’s foot for the heel poke. Once the baby’s foot is warmed up, the tech holds the baby in her arms while I clean, poke, and gather blood from the heel. The baby doesn’t cry during the whole procedure and the parents proudly state that they have a brave baby.
01:30: I run the bilirubin test to the lab. I then get a phone call. One of the moms is having difficulty feeding her sleepy baby and she would like me to come help.
01:40: I enter the patient’s room and baby is sound asleep on mom’s chest. It has been almost three hours since baby’s last feeding, so I pick up baby to try to wake him. As soon as I change the diaper, baby is awake and crying…success! I help mom with her positioning of the baby and latching. It takes several tries to get baby on the breast, but after about 15 minutes, we are finally able to get him actively sucking. Mom is so excited and profusely thanks me for helping. I leave the room feeling accomplished and sweaty. Helping with breastfeeding is one of the more physically taxing parts of my job.
02:30: I sit down at the computer to do some charting and look at the baby’s bilirubin lab result. While chugging my water I see that the baby’s bilirubin level came back normal. I go tell the parents and they are noticeably relieved.
03:00: Break time! I grab a warm blanket and settle into one of the large lounge chairs in the break area. I typically try to eat healthy while I am at work to avoid feeling sluggish. Today, I have a salad with a variety of exciting toppings, rice cakes, and a La Croix sparkling water. I watch TV on my phone as I munch on my food. During the last 15 minutes of my break, I lay my blanket on the floor and do some stretching while I drink peppermint green tea.
04:00: Feeling refreshed and ready for the last few hours of my shift, I head back to the unit. I give pain medications to a patient, grab a set of vital signs on another, and help with a breastfeeding.
04:30: I get my cesarean section patient up to the bathroom with the help of my tech. While I am in the bathroom with my patient helping her with peri care and Foley catheter removal, the tech is changing the bed linens. The patient stands up from the toilet and says she is feeling dizzy, so we quickly escort her back to bed to relax. She hasn’t slept in over 24 hours, so I encourage her to get a quick nap in before the next breastfeeding.
05:00: I check in on one of my patients I haven’t heard from in a few hours. She is resting in bed with baby skin-to-skin on her chest, and she excitedly tells me she was able to get baby to latch all by herself. I congratulate her and chart about the breastfeeding and a poopy diaper.
06:00: A worried grandmother comes out in the hall seeking help for her daughter’s baby who is spitting up. I hurry into the room and help baby work up the amniotic fluid. I educate the parents on how I helped baby, clean baby up, and put the baby skin-to-skin on dad’s chest.
06:30: My tummy grumbles and I remember about the cookies. I sneak into the break room hoping there are still some left. I snag the last one and hungrily snack on it as I review my charting for the night.
07:10: Feeling a bit delirious, I give report to the day shift nurses. I say goodbye to each of my patients and introduce them to their new nurse. One of my patients gives me a big hug and expresses how much I helped her survive the night. My heart swells as I walk out of the room thinking, “This is what makes it all worth it.”
07:35: I clock out, feeling excited and relieved to have survived another shift.
07:45: Finally home. I am greeted at the door by my very-happy-to-see-me cat. I quickly shower, put on my PJs, turn on relaxing music, and read my book while I snack on nuts and berries.
08:50: Snuggled in bed, I set my alarm for 17:00 and get some much-needed rest so I can wake up and do it all over again!