ADVICE. New grad L&D Nurse

[HUN18]

Hello fellow nurses, I'm looking for some helpful advice.....

I recently started a new grad position on a high risk L&D unit. I am about 7 weeks into my orientation and signed a 2 year contract with the facility. I am slowly realizing that I am falling behind my fellow new graduate orientees. I am not up to speed so to say. I feel as though I am lagging behind compared to the other new grads around me who seem to be excelling.

I have a wonderful preceptor. She is patient and works with me to understand things but sometimes I can't help but feel as though I am slow. Part of me is realizing while I am trying to focus on learning how to be a new nurse, to perform basic tasks and procedures I have the added pressure on learning how to be an L&D nurse on top of that. On my unit we never have "normal" births. We are a high risk facility and take high risk pregnancy transfers from different facilities from up to 4-5 different counties including our own.

I've had to take several courses such as ACLS, EKG, NRP, etc. And have passed with no problem. I recently spoke to my OB clinical coordinator about my upcoming schedule and she told me I would do 2 weeks in OR, 1 week on antepartum, 2 weeks on postpartum and then 2 weeks on night shift and I would be on my own. This all within my "12 week" orientation, really 11 considering the 1st week I sat in a classroom learning about policies, etc. I told my preceptor today about my "upcoming" schedule and she said no and shook her head. She said she would speak to the OB coordinator and she said I was not ready to be on my own so soon. Which was a sigh of relief! Because out of these 7 weeks, a good chunk of work days I have been taking those classes at the hospital.

A part of me is starting to feel like I'm just another nurse they're hoping to churn out after these 12 weeks. Ironically I had the manager come up to me and ask if she had "misinformed"'or "misled" me in anyway when explaining the position during my interview. Granted that was week 2 and I had barely seen just how chaotic it could get.

Now that I've been on the floor for 7 weeks and have seen quite a lot. I understand the utmost importance on patient safety for both BABY AND MOM. Right now I don't feel as though I can provide such care because quite frankly I don't have the knowledge and seem to struggle. My preceptor (and other veteran nurses) on my floor told me they all got 6 months of training back in the day and that it's such a disservice to new graduates because 12 weeks is not enough time, especially on our unit. As much as I love L&D, I don't feel it would be responsible of me not to speak up or say something. My preceptor said she ultimately decides whether or not her new orientee will become an L&D nurse or perhaps be moved to post-partum or inevitably cut ties with the facility amicably. In the past she has only "failed" 2 people. She is highly respected from the higher ups and for good reason, she is one of the best L&D nurses on my floor. I really am lucky to have her.

My question is.... do I wait to speak to my preceptor or manager about this or should I speak up immediately? I love L&D but I can certainly put my wants aside for patient safety. I never want to feel inadequate or unsafe in my care for my patients but I feel as though I'm just not where I should be, learning wise. I feel as though I am capable of patient harm once I'm on my own because I "didn't see it" or it "didn't occur to me". I do feel as though I have failed as a new grad, but I can't let that affect my decision to want to stay out of pride. When it should be about my ability to safely care for both mom and baby on my own. Any advice would be greatly appreciated!! And so sorry for the LONG post but thank you to those who red it all!!

[aphelion, BSN, RN]

Okay, so: you will always feel slow, no matter what orientation or position you are in. You will always feel like you are behind your peers. I still feel like this and I am not a new nurse anymore. There's something called "impostor syndrome" that might provide you with some useful insight if you look it up. You are not alone in feeling overwhelmed and like you're not ready for anything; you're seven weeks in, that's like a little over two months. You *aren't* really ready for anything. There's a reason your preceptor is beside you.

More important than your own assessment is the assessment of your preceptor, because nurses tend to be perfectionists, and we tend to be hard on ourselves. It seems like she really wants to support you and for you to do well. Don't be afraid to straight up ask her how you're doing. A good preceptor will not lie to you. If she says you're doing well, allow yourself to believe her; if she says you have stuff to work on, then at least you have a road map! And you can chip in too - if you think you're having trouble with specific areas, let your preceptor know. For example, identifying "slowness" is good, but slowness at *which specific things* is better - for example, when I started as a new nurse I was atrocious at doing a timely med pass, so my preceptor and I worked on it and I got better.

The second part of your post is a sadly familiar one. 12 weeks is, in fact, not enough time for a fresh new grad, but it's becoming common these days as more hospitals cut corners. With that said, every facility I've ever worked at will extend your orientation if you/your preceptor feel like you need more time. Do ask if they'd be willing to extend your orientation if you still feel it's necessary by the end of 12 weeks, because you really feel like it would help build your confidence, skills, etc. If they say no, then this is not a place you want to work, because it means they are not putting the patients first.

