Frustrations about L&D nursing

Biggest frustration?

Knowing when to call the doc--especially on multips at 2am. How fast will they go? will they deliver right after they SROM at 5cm?

I know you said you love the pushing part, but I feel it gets very tense after too long. I'm more of a labor down person but know that doesn't always work either.

Having MDs 'forget' what they told you or the other shift earlier because their own circumstances have changed or they are now in a hurry.

What are some of your frustrations about your job in L&D?

For me...I can list quite a few, but I'll keep it simple:

1 - Triple and quadruple charting - more time spent on paperwork/computerized charting means less time I can spend with my patients. :uhoh21:

2 - The girls/women who are on public assistance and come in every 1-2 years bearing another child onto our already overly burdened welfare system. :angryfire

3 - Sometimes, feeling like you need to clone yourself so that you can adequately care for all of the patients you are assigned. On our really busy days, we can sometimes have 2-3 active labor patients at once.

Jen

L&D RN

I think the best way it to just move beyone frustration. It is always going to be there so forget it and just enjoy the situation at hand. Let the frustrations go. Who cares? Concentrating on that inhibits you from givng your best!

My biggest single frustration? Computerized charting and medications. I feel more and more like I am nursing "machines", NOT humans. It's enough to make me consider leaving OB altogether. This is NOT what I signed up for when I became a nurse. I just want to care for my patients, period. All the paperwork is truly getting in the way more and more. Betsy is right; these frustations will NOT go away, but realizing this does not make me able to just let it go, either. OB nursing is not what it should be anymore. And I have only been at it 8 years----too soon for burning out!

What is a labor down person? sorry for the ignorance, but I was curious because I never saw that expression before (of course, I'm not a nurse yet either and it may be a common expression).

Kris

Biggest frustration?

I know you said you love the pushing part, but I feel it gets very tense after too long. I'm more of a labor down person but know that doesn't always work either.

I will try to help here: "laboring down" refers to letting a woman who is completely dilated defer from pushing til she is ready, or the baby has been "pushed down " by the uterus, not maternal effort, to a very low station. This is mostly done in the presence of epidural/regional anesthesia, when the urge to push is not present. It tends to minimize the amount of time a woman must spend pushing, thus conserving her energy, and also reduces potential stress on the baby, as well. "Laboring down" is done most of the time where I work for women w/anesthesia, particularly first-time moms, for whom pushing phases can last in excess of 2-3 hours otherwise.

With my third baby the doctor let me "labor down" and it significantly reduced the pushing time. I think I pushed four times and she was out. With my second baby I pushed for about 45 minutes...let's don't even go there with the first one(finally delivered with forceps after three hours pushing).

What is a labor down person? sorry for the ignorance, but I was curious because I never saw that expression before (of course, I'm not a nurse yet either and it may be a common expression).

Kris

Laboring down just means that you let the patient's epidural (if she has one) wear of enough so the patient feels the urge to push (or if no anesthesia, when she feels the urge). Some docs are impatient and want the lady pushing when she can feel NOTHING. All that does is tire her out and increase her risk of an operative delivery. Bottom line: keep the doctor out of the room until the baby is crowning........... Works like a charm!

I'm frustrated by the amount of paperwork. There is absolutely no way that you can keep up on the all the charting when a patient without an epidural enters active labor.

I'm frustrated by a few MD's who regularly call c-sections for failure to progress when I feel the pt. hasn't been given an adequate chance.

I 2nd your frustations, USA! it really drives me to move forward w/my education and consider my options, frankly. I did not go into this to sit at a desk, buried in paperwork. That is partly why I will never manage a nursing unit. YECH.....and the paperwork? It gets worse every year. We were just told our new pitocin protocols will add to that, again, and heavily from what I see....it's enough to make me want to cry. This after going online w/charting and meds just in the past 3 months, turning our whole unit upside down for a while there. It's becoming WAY too much. I do not want to spend my time at a desk, I want to spend it helping women labor/deliver and breastfeed/assume care for their babies! I love nothing more than spending time at the bedside, this is what I wanted to do when I went to school.

I 2nd your frustations, USA! it really drives me to move forward w/my education and consider my options, frankly. I did not go into this to sit at a desk, buried in paperwork. That is partly why I will never manage a nursing unit. YECH.....and the paperwork? It gets worse every year. We were just told our new pitocin protocols will add to that, again, and heavily from what I see....it's enough to make me want to cry. This after going online w/charting and meds just in the past 3 months, turning our whole unit upside down for a while there. It's becoming WAY too much. I do not want to spend my time at a desk, I want to spend it helping women labor/deliver and breastfeed/assume care for their babies! I love nothing more than spending time at the bedside, this is what I wanted to do when I went to school.

We just went hospital-wide online charting this weekend and WHAT A NIGHTMARE. Even when you know what to do and what button to push, it takes longer to do things than it did before. I am sure portions of it will get easier as time goes on but otherwise............OMG! Last night was the pits and I have to do it again this evening and days tomorrow!! Like you, I would just like to concentrate on my labor patient. We have had computerized bedside charting (for labor) for a long time but this hospital wide stuff..............YUK (and I am computer literate). I feel for those who are not.

we must be kindred spirits, Betsy.....

I have only been an RN 7 1/2 years, but already, I find myself missing the "old days"....

Guess you can tell I'm from the south?!

Well, I agree with the listed frustrations. I am also frustrated with the fact that in most of the 12 hospitals I've worked at in my career, it seems just fine to float L&D nurses anywhere, but NOBODY can ever float to L&D, even when we're drowning. What kind of administrative double-standard is that?

Also, frustrated with being hired (where I am now) for my long history of working in L&D and being certified, yet now being told I will have to "be comfortable with pediatric patients" although we have absolutely NO peds nursing orientation program.... GRRRRRRR!

Doctors, hours, and other things gripe me, but I love working with moms in labor. So I'm still "counting"... haha!

Thanks for asking,

KC in FL