Advise please? (Long)

  1. Hello all,

    I have recently been offered a position in a high-risk L&D unit. 11 LDRs and three OR suites, all on the unit. There were over 6000 deliveries in 2000. For as long as I can remember, all I've ever wanted to do was to work in L&D. Understandably, I was thrilled to get this job, finally. But here's the story:

    I graduated with full scholarships, top of my class, and passed the boards in '95. My last year and a half in school (BSN) I worked as a nurse tech in MICU. As soon as I passed the boards, I wanted to head straight to L&D. However, no one would take me without experience. At the very same hospital where I was working, I interviewed for L&D. Basically, I was told they needed someone with experience who could speak Chinese. End of discussion

    Anyhow, I was offered a job on the step-down unit where patients are sent after MICU/CCU/SICU. The unit also had telemetry, family practice and 6 beds for vent patients. I took it because I thought it would give me a solid foundation for a later position in L&D

    I was excited about the job, rearing to go, ready to learn. To sum it all up: I was consistently given the worse district. Most times, I was given Family practice (8 -12 patients) with one or two patients on vents with pegs for meds, triple-lumens, others on telemetry, wound-care, bed rest only. It was a relief if I had a patient who was A&O x 3 and who could take po meds. I remember distinctly, one of the other nurses passing through my district and saying. "This is a heavy district!"

    I was OVERWHELMED with no help in sight. Generally, the other nurses were not helpful. They were too busy themselves. Others were simply down right mean.

    Every day, I prayed for God to help me and for me not to hurt anyone. Most days I cried on the way to and from work. I can honestly say, I wanted to die some days rather than show up there. After barely six months, for my own sanity, I had to quit.

    I was so traumatized, any thought of working in a hospital was enough to start my heart racing, make my mouth go dry and to make my hands shake. I ended up getting a job in Home Care. Specifically Home Attendant Provider agencies. The work was calm, gratifying and I was good at it. But I didn't feel fulfilled. It's not what I went to school for. It was mostly theory, teaching, social work and just being a good listerner, geriatric patients, no hands-on care. On weekends, I'd do fee-for-service wound care or insulin administration.

    I considered giving up on nursing because I wanted a career, a passion, not just a job. It had become merely a job to me. But I couldn't give up without trying what I had originally gone to nursing school for.

    So now, I have this wonderful opportunity in an excellent unit. I'm older and, I think, wiser. More able to deal with my anxiety and to speak up for myself. I'm motivated. Reading up on Maternal/Neonatal, Fetal Monitoring and preparing for my NRP. However, I've been out of the hospital nurse loop for so long, I need some encouragement, advice, anything that you can give me. Is it possible or reasonable to expect that I can go into a specialty unit after being away from the beside for so long?

    The staff at this hospital are taking a chance on me and I know it. I've got so much to remember and to learn. I don't want to let them down. More importantly, I don't want to let myself down. I want to succeed. I don't want to waste anyone's time. Do you have any words for me?

    I would please like advice on where I should concentrate my studies, more effective communication (so that I can get along with the other nurses, physicians, and ancillary staff), good malpractice insurance for L&D, kind words, constructive criticism, all are welcome.

    Thank you in advance for slogging through all of this.

    Regards,

    Cynna
    •  
  2. 7 Comments

  3. by   shay
    Jeepers....okay.....well...here goes, I'm gonna take a crack at this...

    For starters, keep your nose out of the books, believe me, you'll learn plenty with on-the-job training. You probably already know how to 'communicate effectively,' so skip that. Malpractice insurance....I have always been advised by lawyers and fellow nurses to never carry personal malpractice ins. if you work at a hospital. That singles you out to be sued individually. 2 nurses I know carry it, and both of them are currently being sued individually right now for a case that the MD and the hospital have already settled out of court for. Others may have good arguments why you should carry it. That's a personal decision.

    Okay. That being said, let's talk turkey. That's a looooooooooooot of deliveries a year going on at that place. Break it down: 6000 a year-- that's approximately 500 deliveries a month, which is approximately 16-17 a day. On my worst
    day at work EVER at the WORST hospital, we had maybe 15 deliveries, and that in and of itself was unusual. My advice? Work on your assertiveness training, and work on stress-management. You'll need both. You are going into a very fast-paced, high-stress environment, more stressful than your first job, and you're going to need the skills necessary to survive that kind of environment. Remember to ask for help when you need it, and find one nurse on the unit who makes you feel safe and comfortable and make her your unofficial 'mentor.' Go to her when you need to vent, when you feel you can't talk to anyone else, when you need advice and you can't ask/don't want to ask your preceptor.

