[Calzonan RN]

You guys are the greatest, thanks so much for your responses, you've made me feel much better. I've been evaluating everything in my mind for the last day and I think part of my problem is I really like bonding with my patients and I try to give them the best birth experience they can get. I've had several of my patients and their families pull me aside and tell me that I did a great job and they were so thankful for the care they received. I think my preceptor is an excellent nurse, but I really don't think she tries to bond with our patients, I think she's more technically gifted, if that makes sense. She does a great job, and I'm amazed by her, but I've noticed she doesn't really converse about anything other than the treatments she's doing. Maybe that's one of the reasons I'm not 'quick' enough. Also, everything you all have mentioned. I may be expecting too much of myself after only 12 weeks of orientation as an RN. Thanks again for your responses, you've helped put things back in perspective for me.

[magz53]

We are required to chart at minimum q 5 min during second stage......usually done after the fact with the strip in hand. We are all refusing to hold legs now ( utilizing the equipment that is there for that purpose ) so that frees us to actually keep up. Remember the old adage we have heard for years.......If it is not written, it wasn't done.......that is how it will be looked at in court. If you say in court, " Well, I assessed my patients every 5 minutes, but only charted every 15" ......doubt that fly !!! Don't want to be discouraging, but after a long career in L & D, I still have evenings where I am never caught up, haven't done enough for my patient, charting is sketchy and nurse manager waiting to criticize. There are other threads that address the stress.

[10MG-IV]

Originally Posted by Calzonan RN

I'm due to come off of orientation this week and I feel like there's just so much I don't know. I'll have a really good night where I get all my charting done, the patient out of the room two hours after delivery (even after dealing with her hemorrhaging at placental delivery, doing all mom/baby vitals, giving baby a bath, all with about 15 visitors in the room), and everything just flows, and then the next night I can't seem to remember anything I'm supposed to be doing. Last night was my third night in a row, I went into my pt's room and she was complete and had been pushing for over an hour. She was laboring 'naturally' had done awesome all day long and was in complete control. She had a doula, her brother, her mother and her dad and a midwife so I was just trying to help where I could and not be one of the many voices. I also tried to keep up on my charting (we have to chart FHR Q5 min while pushing). Everything was going great until the doc decided that the baby just wasn't going to come out that way. In all of my orientation I hadn't done a laboring pt to c-section, when I was the nurse. We got the pt into the OR, everything turned out okay, the baby was OP with a brow presentation. When we got to PACU my preceptor told me "okay, you have one hour to get her to postpartum". I still had the last hour of FHR to chart (Q5min) that hadn't been charted because I was getting mom ready for her c-section, signing consents, etc. plus mom wanted to bf baby as soon as possible, which meant her PACU clean-up was delayed, dayshift hadn't printed/filed any of the admit papers or faxed any of the orders to the pharmacy, patient was in pain and her pain was not under control yet, the list goes on. Meanwhile my preceptor is watching me asking me "did you do this yet, have you done this" and everytime she did that I lost my train of thought and panicked. I felt her disapproval all night long. She had just told me two nights before that I needed to step up my pace and that they had a nurse who always had three hour recoveries and she didn't work there anymore, hint, hint. So my one hour PACU recovery turned into a 2.5 hour recovery and now I have to go see my manager today. I feel like a total failure and have spent the day crying my eyes out. I really love L&D, but I'm wondering if I'm just not fast enough for it. I feel like instead of trying to make a wonderful experience for the patient, I have to focus on watching the clock and running her to postpartum within two hours. I'm just feeling so sick about this I can't even sleep.
My preceptor is a really good nurse. She's been in OB for over 4 years and knows her stuff, dots all the i, crosses all the t's. etc. She usually works four nights a week, picks up overtime whenever she can, so she's got tons of experience and I'm just wondering if she's comparing me to other new grads coming off of orientation, or if she's thinking I should be able to do what she does, I just don't know. I've talked to the other grads that were hired on with me and they are totally scared and feel overwhelmed too, but I didn't go into specifics so I'm not sure how they're really doing. My preceptor will occasionally 'throw me a bone' and say 'good work, you got them out of there in two hours' or whatever, but it just seems like there's this air of disapproval and constant disappointment lately.
Thanks for listening.

unless you are selling tickets....Get those visitors out of there......

[IndigoCarmine]

Originally Posted by Calzonan RN

I'm due to come off of orientation this week and I feel like there's just so much I don't know...In all of my orientation I hadn't done a laboring pt to c-section, when I was the nurse... I still had the last hour of FHR to chart (Q5min) that hadn't been charted because I was getting mom ready for her c-section, signing consents, etc. plus mom wanted to bf baby as soon as possible, which meant her PACU clean-up was delayed, dayshift hadn't printed/filed any of the admit papers or faxed any of the orders to the pharmacy, patient was in pain and her pain was not under control yet, the list goes on. Meanwhile my preceptor is watching me asking me "did you do this yet, have you done this" and everytime she did that I lost my train of thought and panicked. I felt her disapproval all night long. She had just told me two nights before that I needed to step up my pace and that they had a nurse who always had three hour recoveries and she didn't work there anymore, hint, hint... I feel like a total failure and have spent the day crying my eyes out. I really love L&D, but I'm wondering if I'm just not fast enough for it. I feel like instead of trying to make a wonderful experience for the patient, I have to focus on watching the clock and running her to postpartum within two hours. I'm just feeling so sick about this I can't even sleep.

