Have SO Many questions for experienced RNs in Ob/Gyn Nursng

cayenne06, MSN, CNM · Feb 5, 2014

L&D is different from every other nursing specialty. Like you, I went into nursing knowing I wanted to work in women's health. I was a CPM and went back for my RN specifically to go to CNM school (where I am currently enrolled!!!), so I didn't make this decision lightly.

I have been an RN for 2 years and have been lucky to be in OBGYN for almost all of my two years. While I am thrilled about this and recognize how rare it is for new nurses to get into L&D, I am also woefully aware of my lack of basic medsurg nursing. I wouldn't change anything about my career so far, but in retrospect, a year in medsurg would have been great for my skill set.

L&D almost never hires new grads because it is a highly desirable specialty with a decent retention rate and plenty of experienced RNs chomping at the bit to get on the unit. Even with my extensive background as a CPM, I only got my jobs because of personal contacts at the facilities I currently work at. Your best bet, if you don't have an inside contact, is to try hard to get a job at any hospital with an L&D unit, put in your time and then try to transfer as an internal candidate.

Also, don't forget to look for work in OBGYN clinics. I work as an outpatient nurse at an OBGYN (my other job is inpatient L&D), and it is a GREAT way to become familiar with OBGYN and get your foot in the door. The pay is less, but theoretically it might be easier for a new grad to land a job like this. However, I will say that I applied for my outpatient job TWICE and never got a call back. After I met the clinic manager face to face, she told me she had never been given my resume :/ . The HR bots are REALLY hard to get through. I never got a real person to look at my resume until I had the inside contact to request my application.

Another option is to look for a maternal/child visiting nurse job. At least it will give you a little experience in the field and give you something semi-related to slap on your resume! And if you get a visiting nurse job that is affiliated with a hospital (as opposed to a home health agency), you will have the option to apply to L&D later on as an internal candidate, which means someone will at least actually look at your resume.

As far as skills/certs to make you valuable- IV skills are nice, as is ACLS and NRP certification. However, these certs aren't very useful without the experience to back it up. Also many programs won't offer these certs to nurses who aren't working in a field that makes them necessary, because they are pretty useless otherwise and the knowledge you gain will disappear if you don't use it regularly. You can also do online fetal monitoring courses.

L&D nurses do work in the nursery, depending on the unit. We are LDRP and do everything for our couplets, from triage to newborn care. Other units divide the work into triage, L&D, and postpartum/newborn.

I would look into doula training. This is a great way to get experience in labor and delivery, and learn extremely valuable labor support skills. You can also become certified as a childbirth educator- a great way to learn about pregnancy & labor as well as a way to make some money and find some contacts in the field.

Do you know any home birth or birth center midwives? Many are happy to have interested students shadow them. I am a huge proponent of home birth (with experienced providers) and wish more L&D nurses had been exposed to out of hospital birth.

Good luck. Reproductive health is the best field ever!

RunBabyRN · Feb 7, 2014

Bear with me, as I'm still a student, but I am precepting in post partum, and have kept my finger on the pulse of this area quite steadily for years.