Being a new grad is hard in and of itself, and on top of that you're dealing with a complex workplace situation. Let me be clear: this isn't on you. You've been a nurse for seven weeks. All that is expected of you at this point is that you're working hard, which is sounds like you are. Cut yourself some slack. You want to be an excellent nurse, and are doing everything you can to get there. That's proof that you *are* a good new grad. You are not failing anything or anyone.

The one thing I wish someone had told me as a new grad, and which I will pass to you, is that it is your right, your duty, and your obligation to say no. If you need more time in orientation, say so. If you feel like you need more training, especially if you have specifics, say so. If they fire you for it, it doesn't mean you failed, it means that you avoided a potentially dangerous situation that could have cost a patient their life, and you your license. Listen to your instincts and have faith in yourself. Keep going, and don't give up.

[casa_bella, NP]

Everything ^. I was a new grad in L&D as well. Not considered a "high risk" facility, but high risk patients nonetheless.

[Nurse SMS, MSN, RN]

If you compare yourself to others, regardless of the subject, you will always find others who seem to be more "together" than you.

Listen to your preceptor and manager. Stop comparing. Just because they "seem" to have it all together doesn't mean they actually do. You may seem this way to them. Or they may envy your rapport with patients or with other staff or you home life or your car or your hair or whatever else people pay attention to and make themselves insecure about.

Listen to your preceptor and manager. Those opinions are the ones that matter.

[inthecosmos, BSN, MSN, RN, APRN]

Definitely discuss the need for a longer orientation. Ask your preceptor what you can work on to be better and then make an action plan. Please, do yourself a favor and stop comparing your course against others. The fact you are aware of your inadequacies and are willing to speak up shows character and reassures me that once you get your footing, you will find your groove.

[Marie_N]

Im so sorry you're going through this. I can definitely relate. Im a new grad as well on L&D and my orientation schedule was exactly like yours. Except I oriented on postpartum for 1 month and L&D for 2. I did not feel ready at all. I communicated this with my nurse manager and my preceptor about a dozen times and my NM promised she'd work with me and give me extra time since it "was not fair that my fellow orientees got 3 months in L&D vs. my 2." However she fell short on her promise and rushed me off of orientation. I've been off of orientation for 1 month and things have not gotten any better. The night team is very supportive but I still feel like I'm sinking. I considered leaving before orientation was over and had already began my search for a different position but I was pulled so quickly that I didn't get the chance to find something new. I, like you, do NOT feel like a safe nurse at all and idk if its normal to feel like that as a new grad. I dont mean to discourage you in any way, hopefully your NM is more patient than mine. But only you will know how ready/prepared you are by the end of your orientation.

[klone, MSN, RN]

Well, crap. 12 weeks to learn L&D (HIGH RISK L&D, no less - not even "normal" births), mom/baby AND circulating for C/S? That is NOT ENOUGH TIME. For anyone. Plus, as a NEW GRAD!! That's crazy.

Where I am, new grads get 12 weeks of JUST Mom/Baby. They learn the basics of assessment and time management on generally healthy stable patients. Once they've been on their own for 6-12 months, THEN they get oriented to L&D, and that on its own is 3-4 months of orientation.

I'm sorry. I think what you're describing is unfair to you, as well as the patients. I don't have an answer for you, other than try to find a different job that has a better orientation program.

[klone, MSN, RN]

And I want to be clear: you have NOT FAILED. They are failing you, and all the other new grads they're training by giving such a short, barely-scratch-the-surface orientation in such a critical, high-risk area.

[JKL33]

I am about 7 weeks into my orientation and signed a 2 year contract with the facility.

Ironically I had the manager come up to me and ask if she had "misinformed"'or "misled" me in anyway when explaining the position during my interview. Granted that was week 2 and I had barely seen just how chaotic it could get.

Wow. Well of course she asked you that! They know full well there is a problem and their solution is to put a brand-new employee on the spot to answer a question they can't yet answer, which, even if the brand new employee already suspects that things aren't quite as purported, they would then need to call their new supervisor a liar, essentially, or at the very least be in the uncomfortable position of informing new supervisor that s/he did indeed misrepresent things. Seriously. Who is going to be on the floor for only a couple of days (the first week having been consumed with general orientation procedures) and when approached by new manager with this type of question is going to say, "You know, now that you mention it, I think you did kind of misrepresent things."

It appears they hope to catch you at Wk 2 testifying to not having been misinformed or misled in any way so they have their "gotcha" all ready to go should you claim in the future to want out of your contract...

Some underhanded folks, you're dealing with, OP!