feeling overwhelmed: Cardiac RN to now Postpartum

SmilingBluEyes · Sep 25, 2002

Hey, we all go thru that. I entered OB right out of school...talk about a fish out of water. you bring much to PP and your coworkers I DID NOT, being green. Hang in there, and just take it day by day. Don't GET DISCOURAGED......hey some of your cardiac training one day may save a life. PP can get complicated and often times, cardiac complications can be involved. I love what I do now...been at it 5 years. You will, too. Give it time and just allow yourself to learn. I wish you well.

at your cervix · Sep 26, 2002

Think back to when you started cardiac nursing. I am sure that you may have felt the same way. We probably all feel that way when we start something new. If you still feel uncomfortable after orientation, you should talk to your manager and see if they will extend your orientation. Never be afraid to ask questions of the other nurses. Asking is the only way that we learn new things. I am sure that you will do a great job. Hang in there and have faith in yourself, and before you know it, you will be one of the been there, done that nurses!!

LINUS · Feb 5, 2004

I can totally feel for you! I worked med/surg for six months, then moved to a new hospital to work in PP. I feel likeI did when I started med/surg. I've been here a month and I still feel pretty overwhelmed. Assessments just drive me crazy. I finally can count apical pulses on the baby, but counting their respirations is hard, especially when you have mom/dad/family/etc. trying to talk to you at the same time. I don't have any kids myself, so this is all new to me. I still don't know what I'm actually looking at when I check their incisions (perineal incisions). I know what a hemorrhoid looks like, but stitches? I know they have them, but I don't really see them. I feel like a fish out of water here.... Any helpful hints from anyone on doing assessments? The people here don't listen to lungs or bowel sounds ever! How do other hospitals check their patients?

dawngloves, BSN, RN · Feb 5, 2004

Oh honey! BTDT! I did CCU for five years before I went to NICU and it is a whole new ballgame! You really do start from scratch. But now you have so many more skills and more confidence then back then. Keep it up! You'll feel better in a couple of weeks.:)

crankyasanoldma · Feb 5, 2004

Actually, you are three-quarters of the way there already!!

unconsciously incompetent- you know nothing

consciously incompetent- you begin to realize you know nothing

consciously competent- you have to think about your actions

unconsciously competent- you act instinctively

You can do it!

BarbPick · Feb 5, 2004

What is different this job change is you already know how to be a nurse. You know how to budget your time, complete your charting etc. The assessments are actually the same. If you do mother baby, you assess mom and baby. Mother /Baby has one major blessing. You usually have

well" patients who bounce back quickly and go home. I don't think you will do the "caution" antepartum patients right out of the gate. The majority of the time your patients will leave happy. I suggest you give yourself a break.

Dayray, RN · Feb 8, 2004

I really understand what you are feeling. I too came from cardiac into PP and then into OB. It's hard because the two areas are so different. In cardiac you know what you are looking for and when things get hairy all you have to remember is ABC and your ACLS.

In PP problems are not as obvious and emergencies aren't as clear cut.

Another problem is that the nursing culture is so different. Mom baby nurses approach everything differently then cardiac and CC nurses.

Working cardiac you know and accept that even if you do everything right some patients are going to die but in mom baby ... well lets not talk about it =)

All I can say is give it time, and be willing to learn/ask questions. after 2 years I feel like I am reasonably proficient at this type of nursing, not perfect nor will I ever be. When I worked cardiac I "knew" I wasn't the best but I was confident that I was a damn good nurse. I really miss that feeling of confidence. Overtime you'll learn more and you will get used to feeling like your just 1 step ahead of disaster. Slowly you'll gain back confidence but it's never the same as the confidence you had in cardiac.