    Finally, get a new pair of super supportive shoes as a congrats-to-me gift for yourself, and get a nice pair of support hose. Take a deep breath, look yourself in the mirror, smile, and tell yourself you're gonna do great. Have a fabulous dinner, get a good night's rest, and jump in with both feet. In the immortal words from the movie 'The Water Boy,'

    YOU CAN DO IT!!!
  4. by   ERNurse752
    This is a little different ballgame here...you didn't really have any great desire to do what you did in your previous job. OB has always been a passion for you...it's hard to stay with a job that's tough if it's not even where you want to be.

    My main question would be, how long of an orientation are they going to give you? Because you're going to be bypassing all the "normal" delivery stuff, and jumping right into high risk.
    I'm not an OB nurse, so I can't say too much with authority...just my $.02
    Good luck and enjoy!
  5. by   Angel Baby
    Ditto for Shay and Tricia.

    I hope you will have a preceptor to guide you through the first 3-4 months--this field is as specialized as ER or Critical Care except Mom's are wierd. They don't do things like any other adult patients, their physiology is different, they compensate--compensate--compensate then crash; heck, even lab values are different. Now, on to the baby--you can get a good idea as to whether he/she is happy (or not) but you have to go through Mom to treat and resuscitate--until delivery.

    To do all of these things truly requires a consistent preceptor/mentor and direct supervision (for a while, at least).

    Good luck and welcome to the sisterhood!!!!!
  6. by   Cynna
    Thanks for all of the replies, everyone.

    I'm very happy that I found this forum where I can seek advice from those of you who are "in the know". I've considered everything that you've told me and am relieved that out of the responses so far, no one has said flat out "forget it." It wouldn't have stopped me. I'm stubborn that way But your thoughts that it is not impossible give me encouragement.

    According to the nurse manager, I will have two weeks of classroom study followed by 3 months with a preceptor. She also mentioned that orientation goes according to the skills that I develop and the experiences that I receive while with my preceptor. I might catch on quickly, I might need more time and assistance. They seem flexible. I would not have accepted the job otherwise. I'm concerned about accepting another job where I will feel like I've been left alone to sink or swim.

    The only kink is that I will work with my preceptor on days. Once that's over, I will move onto my regular night shift where everyone will be a stranger to me. Hopefully, I will meet someone nice who doesn't mind lots of questions and being asked to check behind me when I feel that I need it.

    I also approached one of the nurses at my GYN's office that's still actively involved in L&D. She's been an L&D nurse for 25yrs. When I told her what I was up to, she automatically gave me (a complete stranger) her home phone number and told me to call her anytime. She doesn't work at the same hospital, however, I'll be grateful for any support and wisdom that she can pass on to me.

    Thanks again for taking the time to reply. I do feel like I am about to become a part of a proud and wonderful sisterhood When I read the other forums and see how dissatisfied some nurses are and then come here to see how OB nurses seem genuinely happy and in love with their work, no matter how hard it is, I believe I'll be okay

    And, Shay, I'll be looking for a pair of good shoes tomorrow

    -- Cynna
  7. by   finallyRN
    Cynna-
    Regarding going to nights after orientation, I did the same thing, the best advise i can give you regarding this is get to know them on nights during shift changes, find someone who you are comfortable with and try and talk to her when you can. They won't be complete strangers but it will take some adjustmensts. The other thing is that (at least where I work), night shift nurses are much more helpful, we work more like a team than single nurses. This was true for me in both medsurg and OB. Maybe night shift works better because we don't have the ancillary help days does.
    Anyway good luck with everything. Also don't forget to come back here and post with concerns.
  8. by   Jolie
    Going to night shift after completing orientation is not unusual, and is not necessarily a bad thing. But there is one very important thing you need to know before you start: What is the ratio of experienced nurses (more than 2 years) to new nurses on night shift? If more than 50% of the staff on nights is new, then you need to look elsewhere. OB is a high stress specialty where things can go bad very fast. You MUST have a sufficient number of experienced nurses on your shift to ensure patient safety at all times while you are learning. You should also have an indentified mentor on nights. Good luck to you. With the proper orientation and support, you can do it!
  9. by   joyrochelle
    Originally posted by Cynna
    Thanks for all of the replies, everyone.

    The only kink is that I will work with my preceptor on days. Once that's over, I will move onto my regular night shift where everyone will be a stranger to me. Hopefully, I will meet someone nice who doesn't mind lots of questions and being asked to check behind me when I feel that I need it.



    -- Cynna
    I am working with my OB preceptor on days as well, only at the end of this month I will go to midnights with another preceptor for 2 weeks so that I get acclimated to the new environment on nights....they may do the same for you! ( if wise! ) I know I need that....

close