Honest opinion on length of time it takes to admit a new labor patient

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Hi everyone,

I have been a nurse for 30 plus years but most of that time was spent working home health and hospice. Recently I have started working in OB. I actually love working the unit because it is nice after 15 years of being present at the end of life to actually be able to be present at the beginning of life.

I have been orientating for four weeks I have worked a total of (11 days) twelve hour shifts. My preceptor has been very tough on me. She constantly finds things wrong with everything I do and is very demeaning in her attitude when what I do is not perfect. After only four weeks she gave me a paper that she and the director of the unit put together stating that I was too slow and that I was only going to be given a four day time frame to be able to competently admit a labor paitient, a c-section patient, and a newborn to the nursery.

Here is a list of the expectations that they listed for me to be able to complete on each patient in a one hour time frame. Patient's Height, Weight, vital signs, assessment, start IV, get labs and send them to lab, set patient up on the monitor, do a lady partsl exam, set patient up on the pitocin drip at 1mu/mn and do all my admission charting on two different charting systems in a one hour time frame.

My question is this to all the experienced OB nurses out there. Is this truly a realistic time frame to be able to expect someone new to be able to function in. I consider myself a very good nurse and I want to be a successful OB nurse. I don't give up easilly and am trying to learn as fast as I can, however trying to learn two different charting systems on the computer, where everything is located in a new hospital, where all the departments are in a new hospital, the flow of the new paper work, how to operate the new equipment like the warming units, the fetal heart monitor, each doctors different protocol for admission and how each doctor likes their delivery table set up is a lot to learn. I don't feel four weeks is a long enough time to judge someones abilities on being able to be successful.

There is a lot more to the story than this brief synopsis and I have submitted a letter to human resources about the way I was treated, but I don't want to spend hours boring you with those details. Basically I would just like to know from some experienced people if you expect your new employees to be able to meet all of those goals in a one hour time frame. Any feedback you can send me positive or negative will be greatly appreciated.

Thanks... Donna AKA Bandaidlady

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Hi - I am sorry you are feeling so stressed. :redbeathe

It takes longer than 4 weeks to be oriented to any speciality.

And learning new computer charting systems, where supplies are, how to operate things, learning how each doc likes things ADDS time to what your preceptor and the director want you to do in an hour.

They must take into consideration, you are new and learning.

If you are asking me simply - how long does it take to do the following for one patient at a time:

"Here is a list of the expectations that they listed for me to be able to complete on each patient in a one hour time frame. Patient's Height, Weight, vital signs, assessment, start IV, get labs and send them to lab, set patient up on the monitor, do a lady partsl exam, set patient up on the pitocin drip at 1mu/mn and do all my admission charting on two different charting systems in a one hour time frame"

I would say an hour should do it. But that is when you are appropriately oriented to your job - which takes a lot of time. Labor and Delivery is complicated - things can turn on a dime.

I'd ask for more time, pointing out the logistics.

I wish you the best.

steph

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Specializes in Blood Center Collections, Quality and Regulatory A.

I am also sorry that you have found yourself in a difficult "new to the specialty" situation - welcome to reality - "eating the young" seems to fit here as well as "you're a nurse, you should know that" after asking a question....

I've never worked in L&D or OB, so I can't help you there but just know you aren't alone and you are in a difficult situation - it may not be you at all.....

Good luck! Just keep hanging in there and fighting the good fight if that is the specialty you want. Also congrats on having a job - it seems there are too many posts about lack of jobs lately and difficulty getting the training you need to transition to a new specialty...

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Specializes in Rural Health.

To answer your question simply, is 1 hour enough time, not always. Very rarely do I get a patient totally admitted including the paperwork/charting associated with the admit done in 1 hour. *Something* always gets in my way. Does that make me a horrible and incompetent nurse? No, it makes me fluid and able to roll with the punches of OB nursing.

Keep your chin up and keep trying. You'll get there!!!!

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Specializes in L&D.

Four weeks is not enough for you to be a competent labor nurse, but other things being equal, you should be able to do that admission in 1 hour by now. Does your preceptor have any suggestions for how you can better organize yourself during admissions. Or talk with the other staff nurses about how they organized the tasks associated with admission.

Perhaps you could work with another preceptor for the last part of your orientation (which seems short to me). Some people's personalities just don't mesh well and it's hard to learn from someone who has a teaching style that you find demeaning.