PS crankyasanoldma - I love this!

unconsciously incompetent- you know nothing consciously incompetent- you begin to realize you know nothing consciously competent- you have to think about your actions unconsciously competent- you act instinctely

L&D_RN_OH · Feb 9, 2004

Originally posted by LINUS
Assessments just drive me crazy. I finally can count apical pulses on the baby, but counting their respirations is hard, especially when you have mom/dad/family/etc. trying to talk to you at the same time. I don't have any kids myself, so this is all new to me. I still don't know what I'm actually looking at when I check their incisions (perineal incisions). I know what a hemorrhoid looks like, but stitches? I know they have them, but I don't really see them. I feel like a fish out of water here.... Any helpful hints from anyone on doing assessments? The people here don't listen to lungs or bowel sounds ever! How do other hospitals check their patients?

LINUS, continue to do your med/surg ax as you've always done them if that makes you feel more comfortable. Just add a couple extra, like perineal ax- REEDA : redness, edema, ecchymosis, drainage, approximation. You won't actually see the stitches, you are ax for healing. Breast exams-soft, filling, engorged, any nipple problems- cracked, bleeding, inverted, flat, etc. I do listen to lung sounds on everyone and bowel sounds on CS pts, but if I have a vag delivery who's been eating since delivery, I usually skip BS. Also check homan's sign, bleeding, and fundus and I think you're set.

For resp ax on babes, I either listen with a stethoscope or place my hand on baby's chest and count. If you are really having trouble with your ax, just explain to the family that you are trying to count resp and you need to listen for just a minute. I'm sure they won't mind.

And rndiva, just as you acclimated to other areas, you will soon feel comfy in PP. And like someone else said, your cardiac experience is helpful. We had a CS pt the other day, with pressures in the 80's/30's, then 50's/20's. She had classic shock symptoms. We volume loaded (thank God for albumin) and they took her back to OR, where they removed 2000 cc of blood that had been oozing (doc's term) from the uterine incision. Thank God she didn't code. With that much blood in her abdomen, I don't know if we would have got her back.

BETSRN · Feb 9, 2004

Most laceration stitchesd are INSIDE, not where you can see them. You are assessing the outer perineum and also looking for unusual pain inside that might signal a hematoma. Ask the older more experienced nurses to help you. You'll leanr. It would be just as hard for an OB nurse to go to Med-surg, telemetry or any other specialty.

huggietoes · Feb 9, 2004

I know nothing about postpartum, just wanted to lend my support. I just began a new area of nursing and it can be so overwhelming and discouraging at times, we become so comfortable with what is familiar. Remember that it can also be exciting, open yourself up to the experience learn from those around you and before you know it you will be a seasoned veteran. Best of luck to you.

newmommynurse · Apr 18, 2004

I can totally feel for you! I worked med/surg for six months, then moved to a new hospital to work in PP. I feel likeI did when I started med/surg. I've been here a month and I still feel pretty overwhelmed. Assessments just drive me crazy. I finally can count apical pulses on the baby, but counting their respirations is hard, especially when you have mom/dad/family/etc. trying to talk to you at the same time. I don't have any kids myself, so this is all new to me. I still don't know what I'm actually looking at when I check their incisions (perineal incisions). I know what a hemorrhoid looks like, but stitches? I know they have them, but I don't really see them. I feel like a fish out of water here.... Any helpful hints from anyone on doing assessments? The people here don't listen to lungs or bowel sounds ever! How do other hospitals check their patients?

You just capsized my entire orientation to PP. I too have trouble counting respirations on the baby. If you look at the side of their stomach sometimes you can get a better view. Also, try lightly putting your hand on their chest and feeling for the rise and fall of the chest. How about feeling pulses on a baby??Impossible sometimes! And I also have problems finding the mom's stitches. How far are we supposed to go with that part of the assessment? They are sore as it is, they dont need us pulling their buttocks apart to view their stitches. Ive thought of using a penlight for better visualization, but I think it would weird the patients out! Also, for the mom's assessment, try the BUBBLEHE method:Assess the Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy, Homan's sign and Emotional status. This has helped me.