I'm due to come off of orientation this week and I feel like there's just so much I don't know. I'll have a really good night where I get all my charting done, the patient out of the room two hours after delivery (even after dealing with her hemorrhaging at placental delivery, doing all mom/baby vitals, giving baby a bath, all with about 15 visitors in the room), and everything just flows, and then the next night I can't seem to remember anything I'm supposed to be doing. Last night was my third night in a row, I went into my pt's room and she was complete and had been pushing for over an hour. She was laboring 'naturally' had done awesome all day long and was in complete control. She had a doula, her brother, her mother and her dad and a midwife so I was just trying to help where I could and not be one of the many voices. I also tried to keep up on my charting (we have to chart FHR Q5 min while pushing). Everything was going great until the doc decided that the baby just wasn't going to come out that way. In all of my orientation I hadn't done a laboring pt to c-section, when I was the nurse. We got the pt into the OR, everything turned out okay, the baby was OP with a brow presentation. When we got to PACU my preceptor told me "okay, you have one hour to get her to postpartum". I still had the last hour of FHR to chart (Q5min) that hadn't been charted because I was getting mom ready for her c-section, signing consents, etc. plus mom wanted to bf baby as soon as possible, which meant her PACU clean-up was delayed, dayshift hadn't printed/filed any of the admit papers or faxed any of the orders to the pharmacy, patient was in pain and her pain was not under control yet, the list goes on. Meanwhile my preceptor is watching me asking me "did you do this yet, have you done this" and everytime she did that I lost my train of thought and panicked. I felt her disapproval all night long. She had just told me two nights before that I needed to step up my pace and that they had a nurse who always had three hour recoveries and she didn't work there anymore, hint, hint. So my one hour PACU recovery turned into a 2.5 hour recovery and now I have to go see my manager today. I feel like a total failure and have spent the day crying my eyes out. I really love L&D, but I'm wondering if I'm just not fast enough for it. I feel like instead of trying to make a wonderful experience for the patient, I have to focus on watching the clock and running her to postpartum within two hours. I'm just feeling so sick about this I can't even sleep.
My preceptor is a really good nurse. She's been in OB for over 4 years and knows her stuff, dots all the i, crosses all the t's. etc. She usually works four nights a week, picks up overtime whenever she can, so she's got tons of experience and I'm just wondering if she's comparing me to other new grads coming off of orientation, or if she's thinking I should be able to do what she does, I just don't know. I've talked to the other grads that were hired on with me and they are totally scared and feel overwhelmed too, but I didn't go into specifics so I'm not sure how they're really doing. My preceptor will occasionally 'throw me a bone' and say 'good work, you got them out of there in two hours' or whatever, but it just seems like there's this air of disapproval and constant disappointment lately.
...I am a night shift nurse, but was being trained on day shift - I went back to night shift, and low and behold, my precetor on nights thinks I am doing GREAT! So......hang in there and do your best - I agree, I'm slower than my precetor, but that doesn't mean I don't get the job done. My night presceptor told me that she still has to stay over sometimes to catch up on charting, particularly if baby comes quickly after picking up patient or ir things change /quote]
I work nights, too, and of course was oriented on days. I've never really understood why hospitals do this. It makes sense for the first several weeks or so, as you have guaranteed scheduled c-sections and admissions to work and stuff but I felt very lost on nights by the time I got there because the routine was so different. I always thought it would be best for those hired for nights to spend a least a *little* while orienting on nights instead of being thrown there.
And yeah, we ALL stay late sometimes to finish up paperwork etc! I know ladies who've been on L&D for 20 years and still sometimes get stuck! Don't let that worry you! It doesn't ever go away!
. 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.
You probably won't be able to judge that until after you have more experience. Then you can look back and re-evaluate if their expectations were reasonable or not. Still, in cases like this, where you're highly motivated and making good progress and yet still not "making the grade" and you wonder "is it me or... ?" the answer is often "it's not you!"
All you can do is continue to do your best, show your sincere motivation, demonstrate your willingness to learn and accept feedback (even if you ultimately judge that feedback as not useful), and fight for your right to keep trying. They may ultimately decide to let you go, but til then, fight for it and learn all you can. Whether you stay there, this is a priceless learning opportunity that will serve you well in the future.
:yeahthat: totally..100% agree...
