Don't know if I'm going to make it as an OB nurse

trace_element · May 11, 2008

As I am reading your post i am thinking to myself "Giving birth was was of the most monumental and important experiences of my life. It is scary that the nurses who take care of me in this time would be bullied and treated the way you are describing - just for taking good care of the pt."

Some nurses (and people in general) are just bullies by nature and and it sounds like that is what you are dealing with.....and some nurses just love to complain to mgmt over anything they can so maybe that is what is going on with getting called in the office (it happened to me recently).....sometimes you are better off just to ignore it but I guess it will depend on how your meeting goes.

Preceptors should understand that it takes a while to get up to par and should assist you in that, but unfortunately some are more understanding of that than others. Keep you chin up and hang in there - but do what is best for yourself in the end.

p.s. I also empathize with you about losing your train of thought when people are watching over you relentlessly......maybe in your meeting you should bring this up and just respectfully ask for another preceptor?? Say that you really don't connect with your current one.....which is understandable.

JaneyW · May 12, 2008

Chart FHR q5???? That's crazy! I have had policy tell me I need to be monitoring the FHR q5 but charting q15. I have been working OB for over 5 years and I still have trouble doing things as fast as it is expected. I also feel that if I do things that fast, I haven't taken very good care of my patient(s). It is a true moral dilemma for L&D nurses (those that care) when it comes to getting people "out" in 2 hours or 1 hour or whatever arbitrary time limit is given you. What if there are complications? What if the mother and father have questions? What if I am trying to feed her lunch after her not eating for the last 20 hours? Recovery can be very not patient centered to the detriment of the process, I believe. Sometimes I think I need to find an LDRP hospital.

Hang in there. There is no way they can expect perfection from you at this point. I am sorry you are having this experience. It will get better with time and practice. Also, remember that you are often being asked to do the impossible perfectly and give yourself some slack. Bond with your patients and try to put them first. If you get flack from management fall back on EBP (the need for that skin-to-skin bonding and the importance of that first breasting) and pt safety.

Hugs!

nursegreen · May 12, 2008

Are you meeting with just your manager or your manager and preceptor? I personally think it would be a good idea for you to talk to your preceptor about this, but do it without accusations. While having both of them there you can explain that it was your first time in that particular situation and you felt very overwhelmed. When I did my preceptorship, I would ask my preceptor at the end of every or every other shift if there was anything she observed that I could work on to improve. I asked for specifics because just telling me I need to step up my game doesn't tell me exactly what I needed to work on. Maybe that will help with your situation, unless you have already tried that. Keep in mind, that she may have a hard time communicating this to you also(Maybe not). I don't think you should ask for another preceptor without first talking to your current one and your manager. This is suppose to be a time for you to learn and you're not going to have it mastered by the end of orientation. You're probably doing better than you think. Stay positive and Good Luck!!!!!!

:yeah: :nurse:

Belinda-wales, RN · May 12, 2008

Keli- Knowing you as I do you can be sucessful in L&D it is were your heart is- I think thats is where your problem lies you see your clients as indvidual people who are going through a wounderful times in their lives not just a list of boxes that need ticking - as a manager for me its not all about how quickly that patient can get turned over its about the care that we give - I did warn you about going to areally busy hospital to learn your trade some times it feels like a baby factory- what ever happens you have got what it takes to be a great L&D nurse I even see a midwife hiding in you -you just need to find some where more holistic start looking - Staywhere you are for a while take what you can from it then move on.

cardiacRN2006, ADN, RN · May 12, 2008

I think this is a normal feeling and happens across the board.

For me, I did lots of conscious sedations, and my preceptor told me, "get this pt out and get the next one in stat."

Well, I was too busy administering the meds-but I hadn't charted the meds or VS yet, and I'd like to recover the pt first!

It was a hard transition for sure.

I think you are doing fine, and you will find the right balance of caring for the pt (and giving them a good experience) and charting all the stuff that you have to chart. You are new! Cut yourself some slack! I bet you never thought that you'd be where you are now. Look how far you've come...