I have so many questions I could type all day long but I'm going to keep it short.
I will be starting college in the fall to receive my ADN.
I chose Nursing as the field to go in because I believe my purpose in life is to help people. My first option is to really consider going into L&D.
I think child birth is beautiful despite that there is definitely not always happy mothers and happy babies
True- a lot can go wrong, especially if you're in a bigger city hospital with a higher level NICU
but I want to know the REAL.
I need someone to lay me with the facts and not sugar coat anything and tell me what your average day is like? What's the advantages/disadvantages of working in L&D?
There can be a lot of downtime, depending on your unit, or you can be going nonstop all the time. It varies widely, from what I've seen on the various units where I've attended births or spent clinicals. Advantages- it's amazing. If you're a birth junkie like me, there are too many to list.
Does L&D hire new grads often?
Nope. Almost never (it does happen, but it's extremely rare). Even experienced nurses have a hard time getting in. Slots don't open often, and they're highly sought-after. Plus, there's a lot to know. Right now, the job market, particularly for new grads, is really rough. You may be taking what you can get right out of school, especially if you don't have prior medical experience. I have two very promising job leads in OB nursing (one at a freestanding birth center, and one on the unit where I am currently precepting, though I want to ask about L&D, too), but only because of personal connections.
Getting those med/surg skills down can be really helpful. You'll see stuff sometimes that's out of the usual OB floor spectrum, and knowing how to care for those patients is really important. We recently had an NG tube gone bad on a patient in post partum. We also had a woman who transferred from ICU and was, frankly, inappropriate for the floor, after she'd had an ovarian abscess that went septic. She needed multiple piggyback IV antibiotics, ABGs, respiratory therapy and more that was way out of the norm for the floor.
And is there any extra classes I should consider to take while working to receive my ADN to make me stand out on my resume?
I agree about NRP and ACLS, and I know that here, you can take them even if you're not working on a unit. AWHONN has fetal monitoring classes, and most positions require you take them within 3 months of hire. Doula certification can get you some useful experience, and, likely, connections that will be useful when it comes time for looking for a job.
And also can RNs that work in L&D work in the nursery?
Depends on the hospital. Here, there isn't a well nursery, only a NICU, and that's staffed with its own nurses. Occasionally nurses do float between the units on that floor (L&D, post partum and NICU), but you're usually tied to one unit.
I know I said ALOT. But would really appreciate it if someone laid me with the facts. I want to know exactly what I'm considering but also know that I have to experience it for myself to really know. Thank you to whom ever replies.

@cayenne06- LDRP!! :up: Oh how I wish we had it here!! None of the hospitals in the area do. We're so archaic... At least we're finally getting TUBS in a couple of rooms.

Janinern84 · Feb 8, 2014

I need someone to lay me with the facts and not sugar coat anything and tell me what your average day is like?

Average day for me.

I get up at 4:30, get my kids ready, my lunch ready, and head into work. I get there by 6:30, look at the "day" for what scheduled things are on the books. I work in an ldrp and am usually a charge nurse. I see that it is ethier going to be a no lunch day or an okay day (usually no lunch)

I make the assignments, check the ORs, make sure I have triage ready and a few labor rooms. I look to see what doctors are on and anesthesia. Also, I check on our special care nursery and the social issues on the floor (there are more bad situations than good)

The day changes from there. You never know what your scheduled induction/c/s can do, along with social issues with taking the baby home with the drug addict mother or the teen mom with no resources. There are good patients and bad, you will see

What's the advantages/disadvantages of working in L&D? Advantages - everyday is different and exciting! The good happy families. Disadvantages - no scheduled breaks, fetal demises.

Does L&D hire new grads often? - No.

And is there any extra classes I should consider to take while working to receive my ADN to make me stand out on my resume? Maybe a job as an aide?

And also can RNs that work in L&D work in the nursery? Yes, we do in our dept.