Honestly Keli, it really sounds like you are doing great. Espcially if all these OB nurses say so! Try not to beat yourself up. I know it is hard but really you need to preserve the little confidence you have left to survive! Please keep us updated on what happens!:redbeathe
I'm due to come off of orientation this week and I feel like there's just so much I don't know. I'll have a really good night where I get all my charting done, the patient out of the room two hours after delivery (even after dealing with her hemorrhaging at placental delivery, doing all mom/baby vitals, giving baby a bath, all with about 15 visitors in the room), and everything just flows, and then the next night I can't seem to remember anything I'm supposed to be doing. Last night was my third night in a row, I went into my pt's room and she was complete and had been pushing for over an hour. She was laboring 'naturally' had done awesome all day long and was in complete control. She had a doula, her brother, her mother and her dad and a midwife so I was just trying to help where I could and not be one of the many voices. I also tried to keep up on my charting (we have to chart FHR Q5 min while pushing). Everything was going great until the doc decided that the baby just wasn't going to come out that way. In all of my orientation I hadn't done a laboring pt to c-section, when I was the nurse. We got the pt into the OR, everything turned out okay, the baby was OP with a brow presentation. When we got to PACU my preceptor told me "okay, you have one hour to get her to postpartum". I still had the last hour of FHR to chart (Q5min) that hadn't been charted because I was getting mom ready for her c-section, signing consents, etc. plus mom wanted to bf baby as soon as possible, which meant her PACU clean-up was delayed, dayshift hadn't printed/filed any of the admit papers or faxed any of the orders to the pharmacy, patient was in pain and her pain was not under control yet, the list goes on. Meanwhile my preceptor is watching me asking me "did you do this yet, have you done this" and everytime she did that I lost my train of thought and panicked. I felt her disapproval all night long. She had just told me two nights before that I needed to step up my pace and that they had a nurse who always had three hour recoveries and she didn't work there anymore, hint, hint. So my one hour PACU recovery turned into a 2.5 hour recovery and now I have to go see my manager today. I feel like a total failure and have spent the day crying my eyes out. I really love L&D, but I'm wondering if I'm just not fast enough for it. I feel like instead of trying to make a wonderful experience for the patient, I have to focus on watching the clock and running her to postpartum within two hours. I'm just feeling so sick about this I can't even sleep.
My preceptor is a really good nurse. She's been in OB for over 4 years and knows her stuff, dots all the i, crosses all the t's. etc. She usually works four nights a week, picks up overtime whenever she can, so she's got tons of experience and I'm just wondering if she's comparing me to other new grads coming off of orientation, or if she's thinking I should be able to do what she does, I just don't know. I've talked to the other grads that were hired on with me and they are totally scared and feel overwhelmed too, but I didn't go into specifics so I'm not sure how they're really doing. My preceptor will occasionally 'throw me a bone' and say 'good work, you got them out of there in two hours' or whatever, but it just seems like there's this air of disapproval and constant disappointment lately.
Thanks for listening.
Hey Keli:heartbeat
I too feel this way alot. I am a LDRP+nursery+GYN nurse. We do all of this on the same floor, in the same room. Sometimes we would have a laboring pt and a GYN pt (ect) at the same time. I have only been a nurse for 9 months. I feel pretty confident about my skills but when an emergency happens, they begin to fall apart. I had a good orientation, 14weeks long, but at the same time, I am at a small hospital that only does about 50 deliveries a month. I dont think that I am on the level that I should be on and it is discouraging. I think that in my 9 months, I may have had 2 c/s with me circulating by myself, 2 c/s with my preceptor (all but 1 being an emergency), an average about 1 delivery in a 1 week period, 2 precipitous deliveries that I caught on my own, and tons of laboring because I work nights. So I have yet to be comfortable with the routine things let alone an emergency. One encouraging thing is that you find yourself getting better and making "big girl" decisions as time goes on. I found myself putting pts in positions that I never thought of before to get fht back up and clamping the cord, suctioning, ect like I had done it a million times before when I had to catch that baby. So it gets better, just not quick enough:mad:
I just wanted to update everyone. I'm throwing in the towel. I absolutely love L&D but I'm in a no-win situation. I worked with a preceptor the other day, had two patients getting cervidil (which I placed w/o any problems). I did great all day long, kept up on my charting for the most part but then after both my patients got their epidurals they both crashed at the same time. I was in one patients room her B/P was 80/35, I was trying to take care of her when my other patient called out (she was nauseous and anxious). My preceptor went and helped her, I finally got my B/P patient stable and went out to get caught up on everything, didn't stay late or anything. After the shift I asked my preceptor how I did and she said 'Great, no problems at all". Two days later I worked with another preceptor, started the day with a c-section, recovered her then had two laboring patients, one of which I gave up because my first one was complete. Great birth, everything done on time etc, great day. I asked that preceptor how I did and she said "wow, you really impressed me in the OR, you're better than most of the experienced nurses here, that may be your calling" She also said I did really well with my laboring patient, great day. Then she said my other preceptor told her I had a hard time juggling two patients, and two Cervidil patients at that (easy patients). I couldn't believe it!! The only problem I had was when they were both crashing at the same time!! The rest of the day was fine!! I'm just so tired of working my butt off to please them and to do a good job, and they find one thing wrong that any other nurse would've had a problem with! I'm exhausted, mentally and physically. I'm so stressed out I just want to cry on my days off, and I just feel like there's nothing I can do to make any of this any better, I've tried my best, given it my all, and I'm just not good enough. I really wish I'd started at a slower hospital without all the pressure of 'get them out run run run'. Part of my problem is I'm not a high anxiety stress person, and my preceptor has mentioned that I need to have an ER personality. She also mentioned that she never knew when I needed help, that I didn't communicate what was going on. Well my manager had told me that she wanted to know if I could handle things on my own, so of course I didn't tell my preceptor every step I was doing, I was just trying to do it on my own, and if I had a question I asked!!! I told my preceptor the reason I didn't ask for any help or ask any questions, is that I didn't need any help!! I just can't win.