CarrieRNC · May 12, 2008

I came into LDRP 6yrs ago, right out of nursing school. It was the most stressful thing I could have ever done. I would go home every night and stress, cry and say that there is no way I can do this. My preceptor was very strict, I thought she hated me and felt that she was always setting me up for failure!! One thing that the dean of my nursing school said was never make any decisions about leaving a job for at least 6mo, thank God because it was probably about that time that I thought that maybe I could do this. It wasn't till about 1yr that I could say that I was a little more comfortable in my shoes (thanks to my preceptor who is my second mother, luv her to death!!) Now I have been and L&D for 6 years,(about 5k births a year) I luv my job and I still have so much to learn, there is always something new to learn and there are days that you feel you could have done better. Always go by your gut and don't second guess yourself because your gut is usually right. A little advise: never(reqardless of induction or active labor) walk out of room without setting it up for delivery because you never know how a labor will go. If you are not sure how a labor is progressing and there is any question in your mind that you may be heading for a section, get everything you need (pepcid, reglan, foley, comp boots, consents and paperwork etc.) and put it on the counter in the room. If you don't need it you can always put everything back. If its worth anything we say it's warding off evil spirits:)

Hang in there you will probably be one of the best nurses on your unit, because its obvious that your patients come first, as it should be!! Do what YOU think is right, take constructive criticism, but always keep your patients first!! Quick note, if you have to chart every 5min during 2stage, as we do too and everything is status quo try charting this way if ok with the higher ups. ie instead charting the same thing at 0600, 0605, 0610etc. chart 0600-0615 then what had accured. We had this discussion not to long ago with management and we came to this conclusion as long as nothing in that 15min period has changed drastically this charting would be as acceptable as charting q5min.

Sorry for the long responce, hope this helps, keep your chin up and don't give up!!

NurseBlueEyesRN · May 12, 2008

I'm in your shoes right now! Are you a new grad or transferred from another unit. I was a float nurse for two years prior to working here, so I'm kinda used to being stressed like this, and have worked in some busy units...I worked in a different facility, so he charting is COMPLETELY new, and obviously, L&D charting is different than med/surg charting.

We have to do EFM charting q5m during second stage also. Most of my labors have been pretty quick, which has meant little charting, but yeserday I had a gal push for two and a half hours. We ended up having to do alot of interventions, especially at the end (vaccum, forceps and OP kid and bad shoulder dystocia), so I got behind on my charting...that sucked!

I do agree with going with your gut. THe other day, I admitted a gal who didn't speak english who'd water had broken. The doctor wanted to start pit on her (hadn't seen her or evaluated her). A nurse who's worked there for like 30 years checked her first said the head was really high but thought MAYBE she felt suture lines...when I checked her, I definately did NOT feel a head. I felt like pit wasn't safe until we got an u/s, The doctor initially sided with the nurse that had been there longer, but finally came in, because the baby started looking kinda ugly and low and behold, it was transverse, and we did a c-section.Soooo, if you have a strong feeling in your gut, sometimes you need to stand up to the doctor. In this case, this was the old doctor that all the new girls (including me) are kinda scared of. He did ask my preceptor who's call it was to call him, and she said it was mine, that she lettting me take this patient, and just watching me (I was pretty much independent on this one), and so I did get some kudos from him. That felt good!

RNmama05 · May 12, 2008

This is a bit of a tangent, but where I work there is some confusion about "charting every 5 minutes during second stage." What we are actually required to do is assess the strip every five minutes in second stage. That means look at it, evaluate it and sign it (either electronically or on the actual paper strip). We are required to document every 15 minutes in second stage. i.e. "FHR 140, mod variability, pos accels, periodic variable decels; ctx q3-4 minutes, lasting 70-90 sec, palpate strong, uterus soft between ctx." I would clarify what your policy is.

JaneyW · May 12, 2008

That's exactly what I was saying in my post. Assessing a strip and documenting are two different things.

Calzonan RN · May 12, 2008

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.

:yeah: :tku:

magz53 · May 12, 2008

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.