Help me manage 2nd stage, please. New Gr

nursenatalie, ADN, RN · Feb 27, 2006

Ok, I may not be the one to answer your questions as I am not a L&D nurse. I have, however, precepted many people. Your question "help me manage 2nd stage" seems to be only the tip of the iceberg. I am sure there are many clues that signal different nurses when to prepare for delivery...ask everyone you work with what prompts them to get things rolling. Sounds like no one was in charge when you had the delivery without md on bed. Talk with that preceptor and tell her that you need clear instructions of what is expected. If you had no instruction or hint on when and how to get things rolling or how to do bp cuff then you had no business being in charge of the situation. How far are you into orientation? Sounds like your process could use a little organization. If you are early on then don't give up, and take responsibility for learning what you need to. Keep a notebook and jot down things you learn each day and reference back to it. This is a good place to put things such as Dr. X wears size 7 gloves and prefers this, and really hates this. Don't assume who is doing what, that should be designated early on. It only takes your preceptor a minute to say "this delivery is yours, I'll step in if you need me." Be proactive, ask questions until you get an answer, just be sure you listen and learn from questions answered.

lafrn97 · Feb 27, 2006

Be patient with yourself. Do these nurses not realize that you're going to be a part of their team? You would think they would want to teach you the best they could. Labor & Delivery is challenging enough let alone being a brand new nurse. Sounds like your hosp. needs a more organized orientation program. Don't be afraid to ask questions.

jessnurse05 · Feb 27, 2006

Hi,

I am not an L&D nurse, so I can't give you any info there. But I am a new grad and I had a similar experience with orientation. I oriented in Peds for 3 months with the same preceptor, but it took until the 5th week when we had a meeting with the manager for me to realize that there was a BIG gap in our communication. I had a good talk with my preceptor and we found out that we were not communicating about so many things, there was even an issue when I was joking about something and she thought I was serious, so she thought I hated working there (I had been joking about her sitting around all the time while I did all the work). So I suggest trying to sit down with your preceptor (it took me about 10 minutes to have this conversation) and say "look this is where I am, this is what I'm comfortable doing, this is where I need you to cue me as to what to do" and go from there. My preceptor and I even came up with a signal that meant I was over my head and needed her to step in. Also, ask for feedback (positive feedback too!) about how you are doing. I also would try to talk with my preceptor at the end of the day and say this is how I felt the day went, this is what I thought I did good, this is what I know I need to improve on, what do you think? I probably drove her nuts, but I NEED to know when I do something wrong or even if there is a better way than what I am doing.

Also, ask your manager if there are any educational materials about L&D that you can look at, it may help if you can say "I read that such and such is supposed to be handled this way, is that what you do?" instead of just saying "I don't know how to do this." They say there is no such thing as a stupid question, but I know people got tired of answering mine, and they wouldn't say it to my face, but I know they were thinking "did she learn anything in nursing school?"

I hope everything works out well for you. :)

Jessica

**canoehead, BSN, RN** · Feb 27, 2006

You almost have to be there to tell when the doc needs to come. But even if it's a primip I would call and notify when she's fully dilated. You might end up calling again in 30 seconds if she's pushing well...

Definitely have a heart to heart, and then maybe ask if it would help if you went over each delivery afterwards, and save some questions for then. It's hard to concentrate on the patient and answer questions at the same time. If you are far enough alone in your orientation some questions may be hard to answer honestly and thoroughly with a patient present.

SpudID · Feb 27, 2006

Just to fill in some more details. Patient at last check was 6 cm and never had a subsequent check. I have not been taught cervical exams and really they seldom do them at this hospital. She never made an all out pushing noise (I know what that sounds like) but two briefs moments I thought she grunted. This is a hi risk L & D. Mom was also GDM and spanish speaking only. I was a little lost because I wanted to ask her if she felt like pushing but was a little tongue tied. I will have some time to talk to my preceptor tonight I hope and at least establish some communication guidelines. Thanks for everyone's help.

ERNurse752, RN · Feb 27, 2006

Don't just assume that it's you. Some people just aren't good teachers, and it sounds like you're having some bad luck in that area! Is there any way you could go back to the second preceptor, the one you had when you felt like you were actually learning? It is so important to have a preceptor who WANTS to teach and is able to teach you - different people have different ways of learning, just as different people have different ways of teaching.

I hope things go more smoothly for you soon...hang in there.