Oh, lady. Been there. Felt that. Big time.

I went straight into OB out of nursing school. Four months of postpartum (ugh) then right to L&D as soon as a position was available. It was all I'd ever wanted and when I got there I found it to be a complete and total nightmare. Why? Because it's freakin' HARD! Very high pressure, charting horrors (we charted long hand, NO computers, yeah. I've since quit) and time, time, time never seems to be on your side when the delivery is over.

First off let me reassure you: if I could do it, you could do it, as long as you want it badly enough. Secondly, your preceptor may have all the experience in the universe, but if she's "hint hint'-ing you about pther people's performance when you'd never had a laboring pt go to a c/s before, then she's a jerk. You don't have to confront her about it, but you do have to keep it in the back of your mind that her agenda may have less to do with helping you learn and more to do about her being on a power trip. Straight out of orientation you're entitled to finding your sea legs.

Not fast enough for L&D? Perhaps, but how can you know so soon after starting? You'll know the answer to that question in a spell, and you'll have to be honest with yourself about it.

Lastly, a bit about Q5 charting. Both my last job (the one with the longhand charting) and my new travel position (QS) both required Q5 charting during the second stage even though according to the NCC Q15 is fine for "pregnancy without complication". I was getting wrist cramps writing out the FHR and ctx patterns for years before going to a class on OB charting where I was told that it was perfectly acceptable to write (in the even that nothing had changed in the last five minutes)

"FHR/CTX Assessment unchanged".

Now that I'm using the QS from the pt's bedside -- thank heavens--and not having to drop a woman's leg while whipping out a pen and clearing off a flat surface to write a note by hand, I find that hitting the "mark" button on the EFM and typing "Assessment unchanged" under the "FHR Comments" tab in QS to work well. Then q15 I type something more substantial if I have to. I don't get nearly as behind on charting as I used to.

The thing of it is, you have to read the exact wording of the charting policy on your unit. If it says that you have to "assess" q5 that's worlds different from having to "chart" q5.

The gals at my new place are appalled that I don't fully type out a complete FHR/CTX analysis q5 while pushing. Of course I *do* if it's warranted, but I certainly don't waste my time if all is well and good.


Sorry for the rambling about charting. Believe me I could go on.

Good luck to you and don't get too worked up about whether you're cut out for OB just yet. Give yourself a fighting chance.

[zahryia]

Yikes! Lately I've been feeling that 'not so good' feeling about my upcoming new job in a high risk L and D unit.

And I think this is exactly why. I'm going to stick it out for a year, and will probably leave to work in a more 'calmer' setting.

I'm actually training in the gym so I can maintain my stamina for the job. I know that sounds corny, but when you've gained 40 lbs over the past two years, it really slows you down.

This thread was really helpful. I'll try not to be so hard on myself. My ultimate objective is to be a midwife, so I might have to do peds while I'm in grad school, because this 'rush, rush' type of setting is not what I want to be engrained with as I start my midwifery career in a few years.

[NurseNora]

Yes, read your departmental policy about that q5min thing. If you're doing intermitent ascultation, you do have to chart it q5min because there's no other record. AWHONN standards say FHT must be evaluated Q5min. If you are doing continuous electronic monitoring, you have a record. If you are hand charting, you can say that you have been in continuous attendance with the patient with ongoing fetal assesment and just make a note q15min. Unless your unit's policies specificially state otherwise. If so, see about getting them changed.

It's always hard to strike a balance between the hands-on, supportative care and the paperwork. Since the US is a very law suit country, the paper work is very important. You'll get it. It takes longer than 12 weeks to get it all together. Tincture of time and practice is necessary.

You do have to be able to express your needs. "This is the first time I've taken one of my patients to C/S, any advice?" is an acceptable question. It's also OK in most places to ask for help. In my unit, if someone's patient goes for C/S, someone brings the pre op meds and consents, someone tries to get the chart together, while you put in the foley, shave, and do preop teaching. But if no one knows you need help, you may not be offered any. If your preceptor was there with you, you could have asked her to fax the orders and do some of the other routine, but time consuming things so you could do your patient care and charting. When I'm orienting someone who's near the end of her orientation, I don't offer help unless she asks for it, no matter how far behind she gets. Sometimes I have to remind her that it's OK to ask for help. I believe that it's as important to recognize when you're getting in over your head as it is to keep your head above water in the first place. Everyone gets behind and needs help sometimes. You just have to recognize it.

Something I've noticed when people get behind is that they keep falling further behind while trying to catch up. Sometimes it's best to just restart from where you are and stay up to date and catch up later with Late Notes. Perhaps if you were just doing your Recovery work and charting, you could have finished in 1 hr and gotten her to the PP floor, then finished your labor charting more quickly since you would have turned the patient care over to another nurse. Or perhaps your preceptor wouldn't have gone for that, but it's worth discussing.

