Clinical advice please!

nurz2be · Oct 22, 2008

I as well am on my OB/Peds rotation, I am also a woman who went through labor and delivery. I would like to throw an idea out to you regarding the latter. The moms-to-be are going through something of such an enormous magnitude that, unless you have physically and emotionally been through it yourself, you cannot imagine. It is VERY personal and private to a lot of women and their spouses or significant others. The nurses are thinking of that very thing and they have to go ask their patients if a nursing student can basically come in and observe. I personally would not have allowed students in with me, it is my personally feeling in the matter. My husband and I had already lost 2 children so it was a tense day to say the least. Not knowing each patient's history it is hard to judge the nurses for watching out for their moms. Try to imagine if you were there in their state and people in and out the door, contractions, things happening to your body you don't fully understand, very invasive physical examinations often and without fail when you are starting to drift to sleep, monitors beeping, heart monitor thumping, and all to realize your world is about to change forever.

Now, on the student side, I went room to room getting ice chips, blankets, answering call lights, asking questions when appropriate, watching the fetal heart monitors, and all that interest lead a nurse to ask me to insert a foley! (Not so easy a task when a woman's water has broken). Anyways, try to think of it as an observation and if you get to be involved great, if not you saw some fantastic nurses doing incredibly wonderful jobs.

Enjoy the time you have, make things happen for yourself.

P.S. Individuals in our group observed 2 C-sections and 3 regular delivers our first week in clinicals.

NightOwl0624 · Oct 22, 2008

Hello...

I just finished my OB rotation, and it was very different from the other clinicals thus far. I was lucky to be in a very large and busy teaching hospital, so there was plenty of action!

For the L&D, basically we were there to support and observe only. Ice chips, watching the monitor, perhaps holding on to legs during pushing, and really getting out of the way. There was stand around time, as you can't really control the labor process too much, and don't want to bother the moms unless they want or need you there. Our instructor was kind enough to let us study in a conference room while we waited.

Post partum we were assigned 2 patients and did assessments on them. We were allowed to do most care, but I am a second-year and have been checked off on various skills. Post partum was much busier for us, as the nurses found a lot for us to do.

My advice is to be prepared, willing and able to learn, but also accept that in this rotation, you can't really control your learning experience as much as you might like. Talk to your instructor about it, she may have good advice for you.

xt1 · Oct 22, 2008

wow, can't believe your doing ob without having learned any skills yet. Newborn Nursery was fun.

Jolie, BSN · Oct 22, 2008

While I don't defend the "unwelcome" attitude of the staff on the unit, I have to wonder why your program is placing you in OB without having validated the most basic clinical skills.

Perhaps this is the basis of the staff nurses' lack of enthusiasm for having students.

NoviceRN10 · Oct 22, 2008

I can't believe you are doing an OB rotation without having any skills practiced yet. What order is your program? We do a fundamentals clinical, then med-surge I, then mental health (psych), then med-surge II, followed by OB.

queenjean · Oct 23, 2008

When there is nothing for you to do, that's the time to learn something.

Look up all the meds that your pts are on, and what is routinely given in preterm labor, active labor, birth, and postpartum. In the nursery: What meds do they routinely give? What are the dosages, sx of reaction, intended action, contraindications, etc? What are the routine procedures? Ask to see their policy, procedures, and protocol manuals, and read them when there isn't anything to do. L&D, nursery, and PP have TONS of policies, procedures and protocols, and you'll learn a lot by reading through these. Read every protocol and procedure that applies to your assigned pt first (IV therapy, epidural, fetal monitoring, etc); then if you run out of things to do, start reading the procedures and protocols on anything to do with L&D, Nursery, and postpartum.Ask to see their teaching information (the info they give to the parents--there should be a lot of this on the OB/M&B floor). If someone is setting up a room, cleaning it, prepping for anything, ask to help or to be able at least to watch.

Nurses on these floors typically have to have NRP and ACLS certifications--and their floor should have these manuals available. The NRP one would be particularly informative for you.

Sometimes it isn't as exciting, but there is still a lot you can learn, even if nothing is going on.

Singangel28 · Oct 23, 2008

I understand where you're coming from with the lack of skills and then being expected to perform.

I had a horrible day today with my clinical instructor. I had never done a real IM injection on a person, but I was expected to give flu shots today. Not only that, but we used a retracted needle which we never used in Lab for practice.

