new grad confusion

  1. Hello all---a lovely cloudy day to you...( as it is here in detroit...blegh)

    ok then...here I go...um, well i have actually posted about this earlier, and obviously it's a bug in my arse.
    I started as a GN in a beautiful....and low risk, LDRP in April with intentions to stay on as an L&D nurse once registered. It is a really nice suburban hospital, nice staff, middle class clientele, non-teaching, roughly 2000 deliveries a year.
    I worked previously at a hospital that did twice as many per year, rotating between NICU, pp, and L&D. The L&D nurse manager wore a suit of ice, and although the charges were SO awesome, I wasn't too certain that I would even apply or get a job there if I did. The NM made me feel very unwelcome and even though they had hired two GN's for the last two years prior, she made it sound as though I had little chance of hire once graduated.

    Now, I saw that there are two MN f/t positions open in that unit, so i applied online, and spoke to my favorite charge there, and she said she would speak to the NM about it, kind of an advocate i think. ( i admire her so much!)

    I guess my major discourse is that I don't want to feel that I am unable to handle some deliveries cuz I don't have the high risk experience. I ultimately want to become a CNM, and i feel that the most experience i can acquire is of utmost importance. The charge i spoke to brought up the two main pints here: a unit like the lower risk one is good for building a foundation and moving on, yet the higher risk one is good to develop a well rounded base for future positions in any environment....grrr.

    I wish I had a magic ball telling me what to do! I mean, i can't make the NM give me the position anyway, so I guess it's out of my hands. And I definitely don't want to burn any bridges at the other hospital that I am orienting at, there are very nice and have almost completed my orientation!

    ANY input out there??? I am such a freak about this!

    Please help a new grad in distress...and Shay--please don't rip me a new one about this!
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  2. 16 Comments

  3. by   fedupnurse
    Interview at both. There's a shortage out there. Weigh the pro's and con's of each facility. If your goal is to be a CNM than the higher risk type environment would be a better learning experience. Listen to your gut. If you think you will be happier at the smaller hsopital than stay. Great learning experiences aren't worth the stress of a bad or inept manager. Your gut never lies. You'll need it as a nurse so the sooner you get used to listening to that inner voice, the better!
    Good luck. If both managers are equal, I'd go with the higher risk hospital.
    Congrats on finishing school and welcome to the wacky world of nursing!
  4. by   Y2KRN
    Hello Joy,

    I am not a new grad but, I am exactly where you are right now. I recently re-located to a new state Got a job in the ER. I had previously been working in the ER for about six months prior to us relocating for my husbands job. Well, we chose an area where the local hospital covers six counties, last year they saw 80,000 patients. That is not including walk outs.

    I love the staff I work with but, at times feel that it is soo unsafe here. I come home every morning feeling like I gave terrible care. When we have lunch for example we cover eachother which means you have 10 patients to watch in an ED. Our ratio is 5-1 and we never clear the board.

    I interviewed at a small hospital that is 45 minutes away. My nurse manager, said you are going to be wasting your skills, and things are going to get better. We are opening a new ER in less than two weeks, with new equipment the works. There has been no inservices no set plan as to how things are going to go there. That is scary.

    We had a meeting with the DON most of the staff showed up, and others were saying how unsafe they feel at times here.

    I am agonizing about going to a smaller hospital, I love the ER and want to become very proficient at it. The small hospital sees 20,000 a year. So, I am right where you are. Will the bigger place get better???

    So, please give us some solid allnurses advice, please.

    Good-luck in you decision!!

    Y2KRN
  5. by   joyrochelle
    thanks! I thing with the NM at the high risk, is that she never comes out of her office, and I know she must do SOMETHING, but the charges run the unit from what i can tell. I dunno. My gut tells me that I would look like a meanie if I left the Low risk unit, even though i would choose my words carefully upon resignation. They have done nothing to dissuade me, it's just the level of patients.
    It would be great if I could work contingent at the low risk and FT at the higher.....* dreaming*
  6. by   Y2KRN
    Hey Joy,

    I think that it is a good plan to work prn at the smaller low risk hospital. It would give you a break from the craziness at the busier place. As you said choose your words, and be honest. I went straight to one of my three managers and said I am looking elsewhere this is why, I feel it is unsafe out there. I am still waiting to hear from the smaller hospital so I will keep my fingers crossed.!! I will try and work prn at the bigger hospital.

    Have a great day. Let me know how things turn out!!

    Y2KRN
  7. by   joyrochelle
    absolutely I will---thanks again...we shall see, right? *smile*
  8. by   fergus51
    If you've only been in low risk since April, I would stay a little longer. I know I didn't feel ready for high risk after 2 months of working low risk!!! It took me about a year to feel confident enough to take the high risk patients independantly (which it sounds like you would be doing). I would NEVER work high risk L&D as a newbie UNLESS there is a very good support system in place (like would you get a longer orientation, a mentor, etc.?).