My manager was supposed to meet with me on Monday 5/26 (memorial day and my husbands birthday which I worked because I was told I was meeting with her) and my manager didn't show up, so I'm still in limbo, but it's not looking good.
So... I've decided to apply for a position in PP at another hospital. I think maybe if I can get used to being a nurse and get my confidence back, then maybe I can look into L&D again, but for now I'm just at the end of my rope.
Thank you for all of your support during this. I'm really going to miss L&D, but at least in PP I'll be able to actually 'bond' with the patients (because I'll have some time to) and maybe help with some teaching as well.
I'm sorry that you finally had to reach that conclusion about your job but I'm also very proud of your for knowing when enough is enough and not giving up on OB all together.
I interviewed just recently at one of those baby cranker facilities much like you described you work at. They deliver an incredible amount of babies there, my orientation (no experience at all whatsoever in L&D, all my experience is ER) was 12 weeks and then I was cut loose on my own. No PP and no WB until I had finished my L&D orientation The whole process seemed backwards.
I thank God now everyday I got and accepted my current position. It's an LDRP unit, however it's a natural progression. 6-12 weeks on PP, 4-8 with WB then approx 6 months doing the couplet thing THEN 6-9 months of L&D orientation. As much as I desire to be an L&D nurse - I want it to make sense and I want to do it when I'm ready.
There are good places out there and you'll find your home I just know you will!!!! Your L&D skills will go with you now on your next journey.
I wish you all the luck in the world in your next exciting step!!!!
Sorry it didn't work out Keli but only you know what is best for YOU. I am glad you are going to move forward to something better. And somewhere you will be appreciated because it sounds to me like you are doing a pretty great job!:redbeathe
BTW..did you get my email? I sent it to your personal email address...??
if you love L&D( and you sound like you are good at it) then find a hospital with LDRP's. I have worked at both and I really love the LDRP nursing much better. Where I work now we take 1 labor with some PP's. At first it was very weird to me, but seriously you can get the PP work done and have plenty of time for labor charting and labor support. The best part is, when your pt delivers, you finish her recovery in the 2 hour time, then she remains your pt and you never move her so you can still catch up on charting etc... It can get really busy, especially with new admissions/triage but our unit is small (1100 del/year).
Our moms get up when they say they are ready (usually 3 hours) and babies are brought to the nursery then for bath. It is so laid back. I really enjoy it more
I just thought I'd let everyone know that my job did not work out. I ended up having to call my manager to find out what was up (after not hearing anything for over a week) and I spoke with the director who told me they were going to try and transfer me to another area. She said that she'd talked to my manager and my skills were great, I got along well with others, the part I needed to work on was time management and perhaps L&D wasn't the place for me right now. Unfortunately they didn't have any other openings anywhere so I sat in limbo for a week and a half. I started applying for positions elsewhere and went for an interview today. I was told all of their L&D spots were full, but they had openings in post partum and I could move into L&D in September. When I got there they reviewed my application again and noticed all of my experience and decided to put me in an L&D slot, not as a new grad but as a new RN with 4+ weeks of orientation plus whatever classes I wanted. The hospital is more holistic based (which is what I was looking for) and there are several midwives who deliver there and appreciate nurses who support their patients. I had a tour and it seems like it's exactly what I'm looking for. A friend of mine from school was already working there and so I got the inside scoop, she loves it!! I explained to her what happened at my last job and she couldn't believe they treated me like that or that they demanded that a new grad be able to handle any emergency that came up on her own. The only downside to my new job is it's pretty far from my house, it takes me about an hour to get to the hospital, which means an hour drive home in the morning after a 12 hour night shift. But I can deal with that as long as I am in the job I love. I'm pretty excited, I didn't think I'd be able to find a job in L&D, but I'm a little nervous too. I've lost a lot of my confidence during this experience, and I don't want to be second guessing myself all the time. I just hope and pray that this job works out!!
Thanks for all of your votes of confidence and all of the great advice you've given me. I'd love to be able to work with such supportive, loving RN's!! I'll keep you updated....
I am glad you were able to find something so quick. Maybe this employer will respect you! If L&D doesn't work out again, or proves to be too stressful, I am sure you could just switch to PP for a while, right?
I got your text the other day but I forgot to ask did you ever talk to my manager about the PP position at my hospital??
I'm glad things are starting to pick up for you... i still cant believe CR did that to you... I know you are a great L&D nurse because I worked with you firsthand at AH and everyone was impressed with you there... Please dont let a couple of old hags ruin your self confidence. You are great and i have a feeling that you are about to realize that with your new job!
As for the drive... keep your hair long and you can roll it up in your car window... whenever you nod off it will pull and you will for sure be woken up!!! LOL
:yeah:
Espcially if all these OB nurses say so! 
Try not to beat yourself up. I know it is hard but really you need to preserve the little confidence you have left to survive! Please keep us updated on what happens!:redbeathe
IndigoCarmine
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