Communication between you and your preceptor is vital. You have to be able to tell her what you find helpful and what you find distracts and confuses you. She has to be able to tell you what you're doing right and what you're doing wrong. It's a shame that she is so stingy with the positive comments. In that situation, it sometimes helps to ask from time to time what you are doing that is right and what you're doing that needs improvement and what you can do to improve it.

[cherokeesummer]

Not trying to be stupid or anything but why the big huge rush? I'm a PP nurse and I know we are often pressured to have a room ready asap b/c l and d has to bring the patient over and we are stressing b/c we don't have a clean room yet or we have a room but not enough nurses, etc. So that makes me wonder what kinds of pressures are being put on the L and D nurses too? How are the L and D nurses able to help their patient if someone is over their shoulder saying you gotta get the patient out now.

I understand things move fast but like above posters said, what if mom hemmoraghes or something else bad happens. I hope the pressure eases a bit. You are a human first and we all make mistakes and we all have a learning curve. I've been a pp nurse for almost 6 months now and it is hard some days, we just have to hope for the bestoutcome for our patients and deal with the charting later.

HUGS!

[Calzonan RN]

I just talked to my manager today and she told me that by the end of 12 weeks of orientation (remember this is a very busy hospital, 500+ births a month, sometimes 25 in a 24 hour period) I should be able to handle two very busy patients, keep up on my charting etc, all the while with that clock ticking in my head to get them out of there 2 hours after a vag delivery, and 1 hour after a c-section. We have QS charting, which means that if you fall behind they can always look and see the real time you charted, so catching up on flow sheets is not an option. The only option I can really see when pushing with a prime is to basically stand at the computer and chart flow sheets instead of being there for her to encourage her between contractions. I really didn't realize this was such a baby factory when I started, although patient safety is high priority, I think their idea of a good birth experience is different from mine. My manager also said that they don't let people off of orientation until they know that if it hits the fan, you'll be able to run the show. I'm just wondering if it's me, or their idea of how much a new grad can actually handle. I know they lose a lot of their new grad orientees, and I'm starting to see why. I really wish they could've given me more of a chance, and I really wish my preceptor could've been a little more honest with me about how things were going until waiting until the end of my orientation. I now have two weeks to 'prove myself' and then I'll be reevaluated. I'm doing great in all my skills, IV starts, FHR ctx pattern assessments, etc, and have great a bedside manner, but I'm not sure I can pull off what they want me to in order to stay.

[NurseNora]

Originally Posted by cherokeesummer

Not trying to be stupid or anything but why the big huge rush? I'm a PP nurse and I know we are often pressured to have a room ready asap b/c l and d has to bring the patient over and we are stressing b/c we don't have a clean room yet or we have a room but not enough nurses, etc. So that makes me wonder what kinds of pressures are being put on the L and D nurses too?
HUGS!

Part of the pressure is that L&D doesn't have the luxury of saying We don't have any clean beds". The patients come in and we have to take them. I've had patients laboring on stretchers in the hall. I've done admission histories with the patient sitting at the nurse's desk with me. I've had the house supervisor bring me more stretchers from PACU. When I worked at the big city teaching hospital, I once had two patients laboring in recliners in the residents lounge (the residents were not amused).

Last night I was one of 3 labor nurses caring for 5 labor patients when a multip came in and delivered in 25 min. Within half an hour of her delivery, one of the other patients (a primip) was complete and pushing, a multip was 9, and another multip was 7. I handed that delivered patient over to our PP nurse right away because we had those three others who needed labor nurses RIGHT NOW.

I hate to admit it, but it is true that sometimes L&D makes a big fuss about getting a patient out immediatly just because she's finished her recovery and we want to get rid of her. It happens more often in some places than in others and some nurses are more likely than others to do it. I'd like to think that the majority of the time when L&D is fussing to hurry up and take this patient, it's because we really need her bed or her nurse for another patient.

[NurseNora]

Originally Posted by Calzonan RN

, I now have two weeks to 'prove myself' and then I'll be reevaluated. I'm doing great in all my skills, IV starts, FHR ctx pattern assessments, etc, and have great a bedside manner, but I'm not sure I can pull off what they want me to in order to stay.

I believe you can do it, so you'd better believe it too. It costs a lot to train a L&D nurse and if you're improving they aren't just going to toss you out even if you haven't quite reached their exalted standards.

Make your preceptor communicate with you. Keep asking what she would have done differently than you did. Assist other nurses in their deliveries. What can you learn from watching them? Do they set their room up in a more efficient way? How do they coach their patients and keep up with the clerical stuff?

I learned to write (still not using computer charting in my L&D yet, but it's coming soon) with one hand, hold the patient's hand with the other and chant my coaching mantra automatically while writing. You'll figure it out too. I do not believe that someone with your passion for what you're doing could fail. So dust yourself off and get back in there. Your patients deserve a patient with your heart.