Rotation Introduction

Welcome to the Newborn Nursery rotation, which is not only a required rotation, but it is a vital rotation for our interns and medical students.  In this setting, interns take the stage as "floor managers" and can build their skills with patient care, examination, history gathering, medical knowledge, teaching, medical decision making, communication, and interdisciplinary teamwork. 

EXPECTATIONS AND SCHEDULE (last updated 8/2021 - there may be deviations to this schedule since then)

DAILY SCHEDULE

6:30 AM:

• Pick up the pager & get sign out from the UMC Night Float Team (3rd floor Trauma Building at sign-out area).  

6:30 AM-9:00 AM:

• Examine your patients and write notes on all new and established patients.

• Prioritize sick infants, potential discharges, and any infants approaching 24 hours of age who have not yet been seen by an attending.

• Make note of which families may need an interpreter.

• Prepare for rounds by reading as necessary.

• Begin anticipatory guidance and appointment scheduling with families, as needed.

• When there is an additional resident (e.g. from family medicine), divide the list. Family Medicine residents are responsible for attending deliveries, pediatric didactic sessions, etc. along with the pediatric residents. 

• Your team may also include medical students, who typically will rotate for 3 days at a time. 

  • Please try to make their experience as valuable as you can.  

  • Medical students are expected to have the same schedule as the pediatric residents, unless authorized by the attending.  

  • They should present and write notes on 1-2 patients per day. 

  • Their notes are for educational purposes only, and you are still responsible for their patients.

• Update the hand-off list as much as possible. 

9:00 AM-12:00 PM:

• Round with your attending. Again, prioritize sick infants, potential discharges, and any infants approaching 24 hours of age who have not yet been seen by an attending.

• Remember to inform your attending of your clinic day, didactics, required conferences, NICU teaching opportunities, etc. so that you can ensure that the nursery pager is covered.

• After rounds, you may run the list with the charge nurse, while your attending supervises.

12:00-5:30 PM:

• Eat lunch. Be sure to inform the charge nurse if you are leaving the floor, and be sure to return in a timely fashion.

• Complete the plan of care: complete discharge planning/orders, follow up on labs/imaging, reassess patients, counsel families, etc.

  • for any patients coming to our clinic, confirm the family's contact information and then message the clinic in Epic

  • if the mother/father is COVID+ make sure to include this in your message

• New admissions should be seen until 5:00 PM. This includes placing orders and writing notes on these new admissions.  (TIP: significant event note is acceptible as long as an full H&P is written the next day)

• Update the hand-off list in anticipation of sign out.

• Attend deliveries. Remember to log them!

5:30 PM-6:30 AM:

• Hand off the nursery pager to the night float senior resident prior to leaving for the day. You should also provide them an updated hand-off tool, and a brief sign out (pending bilirubin's, potential issues, etc.).

• The nurses should call only for urgent questions/issues, and verbal orders should be allowed overnight.

• If at any time there is a significant change in clinical status (e.g. NICU transfer required), or if the senior resident has any significant concern or needs assistance with nursery patients, then the senior resident should contact the on-call attending. 

• The night float intern may not carry the nursery pager.

NOTABLE TIMES & TIMING

• The  Baby's First Exam by a Physician should be done before 24 HOL, and at after at least around 2 hours to allow bonding and Kangaroo Mother Care

• Nurse Signouts are at 7am and 7pm, so any orders timed around 7 may have a delay to it

• Social Work usually rounds between 7-12 (make sure to have any Social Work consults in before then - any maternal drug use history, 15 year old moms, foster care, incarcerated moms, etc, please dont delay this consult because this may delay discharge if we are awaiting a social clearance OR if there is prior CPS cases)

• Lactation Counseling is 2-3 times per week - (you can always make a consultation to this service even when not available, this will help with the needs assessment and hopefully another one can be hired to help!)

• Cardiology Echocardiograms are typically done after 12

• Ultrasound is often a busy service and will unlikely be done the same day any are ordered

• Serum Bilirubin takes about 2-3 hours for the lab to process, thus if you think a patient will likely need a NICU transfer, order it around 1400 (to promote a good transition of care)

• Discharges should be done before 8pm as it is a hospital policy and safety issue

• Medically Cleared Moms can stay with their baby for up to 48 hours if it was a vaginal delivery, and up 72 hours for a cesarean section delivery (starting at the time of the  delivery)

A FEW FINAL NOTES:

• Don't be afraid to ask for help if you need it! We are here for your learning and patient safety.

• Please do not leave early during this rotation unless it is pre-arranged with the attending (you are required to have a minimum of 200 hours in order for your rotation to count with ACGME)

• Direct supervision is immediately available if needed at all times.

• Communication is very important. Remember to update your nurses, and “run the list” with the charge nurse after rounds. Do so again with your attending prior to sign-out.