A day in the life of a Labor and Delivery nurse manager

Apr 20, 2017, 12:50 PM by KirstiAnn Clifford
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For more than two decades, Tandra Medellin has been part of patients’ most exhausting and most exhilarating moments—when they welcome their baby (or babies) into the world.

“Every single birth is exciting and gratifying,” says Medellin, nurse manager of the Labor, Delivery, Recovery and Post-Partum unit at UTMB’s League City Campus Hospital. “Our team gets to witness miracles every day, and that’s something we don’t take for granted.”

As LDRP nurse manager, Medellin oversees a staff of 34, including nurses, surgical techs, unit clerks and a patient care tech. The state-of-the-art unit opened in June 2016, and now averages about 2.2 births a day, or more than 60 births a month. However, those numbers spiked to about 120 a month in January and February, when deliveries had to be diverted to League City after the John Sealy Hospital fire.

I meet up with Medellin on a Wednesday morning in March, when the number of daily deliveries have returned to previous levels. Even so, there is no shortage of action.

“We already had a baby delivered at 6:52 this morning and currently have several patients in various stages of labor,” says Medellin as she greets a few nurses at the nurses station. “We also have a scheduled C-section at 11:30, so that patient should be here anytime.”

Medellin looks over the patient list for the day and her face lights up—she recognizes the name of one of the patients who arrived earlier that morning.

“We have to go say ‘hi!’” she says excitedly. “The patient is the wife of a UTMB construction contractor who helped build this hospital. He’s been so excited about this.”

Labor and Delivery 3We head down the hall to one of the 11 spacious birthing suites, where Medellin hugs the pregnant patient and her husband, who are having their first baby after trying to conceive for 10 years. It’s a happy time—despite being up all night, the couple has never been more ready to become a family of three.

Medellin checks in with their nurse, who will care for both the mother and baby during their stay. In the LDRP unit, mothers and babies stay in the same room throughout their birthing experience, from admission to discharge. One nurse will provide “couplet care” by taking care of the family as a unit, rather than having a post-partum nurse take care of the mom and a nursery nurse take care of the baby.

“That one-on-one nursing care allows us to really build personal relationships with patients and their families,” says Medellin. “Since UTMB started the whole mother-baby movement a few years ago and shifted the way mothers and babies are cared for, we’ve seen satisfaction scores improve. The patients really like the personalized care and mention our staff by name in comments, including our housekeeper, Wanda. All our patients love her because she doesn’t just go in a room and clean, she’ll stop and spend time talking to the families.”

As we head back to her office, Medellin points out that the unit does have a nursery,Labor and Delivery 4 but it is typically reserved for newborns who are undergoing a procedure or require Level 2 care.

“Level 2 is if the baby needs any kind of IV or oxygen therapy or beyond—they truly need to be on monitors and have a nurse practitioner watching,” she says. “But typically, we try to keep the baby in the room with the mom as much as possible. If a baby has jaundice, we can put the bili lights in the room with the mom, and if a baby needs to be in an isolette to help regulate their temperature, we can also do that in the room.

“Most moms want their babies with them. Yes, they may want to get some sleep, but moms don’t sleep for at least 18 years anyway, right?” she says with a laugh.

As nurse manager, Medellin’s role includes a lot of behind-the-scenes responsibilities, such as running reports to make sure all patient services were correctly documented and charged, ordering supplies, and making sure all shifts are appropriately staffed. An employee calls in sick as she checks the staff schedule for the week. Within a few minutes, she’s made a few quick phone calls and has found another team member to cover the shift.

“This is a 24/7 operation, so staffing is huge,” Medellin says. “I always need to make sure we have enough nurses along with other staff at all times, and also need to be prepared to flex up or down according to census and acuity fluctuations. If the staff is happy, like their jobs and enjoy their patients, they will show up here and do a great job. My staff does just that—I’m lucky.”

Labor and Delivery 4While she doesn’t provide as much direct patient care as the rest of her team, Medellin is always ready to step in when needed. She doesn’t see herself as a manager—but more of a leader.

“It’s not like I’m a boss—I’m much more part of the team,” she says. “I try to support my staff so they can provide Best Care every time. I’ll help answer phones, fill in for a nurse’s shift or jump in to help transport a patient to the OR. Providing my team with all the tools they need is so important, since they are the main providers of direct patient care.”

Medellin’s background includes experience in all areas of maternal and infant health. She began her 21-year career at UTMB as a hospital technical assistant with post-partum moms and, over the years, worked her way up while attaining a nursing degree and women’s health care nurse practitioner certification. Her two children, ages 9 and 13, were even born in the same unit she worked in at John Sealy Hospital.

“I stayed in the old unit, where the rooms were very small and had the airplane jet toilets that pulled out from under the sink,” she recalls. “Things were so different back then. Here, we have spacious rooms with large restrooms, vanity mirrors, and comfortable space for a guest to stay overnight. It’s been fun to see how everything has evolved.”

As we discuss other innovations that have changed the way patients receive care, a nurse pops her head into Medellin’s office to let her know that a laboring patient is “crashing.” Medellin immediately jumps into action.

“‘Crashing’ means the patient is having some sort of medical emergency requiring an immediate C-section to deliver the baby. In this case, the baby’s heart rate has gone down, and if it stays that way for more than a few minutes, we may need to rush the patient to the OR,” she says as she reviews the mother’s and baby’s heart rates on a large monitor at the nurses station. “It looks like the patient had been hanging out at 9cm dilated for a while but is now at 10cm, and every time she starts pushing, the baby’s heart rate goes down.”

Labor and Delivery 5Medellin starts preparing a C-section operating room in the middle of the unit in case the obstetrician on call decides to go that route. However, Dr. Crystal Alvarez comes out of the patient’s room to tell Medellin that both the mom’s and baby’s heart rates have gone back to baseline range. No C-section is needed—at least not right now.

With one obstetrician on call at a time, Medellin works closely with the doctor to make sure the laboring patient and her baby will be stable long enough for Alvarez to complete the scheduled patient’s C-section first.

“Things can change in an instant,” says Medellin. “We might think we have a plan for the day, but if something emergent happens, we may have to be in the operating room and doing a C-section within a few minutes. Whether births are short and easy or long and complicated, it’s the same ending. Families are so excited when a healthy baby is put into their arms. It’s such a huge moment they remember forever.”

Medellin points out that while Labor and Delivery is typically the happiest place in the hospital, it can also be one of the most stressful places when complications arise. She explains that if a baby is born before 32 weeks or needs additional support, mother and baby will be transferred to the nursery on the Galveston Campus, where faculty and staff are prepared to care for the highest acuity newborns. While it doesn’t happen often, Medellin and her nursing staff are grateful to be able to seek help from their Galveston colleagues when needed.

Labor and Delivery 6I say goodbye to Medellin as she starts working on her “less glamorous” tasks for the day, including writing a curriculum for a new four-week birthing education class that UTMB will start offering this summer.

She’s excited to provide more services for the growing community, and hopes more families will choose UTMB when it’s time to welcome their little miracles into the world.

“Every time I see a healthy mom and baby leave the hospital, I’m so proud of my experienced team—they are talented, passionate and motivated, and I’ll do everything I can to support them.”

For more information about UTMB’s Labor and Delivery services, visit utmbhealth.com/baby. Registration information and class dates for new Childbirth Education classes at League City Campus will be posted on this site soon.