How long should orientation be for new grads in L & D?

Specialties Ob/Gyn

Published

We get new grads all the time on our busy level 3 unit, and it seems

that they get 12 shifts and then are expected to work by themselves.

And in that time they should know how to deal with a normal delivery,

scrub, circulate and pretty much what ever else may come their way.

To me it feels like we are setting them up for failure. Labour &

delivery is a speciality and a lot of it is not taught in school. I

have talked with a lot of the new staff to find out how they feel, and

they say completely unprepared to deal with anything outside of a

straight forward delivery, but are scared to speak up.

Are you finding this in other hospitals as well?

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Agree with you that L&D orientation should be more than a 12 hour shift. That sounds totally unreasonable and extremely dangerous. I can remember after spending 4 weeks in orientation that I STILL couldn't adequately determine cervical dilatation. Can't imagine handling a complicated labor/delivery with only a 12 hour shift.

Have you discussed this with your nurse manager/administration?

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Specializes in OB, lactation.

I am a new grad hired into L&D. I just finished 12 weeks of orientation. If an orientee is not deemed ready after that time, they get longer (another woman on my unit is getting more time & she wasn't even a new grad... ). We alternate 3 12's one week and 4 12's the next so that's a total of about 42 shifts if you want to look at it that way, plus NRP and fetal monitoring classes. They are also careful to keep a balance of experienced people and new people.

I still don't feel ready (it could be forever before I felt completely ready for any conceivable situation) but I also feel that my coworkers are not going to leave me stranded & if I did I probably wouldn't do this. There are certain "holes" from orientation, things that didn't come up (like I didn't really work with a certain doc who likes things a certain unique way, also I have not worked with IUPC's for example). I already told my preceptor that I would be calling her back up in these situations!

When I asked around about it, I think 12 weeks was the minimum that I heard from anyone, with the range being 12 weeks to a full year. Personally, I wouldn't have considered any L&D position without at least 12 weeks of precepted orientation.

I agree with you that your situation seems like a red flag, FWIW. Do you have a high turnover rate? Is the time in your orientee program very structured? I feel like that is a weakness of ours - not very structured at all.

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12 shifts is 144 hours of time with a preceptor, and yes we do have a huge turnover rate. I think part of the problem is a lot of the more experienced nurses are leaving so there is not a lot of people to preceptor our new grads.

3 of the new grads that I oriented just before going on Mat leave, are now orientating new staff. It is sometimes scary when I get report from a nurse saying the patient is fully dilated and they have begun pushing and I check her and she's only 7 cm dilated.

Still, after almost 5 years of L&D, if I am unsure while doing a lady partsl exam, I will ask another staff member or doctor to check, just to make sure. But I find a lot of the new staff feel intimidated to ask for help.

I was once there, I know how it feels to be overwhelmed with everything there is to know, but then I had over 4 months training with a midwife. I can't imagine, be orientated by someone who just went through orientation themselves!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I think for new graduates, orientation to L/D should never be less than about 6 months.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I agree with Smiling Blu Eyes. I was unique in our department, in that they hired me at the end of my first year in nursing school as an extern. So I got a full year of orientation as a student, and then another 3 months as a graduate/RN. The good news is that I started as an independent RN *very* well trained for a new grad (which is a testimony to the RN I precepted with for a year, she was AWESOME). Other new grads who start in the department after graduation usually get 5-6 months with a preceptor, more if they need it. Our department also doesn't have any problems with pulling a new nurse BACK into training if she or others deem her not ready yet after a trial on her own.

Edited to add: I think one thing that has helped me is that I'm NOT afraid to ask for help if I need it. I'm comfortable with asking someone else to follow me on a vag exam if I'm not sure what I'm feeling. If a baby starts crumping, I have no problems asking others to come in and help me out, get me more IV fluids, do whatever needs to be done that one person can't do simultaneously.

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