I was nervous like all of the other students, but it made it worse when my instructor (in front of fellow nursing students and people getting the flu shot) that she wanted to talk to me (alone).

In her exact words, "I don't know what's going on with you, but you better get your act together" When I tried to explain my situation she would blow me off. The instructor was referring to me not pushing the retracting needle button fast enough. I explained to her that I was really nervous and had never used that type of needle. She didn't care. I think she was embarrassed that one or two of her students wasn't perfect.

Needless to say, I started crying a little bit because I don't think she was giving me a chance, and pulling me away in front of all those people. Then, I felt like maybe nursing school was over for me. I may be sensitive, but I don't quit easily. I'll just practice until I'm a pro at IM z-track injections.

It really does seem like many of the instructors in my school (NVCC) are trying to break their students down (weed out the weak SN's). I've heard of other SN's crying and running out during skills testing.

Anyhow, wish me luck with this instructor. She said she is going to write me up or something for not pushing in the needle fast enough (I guess she's concerned about me sticking myself....yeah right.)

Best of Luck to us all! NS will only make us stronger in the end! :yeah:

SunnyAndrsn · Oct 23, 2008

Tons of learning opportunities here. Learn as much as you can about assessment of newborns:

1. How to assess fontanels

2. Normal BG's for newborns, and when and why BG's are checked

3. Heartrate, BP's, and resp. rate of newborns.

4. How to wrap them up in thos hospital blankets like a burrito!

5. Sleep/alert state during the first few days after birth, this changes.

Moms:

1. Read up on how to assess fundal height, and bogginess.

2. How often do you assess mom's uterus after delivery? Why should mom go to the bathroom within a few hours after delivery?

3. Emotional state during post partum...each day is a little different.

4. Fluid balance assessments of mom, especially if labor was long and she was on IV fluids a long time

During labor:

1. Is mom on a monitor? learn about normal variation in babies h/r, and learn how to look for decelerations.

2. Is mom taking medication for pain? Epidural? Can you observe an epidural being done?

3. Try to see a placenta after delivery.

Labs and other

1. Jaundice

2. Required state testing

3. How long does it take a newborn to nurse and/or drink a bottle. How much should they be drinking.

4. Size of baby's tummy first month after birth.

5. How do bili lights work?

6. Circumsicion...how will you answer if a parent asks you what your opinion is on this? Observe one if you can. Learn about after care.

7. Complications of L&D? Of pregnancy?

Education of new moms:

1. Hep-B vaccine questions

2. Jaundice signs and symptoms--what to look for (which way does the discoloration travel, up or down the body)

3. Circumsicion care

4. Cord care

5. Blood flow/discharge/clots...when to call after discharge, when to be concerned.

6. Nursing: Positioning, time, amounts, colostrum, nipple care.

Bring your books/notes and ask lots of questions.

One thing I've learned in nursing, the nurses are almost always very busy, so typically its not that they are upset with the arrival of students, but they may not have the time to welcome you with open arms.

I as well am on my OB/Peds rotation, I am also a woman who went through labor and delivery. I would like to throw an idea out to you regarding the latter. The moms-to-be are going through something of such an enormous magnitude that, unless you have physically and emotionally been through it yourself, you cannot imagine. It is VERY personal and private to a lot of women and their spouses or significant others. The nurses are thinking of that very thing and they have to go ask their patients if a nursing student can basically come in and observe. I personally would not have allowed students in with me, it is my personally feeling in the matter. My husband and I had already lost 2 children so it was a tense day to say the least. Not knowing each patient's history it is hard to judge the nurses for watching out for their moms. Try to imagine if you were there in their state and people in and out the door, contractions, things happening to your body you don't fully understand, very invasive physical examinations often and without fail when you are starting to drift to sleep, monitors beeping, heart monitor thumping, and all to realize your world is about to change forever.
Now, on the student side, I went room to room getting ice chips, blankets, answering call lights, asking questions when appropriate, watching the fetal heart monitors, and all that interest lead a nurse to ask me to insert a foley! (Not so easy a task when a woman's water has broken). Anyways, try to think of it as an observation and if you get to be involved great, if not you saw some fantastic nurses doing incredibly wonderful jobs.
Enjoy the time you have, make things happen for yourself.
P.S. Individuals in our group observed 2 C-sections and 3 regular delivers our first week in clinicals.

shoegalRN, RN · Oct 23, 2008

I am in my OB clinical rotation and I do not like it. I did labor last week and let me tell you, the nurses were from the "old school" and had been ONLY labor and delivery nurses for 30 plus years. Everyone worked together and they have all been L&D nurses for the same amount of time. I think the lowest senority was at 20 years, so they were not very receptive to "outsiders".