passionflower, BSN, MSN, RN · Feb 10, 2014

l&d is different from every other nursing specialty. Like you, i went into nursing knowing i wanted to work in women's health. I was a cpm and went back for my rn specifically to go to cnm school (where i am currently enrolled!!!), so i didn't make this decision lightly.
I have been an rn for 2 years and have been lucky to be in obgyn for almost all of my two years. While i am thrilled about this and recognize how rare it is for new nurses to get into l&d, i am also woefully aware of my lack of basic medsurg nursing. I wouldn't change anything about my career so far, but in retrospect, a year in medsurg would have been great for my skill set.
L&d almost never hires new grads because it is a highly desirable specialty with a decent retention rate and plenty of experienced rns chomping at the bit to get on the unit. Even with my extensive background as a cpm, i only got my jobs because of personal contacts at the facilities i currently work at. Your best bet, if you don't have an inside contact, is to try hard to get a job at any hospital with an l&d unit, put in your time and then try to transfer as an internal candidate.
Also, don't forget to look for work in obgyn clinics. I work as an outpatient nurse at an obgyn (my other job is inpatient l&d), and it is a great way to become familiar with obgyn and get your foot in the door. The pay is less, but theoretically it might be easier for a new grad to land a job like this. However, i will say that i applied for my outpatient job twice and never got a call back. After i met the clinic manager face to face, she told me she had never been given my resume :/ . The hr bots are really hard to get through. I never got a real person to look at my resume until i had the inside contact to request my application.
Another option is to look for a maternal/child visiting nurse job. At least it will give you a little experience in the field and give you something semi-related to slap on your resume! And if you get a visiting nurse job that is affiliated with a hospital (as opposed to a home health agency), you will have the option to apply to l&d later on as an internal candidate, which means someone will at least actually look at your resume.
As far as skills/certs to make you valuable- iv skills are nice, as is acls and nrp certification. However, these certs aren't very useful without the experience to back it up. Also many programs won't offer these certs to nurses who aren't working in a field that makes them necessary, because they are pretty useless otherwise and the knowledge you gain will disappear if you don't use it regularly. You can also do online fetal monitoring courses.
L&d nurses do work in the nursery, depending on the unit. We are ldrp and do everything for our couplets, from triage to newborn care. Other units divide the work into triage, l&d, and postpartum/newborn.
I would look into doula training. This is a great way to get experience in labor and delivery, and learn extremely valuable labor support skills. You can also become certified as a childbirth educator- a great way to learn about pregnancy & labor as well as a way to make some money and find some contacts in the field.
Do you know any home birth or birth center midwives? Many are happy to have interested students shadow them. I am a huge proponent of home birth (with experienced providers) and wish more l&d nurses had been exposed to out of hospital birth.
Good luck. Reproductive health is the best field ever!

i like and agree with everything in this post except visiting nurse option, i don't think new grads should do this independent type role without experience because if an emergency comes up you won't know what to do and also your assessment skills are not yet sharp enough

Road2CNO · Feb 10, 2014

I have been a nurse for almost 5 years and recently started my NP program. After some circumstances within my family I have decided I want my focus to be Neonatal so am now looking to get into NICU. I have an interview for an OB unit tomorrow to get me some L&D and nursery experience but also plan to shadow a friend who works in NICU this week. I was not originally passionate about OB or nursery but now it seems to be all I can think about and can't wait to land a job there.

cayenne06, MSN, CNM · Feb 13, 2014

i like and agree with everything in this post except visiting nurse option, i don't think new grads should do this independent type role without experience because if an emergency comes up you won't know what to do and also your assessment skills are not yet sharp enough

I kind of disagree. Yes, you should get some solid training on postpartum care and newborn assessment as well as a comprehensive orientation, but all that should be provided by your job. More importantly, you need to seek out solid breastfeeding training and be prepared to answer breastfeeding questions and provide skilled, hands on support. For some reason, lactation support is something that OB nurses do not get adequate training in, and a visit by a nurse skilled in lactation counseling can make ALL THE DIFFERENCE in a couplet's breastfeeding success. I personally feel that comprehensive lactation training should be required for all LDRP and M/C visiting nurses. It's shameful that we do not make this a priority. SHAMEFUL.

But. Honestly, M/C nurse visits are, IMO, a great place for new grads. These are healthy patients we are talking about. Yes, it is possible you could run into an emergency like a delayed PPH or a septic baby, but with basic training, these are easy to identify. You are much more likely to discover complications such as mastitis or infected incisions, babies with suboptimal weight gain, things like that. These are all easy to identify with very basic training, and then all you have to do is whisk these patients to the ER or call the provider for an urgent or nonurgent appt, if it is not emergent. Yes, it can be scary to be out on your own, but the patients are straightforward and your main role is providing reassurance and education.

Katie71275 · Feb 16, 2014

I started in L&D as a new grad. In fact, me, and one other nurse in my class, both started as new grads(her with a different hosp but in the same town). It's possible, but is hard. We see patients 14 weeks and up. Below that, the ob is a consult to the ER. We also run an OB clinic through our hospital, so we frequently get patients that way vs walk up or being sent over from a separate OB clinic. We have some emergencies, such as seizures, hemorrhage, emergency sections, etc. Many of our patients are low income, high risk, and come in with no or insufficient prenatal care. We have fetal demises(lately it seems like we have 1 every week or 2). Lots of complications such as pre-eclampsia, chronic hypertension, Diabetics(Type 1 &2, and gestational), etc.

It can be really slow here, or can be very hectic and busy. I LOVE it!