First night off orientation- feeling overwhelmed

[ibambamama]

So Saturday night was my first official night off of orientation - whoohoo! I work on a rather busy L&D floor in NYC (we do about 7,000 births a year) that includes a lot of high risk pts. I spent 3 full months orienting on days and then the last 3 shifts orienting to nights (I think I probably should have done more of my orientation on nights, but well, can't change that now). I'm still really green and know I have a ton to learn, but it was time to go and I felt, well as ready as could be expected.

The night started off great. We only had 4 pts on the board and I was lucky enough to get a lovely midwife pt who was laboring all natural - no pit, no IV, only intermittent monitoring. And b.c. she was my only pt, I got to give a lot of real labor support - it was great. She had a beautiful delivery just before midnight.

I got her to pp and got to take about 30 minutes to eat dinner. (We are supposed to get a total of 1 hr and 50 minutes in break time - if we aren't too busy of course). It wasn't crazy busy when I got back from eating, still maybe just 6-7 pts on the board. I popped my head into a few rooms to see if I could be helpful, but then the charge nurse told me I had an admission. Turns out it was a woman, full-term, G1P0, no previous hx, but GBS + with sudden onset PIH - and at 5 cm and going fast (which was a good thing b.c. as it turned out the only way to get her BP's down was to get that baby out!). I got a bit panicky (so much to do! Everything moving so quickly! And I realized that, even though I had had pts who were on Mag, I'd never actually started the Mag myself) Thankfully the triage nurse had started her IV and hung her loading dose of Ampicillin (God bless the triage nurse!) But I still had to get her set up in the room - the docs were pushing Labetolol (to no avail) and wanted Mag started and a foley placed, we had no prenatals on her, and it was hell trying to do an admission b.c. she was in quite a bit of pain. I managed to get the mag started, another nurse had to help me w. the foley (first time I haven't been able to get one in, head too low maybe? Either - thank god for that nurse too!) and got about halfway through the admission - no progress on prenatal labs (oh, triage also already sent PIH labs - whew!) Mom was moving fast though - I got her at 2:30 and she was fully by 3:30, delivered (vacuum assist, w. peds in room) around 4:40 - whew! Baby looks good - it's 5:30, I realize I still haven't charted a darn thing, mom needs her foley put back in (needed help again - arggg!) and she still needs prenatal labs drawn and sent (PP freaked out on me when I told them she was BF w.o prenatals in the chart - but the kindly Dr said she would sign off on it - I mean really, if the woman had TB or HIV - don't you think she would have told us when we asked?!)

Managed to get through most of my charting by 7:30 - some sort of miracle and I'm afraid I still forgot 20 things....It's funny, but even just writing all this down makes me feel better about it - maybe it wasn't so bad afterall? At the time I felt completely abandoned and alone, but in retrospect I know that I had a lot of other nurses on the floor helping me and maybe this wasn't a crazy emergency pt - it was just the normal crazy of L&D.

Yes?

Sorry for the long post - thanks for reading if you've made it this far :)

[CaLLaCoDe, BSN, RN]

Nice post ;-). I especially like and will encourage you through your career (perhaps you've had a history in other areas besides L%D, I dunno) to always be as appreciative of others helping you out. Especially support staff, sometimes we nurses take them for granted or at worst put them down. Cheers!

[beachmom]

I think you did great. I hate those rush admits with a painful mom. So hard. But it's part of working L&D. If you forgot stuff, don't worry, everyone does. Baby and mom are fine. That's the important part.

When PIH is that bad, the body knows it needs to get the baby out, so often those labors are fast. It's nice you have coworkers who help. That's a godsend. I always try to help others when they are busy, then I don't feel guilty asking them for help when I'm busy.

[Halinja, BSN, RN]

I distinctly remember that overwhelmed feeling the first day...week...month after being off orientation. Busy L&D, high risk, scarier than all get out, and I kept forgetting things. Needless to say, I was too hard on myself, I hope you can keep from beating yourself up over any oversights. At first you make sure you get the biggies, later you'll get the little details too.

[MJB2010]

Hang in there! It sounds very overwhelming! It has to get better!

[Magsulfate, BSN, RN]

From what you've written, it looks like a wonderful learning experience for you!

This is the very best way to learn... you might feel a little alone but there are other nurses there that you can turn to if you need to. Look at it this way.. you should be patting yourself on the back,, be proud of yourself! There was no mistakes .. other than the prenatals.. and that was minor,, Next time this won't happen.. with a mistake comes a new lesson... With a crazy night comes more courage and when you add a bunch of these nights together, , it makes for a very good, experienced ob nurse :) :)

[ibambamama]

Thank you all so much for the encouraging words. I do really feel like I'm lucky to be on a floor where the nurses support each other - and writing it all out made me truly realize how much help I had, even though I felt alone at the time. I guess it is a pretty giant leap from being with a preceptor to suddenly being on your own.

It was also good to hear that that was indeed a hard pt - and not just that I'm incompetent. Of course, I'm sure there will be many more like her in the days and weeks ahead!

Thanks again for all the support - it's so good to have this forum!

[NurseNora, BSN, RN]

This forum has worked for you exactly the way it is supposed to work. You had a chance to vent and in doing so gained a new insight into your situation. That's why I love this place so much.

Sounds like you did well. Also sounds like you work in a good place. Your coworkers had your back and helped you out (the way you offered help when you had the time). L&D is a hurry up and wait kind of place: nothing--nothing--TOO MUCH. That's one of the reasons I like it, the unexpected change of pace.

Over the coming weeks and months you'll go back and forth between feeling like you're really getting it to all at once feeling clueless and that maybe you made the wrong choice in going to L&D. That's just part of the learning curve, it tends to be more jagged than curvy sometimes.

Keep using this forum (and your friends, coworkers, mentors) to work through your feelings about the challenges you'll be facing and you'll do well

[guiltysins]

Thank you all so much for the encouraging words. I do really feel like I'm lucky to be on a floor where the nurses support each other - and writing it all out made me truly realize how much help I had, even though I felt alone at the time. I guess it is a pretty giant leap from being with a preceptor to suddenly being on your own.

It was also good to hear that that was indeed a hard pt - and not just that I'm incompetent. Of course, I'm sure there will be many more like her in the days and weeks ahead!

Thanks again for all the support - it's so good to have this forum!

Can I just ask what hospital you work in? I'm looking into L&D and I'd love to have the support you did. Maybe even work with you someday =)

[vjhappy]

You give me hope that it can be done! Just starting orientation & scared out of my mind, but I know I have a wonderful staff to back me up, like you do. Thanks for posting your story!