However, that didnt stop me from getting all I could get out of my clinical experience. I pay too much money per semester to just "sit around" during clinicals and not take advantage of my learning experience. After I got report from my nurse (BTW, their report was more like a venting session), I asked her can I follow her around and can she help me read the fetal monitor and explain the prenatal care report from the doctor's office, etc. She was very receptive to me taking the initative in my own learning and she was happy to teach and explain things to me.

One thing I noticed in L&D is that the nurses are very independent. In other areas of nursing, the nurse is used to calling the doctor, getting an order, and carrying it out when there is an abnormal lab value, etc. In L&D these nurses made a lot of decisions on their own, THEN they called the doctor to let them know what they were gonna do about whatever the situation was. It is alot of autonomy in L&D and these nurses were very smart.

Also, there were no more than 10 laboring patients on the floor, and the labor process can take so long, so the nurses basically watched the fetal monitoring from the nursing desk and then go in and check the patient every hour or so. It made for a long day. Most of the time, the nurses were at the nursing station, planning their X-mas party.

However, I expressed to my nurse and another nurse how I was interested in seeing a C-Section, but none were not scheduled until later on in the week. I told them since I had a child already lady partslly, I wasnt interested in seeing that, plus, I understand it's so personal to the parents. Then as luck would have it, a patient had to get an emergency C-Section due to the baby being breached and the nurse told me "come on, you're going in". It was a great experience!

Now I'm in PP and I LOVE IT! I get to do assessments on my patients, including checking fundus. I also go to sit in the nursery and do a newborn assessment and that was so different, but exciting at the same time! I really like PP, alot better than Labor and Delivery. The patients are usually very healthy and they don't have alot of meds, except maybe some pain meds. They also are very independant and mobile. My OB rotation also include GYN patients, so I got to do some flu shots, (which I've done a flu clinic before), blood sugars, your regular med surg type of nursing. My PP nurse was a new grad (1 year) and she was very helpful and I helped her alot with her other patients. It sure made the day go by a lot faster.

I think you get out of clinical experience what you put into it.

foxy_cass21 · Oct 23, 2008

i have to agree with the post that asked why your nursing program has you there with no skill check offs. That's just amazing to me. Labor and delivery was my favorite clinical rotation so far. We've been checked off on all skills so inserting foleys, starting ivs, reading the monitors, charting, teaching...all that stuff we did. There are things you can do with no skill check offs though,but do remember, these are well patients. It's not like being on a med surge floor. You do not stay in their rooms. You get in, do your assessments, and get out. Do remember the role of the nursing is that of a caring one. Some of these women are scared,maybe it's their first child,maybe they have no idea what to expect or what to do. Do your research on how to teach these patients relaxation techniques. Ask the patients if there is anything you can do for them. Ask if they have any questions. Maybe there is something they don't understand that you can better explain. Pay attention to their body language. you can figure out what you need to do by just watching them.Learn from the doctors. Ours were great about quizzing us and asking us questions...try to relate to the patient. I realize it's easier when you have children yourself,but try to put yourself in their shoes to understand what they may be going through. It will help you do the right things.

Pmkn10RN · Oct 23, 2008

Thank you everyone for the advice you gave me. It gave me ideas as to how I can make the most out of clinical, from an observation/support standpoint. I do understand that the birth process is a very person thing, and I would not get upset if a mother didn’t want students in her room (b/c I know I wouldn’t allow students to come look at my vaginia….no thanks lol). I wish I knew the answer to why we’re placed in a setting such as OB with no skill set yet. We do LTC for the first 7 weeks, then it’s OB, Peds, or Med/Surg (and I happened to get placed into OB)….in the spring semester we do whichever rotations we haven’t done yet so for me it’ll be Peds and Med/Surg. Knowing what I know now….I plan on doing Peds then Med/Surg so by the time I get to Med/Surg I’ll have a larger skill set. I don’t think we have any skill check offs during clinical…..the only things we get check offs for now are the lab simulations. I’m just interested to see how I’m going to get graded in clinical since I’ll be doing more observation then actual hands on care. My school uses this clinical evaluation tool and adds up the points at the end(based on various things that you've done). Thanks again everyone.