pie123 · Feb 27, 2006

Dear All,
I am in week 4 of my preceptor/new grad orientation on L & D. My experience has been rough. I spent two weeks with a preceptor who disliked precepting and refused to answer questions. She would become frustrated with me and then ignore me in the room and take over. (Admittedly, I had no idea what I was doing or what was expected of me.) She stopped long enough to chide me but never to instruct. An example would be she wanted me to change the BP cuff to auto q 15 minutes. I had never used the machine and couldn't figure it out. She later sent me to an empty room to "figure it out." I asked for a manual for the machine and she said there wasn't one. She refused to go with me and also told me to become familiar with the items in the room. Later, she asked for a patient O2 mask. I could locate it but then she wanted me to connect the water to the wall and then the mask to the water. Again, no one had showed me how to do this simple task. I couldn't do it fast enough. She became angry and then I was an observer in the room; She took over. After two weeks of her complaining about my inabilities (What did you learn in school?), I told the manager that this relationship did not seem healthy for either of us and could I have another preceptor. I was transferred to a second preceptor while my permanent preceptor was being trained in PBDS.
My second preceptor, one week, was great. She taught. Gave me my first tour of the birth room and demonstrated how to use every piece of equipment. She was patient with my questions and never discouraged them. She allowed me to function independently until she saw me ask and she would assist me in finding the answer or take over when it was no longer safe (my first crash csection).
My third preceptor is so nice. I really like her as a person, but I am lost, again. I feel like it must be me. How can I have another preceptor who is a bit frustrated with me unless it is me? Again, I really like her. She is a nice person, but I feel like she is letting me fail with no clear parameters. For example, I had told her I didn't know how to manage 2nd stage and I was unclear about when to page the Dr., Peds, Birth table set up, ect. . . Last night, during 2nd stage, I didn't page the Dr. I was waiting for her to tell me when to do that, because I had already stated that I was unclear about this stage. Instead, she said nothing and baby was born w/o a Dr./CNM on the bed, because I didn't page anyone. Mom was a multip and making minor grunting noises but I was waiting to be told to page or at least asked if I should.
Previously, she has told me that she finds me challenging because of my constant questions. So I am stuck. I can't ask questions but I am supposed to know intuitively answers. Lastly, she never stated that I was the primary nurse for 2nd stage. I guess we were both waiting for each other.
Can someone help me with practical suggestions for 2nd stage or a book or something? I am a previous doula with over 100 births as a doula. This is a hospital that I precepted at and have volunteered as a doula for 5 years now. I graduated with a BSN with a 4.0 and I am so defeated and lost. I knew being a new grad would be difficult but I felt I was reasonably intelligent and it would all work out. Now I don't know and lack any confidence I had when I started.
Can someone, anyone, please help?
SpudId.

Good luck. It's rough being a new nurse. The learning curve is quite steep. I often tell my husband that I wish I could wake up one morning and already have had at least 1 year of experience :crying2:

RaeT,RN · Feb 27, 2006

I am a new grad, too (with 6 months experience, 3 on my own - :w00t: only 6 more until I have a year - I am waiting for it to all of a sudden get easier:p ) I was very lucky to have an awesome preceptor who loves to teach. One of the other new girls that started with me had an experience similar to yours, and she actually ended up leaving L&D. She went to PP before her orientation was over, and I am afraid that it was because of her preceptor.

See if you can't go back to your second preceptor. And remember why you want to work in L&D. Don't stop asking questions - the dangerous nurses are the ones that pretend to know everything and never ask! And anyone who went to nursing school and went into a specialty knows that you spent a very limited amount of time on this stuff.

As for the second stage: with primips, I will call the MD to let them know she is complete and at what station and ask if they would like me to start pushing or labor down. When they "round the corner" around the pubic bone and the head does not shrink back after she pushes, this is usually when I call them for delivery. With multips, I will of course call and tell them she is complete, and maybe do a little test push to see how well she moves the head. If they really move the head well, then I just tell the doc to come on and I DO NOT put her up in stirrups until the MD is at the bedside. Other people, though, may have other criteria, just like another poster said.

Good luck, and feel free to PM or email me at anytime!

epiphany · Feb 27, 2006

I am in my 5th mth of preceptorship in L&D. My first preceptor did not work out at all, after giving a lot of thought to what I wanted to say, I approached my NM and firmly told her I needed a new preceptor (reason: I am losing sleep for fear of making a huge mistake because my preceptor has explosive episodes of screaming.)

Many orientees assume they have no choice of preceptors, and so did I, but I was pushed to the edge. And I wouldn't say my second preceptor is perfect, but she perfect ENOUGH. She can make you very nervous when she watches you doing a task. I take what I need from her, and when we are in disagreement, I do it her way, knowing I will be on my own soon enough. I go along with anything unless the pt's safety is at risk. And when that happens, I will clearly state that I am nervous and I need her to take over, and then LATER, I go over the scenario with her to see what went wrong. But I won't exchange my preceptor for anyone else because she is clinically superior, and I need her for that.

What I am trying to say is that, I have learnt that you can be proactive in your training. For instance, are you making your preceptor nervous when you ask questions because you're putting her under pressure while she's trying to perform a task? Can you put your questions in the back of your mind, and take her aside later when things are calm? Sometimes you just have to give others a good leeway to have their own quirkiness, and work around it. The important thing is that you learn, and she doesn't react badly to your questions.

Orientation is a b*itch because there is no good design in nursing for training new people. A fellow orientee is almost at verge of quiting or being let go, and as much as we've come to be friends, and respect her immensely, I've been telling this - you may have your needs, but so do others, and that includes your preceptors. For most of us who are not lucky enough to get the perfect mentor, we have to take an active role in changing the situation for the better. C'est la Vie.

jrring1019 · Feb 27, 2006

Was your preceptor in the room when the pt delivered w/o the doc present??? THAT is her fault. She should of stepped in to page or suggest that you do it. Was she trying to teach you a lesson? I don't get it.

I wonder if this has anything to do with you being a doula prior to an RN at that hospital.Seriously.. Like they are trying to say...."She thought she knew everything as a doula, now we will show her she didn't know anything!" Just my thoughts.

SpudID · Feb 27, 2006

Thanks so much for your support! I was feeling lost and alone. I was supposed to meet my preceptor last night to "go over the birth", but she called to cancel. I am going to approach her about her expectations, asking questions appropriately, and practicing independently.

Also, I felt like the birth in the bed was my fault but you all helped me feel better about that. Yes, my preceptor was in the room the whole time. I have decided to let go of that "error". I am not going to own it as mine, but I will seek better communication.

I can't tell you how relieved I am to have some support. Thanks! I was feeling mighty isolated and lonely.

SpudId.