    As a CNM you will be present at mostly uncomplicated births, and I think you should get to know those really well before trying for high risk. I know it would be a good experience for those times that uncomplicated births become complicated, but that is not the norm in my experience. You have time to do both, you don't need to rush, high risk isn't going to dissapear if you wait a while. You may have the personality that is perfect for high risk, but I would still wait until you're completely comfortable with low risk before switching.
  9. by   shay
    Originally posted by joyrochelle
    ...and Shay--please don't rip me a new one about this!
    DOOD!!! Uh, if I've ever 'ripped you a new one,' it was totally unintentional....jeepers, I didn't think I'd ever been ugly to you....if I have, I 'pologize now!!! :imbar

    Okay. Here's my take. I did HROB (high risk OB) as a new grad, BUT, that was after 9 mos. of mother/baby and some NICU thrown in there first. It was a good experience. I learned A LOT about fetal monitoring and preterm labor and how to run pit....but that was basically it in a nutshell. The HROB unit I was on was HUGE and averaged 3,000 deliveries a year. It was always busy, and I could almost guarantee at least one stat c-section a shift. I'm not kidding. By the time I left 2 years later, I could do a crash c-section with my eyes closed, cath anything, run pit like a pro, and was veeeeeeeeeery good at reading fetal monitor strips. However, I had no idea how to actually take care of a laboring patient.

    I know, I know...it sounds retarded, but it's true. First of all, the usual was to have 2-3 laboring patients at a time, second, the epidural rate was close to 100% as was the pitocin rate. I rarely saw what raw, unmedicated, 'natural' labor looked like. The only time I ever saw that was when a woman came in crowning. For the most part, my patients were hooked up to the monitor, had IV's, had pit, and had DENSE epidurals. They were on autopilot.

    When I transferred to a LROB (low risk OB) unit, man, culture shock. My first patient *gasp!* had no IV, no pain meds, and wasn't on the monitor. I got a crash course in how to physically care for a woman in labor. I LOVED it. It was fantastic. I have stayed in LROB ever since.

    All that long-winded stuff being said, I feel like this: I wouldn't trade my HROB experience for the world. I learned A LOT. It was like working a trauma/ICU unit for pregnant women. The experience I gained there has proven invaluable. I also wouldn't trade my LROB experience for the world. I feel like I really make a difference in my patients' birth experiences.

    Since you want to be a CNM, Fergus is right. You need the fundamentals of LROB, as that's what you'll be doing primarily. However, it would be valuable, if not essential for you to have HROB experience too. So here's what I'd do if I were you. I'd stay at the LROB place for at least a year, no matter how bad I wanted that HROB job. You don't want to burn those bridges. After a year, go prn at the LROB place, and take a full or part time position at the HROB place. That's actually what I did before I went full time in LROB. I went prn at both the HROB and LROB hospitals and split my time between both. It was an excellent decision and worked well for me. I got my crash c-section adrenaline rush one day, and my soothing calm natural labor stuff the next.

    Okay, I'll shut up now. Hope this has been helpful, and not 'rip-you-a-new-one' ish!!! :kiss
  10. by   joyrochelle
    oh shay, please don't be offended sweets! I don't think you have ripped me one ( ok, that phrase is used up now! ) i just didn't want you to think me as a speedy new grad with no intentions of actually being a good people nurse...( see manual for experienced nurse/ new nurse interrelations). ANyway, the LROB is NOT very non-interventionist at ALL. They are all monitored, primarily Pit'ed, and epidural'd up the wazoo. These are well cared for women with places to go and people to see, ya know?

    I think that what you say has great logic...I just don't want to have an "old nurses job" right off the bat, ( that's what one of my fellow grads said when I first got hired...she's in Peds.) and i haven't much insight in order to weed that bulls*it comment out...

    I want to be the best i can be! And even though as a CNM i will have very low risk deliveries, i do not want to be a CNM that MD's and Nurses will not be able to consult about other HROB cases.

    Oh, just so much to learn...i know. SO much.
  11. by   joyrochelle
    oh, by the way, i have worked in NICU and mother baby for about a year when in school....and the HROB has some great preceptors and orientation...
  12. by   shay
    Originally posted by joyrochelle
    oh shay, please don't be offended sweets! I don't think you have ripped me one ( ok, that phrase is used up now! ) i just didn't want you to think me as a speedy new grad with no intentions of actually being a good people nurse
    Whew! I was worried that I'd inadvertently 'eaten you alive' in some post!!!

    Nah, I don't think you're a 'speedy new grad w/no intentions' of being a good people nurse. I understand the attraction of HROB. It's a rush. And you learn A LOT. I'd never fault anyone for wanting HROB.
  13. by   Christian Nurse
    I am also a new grad. I just graduated from EMU this past April. However, mu confusion is a little bit different from yours. I love OB. And I plan on attending U of M this Fall to start my master's courses to become a nurse midwife. I am also starting my training to become a certified lactation consultant. The problem is everyone keeps discouraging me from going directly to L&D or a mother/baby unit right out of school. If that's what I plan on doing for the rest of my life, why not? I have been to several hospitals in my area and even though they may be in need of nurses, the L&D and mother/baby units turn my down flat. I don't want to be stuck on a med/surg floor until an opening comes along, which is hardly ever. What should I do?
  14. by   fergus51
    I had the same problem Christian nurse. I worked med-surg for a few months until L&D came up. Are you able to relocate? If not, you can either take med-surd for a brief period (or NICU, or peds, or something) and wait, or you can continually harass nurse managers with your desire to work OB. We recently hired a new grad here in L&D (which is basically UNHEARD OF here in Canada) because she had done all her consolidated practicums on L&D, and had taken various extra courses related to OB while in school (like fetal heart monitoring, lactation, etc.). Her persistence paid off.

    joy, if you're going to get a really good orientation time, it may be a good learning experience. That said, you'll still need to do low risk before becoming a midwife anyways. Seems like 6 of one or a half dozen of the other (either lrob, then hrob or hrob then lrob).... No one can tell you what's best for you.

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