Good luck

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Specializes in L&D, High Risk Antepartum, Postpartum.

Not only is it unrealistic after 4 weeks of orientation for you to complete all those tasks, it could be potentially unsafe. Usually the more experienced OB nurses run our triage area at my facility, just like in ER. Those nurses start the admission process and then pass it on to a nurse working on the floor. When you are the nurse admitting a patient you need to feel confident enough to put on those monitors and be ready to recognize when urgent interventions are needed, such as a stat c-section. Your nurse manager should be encouraging you to take the time you need to feel confident in your FHR monitoring, vag exams, and assessments before putting time expectations on you. And it sounds like you need a new preceptor. Preceptors are suppose to encourage questions and promote education. We need more OB nurses!! Talk to your nurse manager and ask for a new preceptor. If you still get the same reactions, you might want to try another facility.

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Specializes in obstetrics.

I totally agree with the about postings! 4 weeks is not enough time for proper orientation is a specialty field. I would ask to be oriented by someone else.

Good luck and keep on going!:yeah:

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I think a lot of it depends on the pt as well. I CAN be done in one hour IF the pt gets gowned, and pees quickly and gets in bed and answers my questions quickly. We admit many inductions around 5AM and I find that they can move VERY slowly and half the time they will be talking with their family (or on the cell phone even) while I am trying to get the adm assess done and they wont pay attention.

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It really saddens me that you are being treated this way. We have a nursing shortage and you are an experienced nurse!!! They should be happy to have a nurse of your caiber on your unit. You could bring knowledge from your other experiences to labor and delivery!! Four weeks is not nearly enough time to be oriented to labor and delivery.

I'm an experienced labor and delivery nurse and it takes me an hour to admit a patient. One bit of advice I can give you is to start assessing the patient the second you meet her. While walking her to the room you can start asking her questions look at her hands, face, feet (if possible). Ask more questions while getting her on the monitor and starting her iv. If my patient was on her phone like one nurse stated earlier I would kindly ask them to hang up and to give you their full undivided attention. The patient is your responsibility and the information you are asking them is very important!!!

Keep trying and I agree with some of the other nurses ask for another preceptor. Good Luck!!!

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Specializes in Labor & Delivery.

I've been an L & D nurse for just under 3 years now. When I was in my old place of employment an hour usually was enough time to get my admission complete. I have changed employment and i'm lucky to be done in an hour! A new place....a new way of doing things! I struggle even more with the hour after delivery. We should ideally have the pt ready to move to PP after delivery but that takes me FOREVER! I still dont have my "flow" and the charting is still time consuming. But I know from experience that in time i'll get the hang of it! So I try to take it easy on myself. Hang in there...it really does just take time.

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I want to thank all of you for your wonderful words of encouragement. It means a lot to me to read your kind words. Unfortunately the hospital placed an ultimatum on me by telling me to either sign the form or resign the position. I left the unit and went to human resources and filed a grievance. It hurt me to do this because I am not that kind of person. The only thing I have asked for in the grievance is to be transfered to a different OB unit in one of the other local hospitals in the system.

There are currently two night OB positions open in another hospital in my area that is owned by the same company. I wanted to try to stay in the system since I have worked in it for sixteen years. I was told by human resources that if there were other experienced applicants who have applied for the position then the other hospital does not have to let me transfer.

I was totally disillusioned at this point and stressed to the max, so my doctor has given me a four week stress medical leave to give me some time to sit back and think about where I am going with my future. It saddens me that hospitals treat good employees this way. I have worked in management for this system for the last sixteen years as a home health- hospice supervisor. In that time frame I never asked more of my employees than I was willing to do myself. I always helped the new orientees and made sure they got the best of training. I got up in the middle of the night to go help a nurse that was having problems getting a patient's pain in control even if I wasn't on call because my fellow nurse needed me and the patient needed me and because it was the right thing to do.

I know that not all nurses have the same type of personality or dedication that I do but I was totally blown away that this company allows supervisors to treat their new employees this way. It is sad really because I think if given a little more time I could have been a really good OB nurse.

Again I want to thank all of you for your kind words of encouragement. I have always found that when times are the hardest there are always great nurses out there to help pick up the pieces and I thank God for you every day of my life.

Donna AKA Bandaidlady

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Specializes in OB.

I can do it in 1 hour if I'm rushing at full speed AND I've been doing it for 11 years! There's no way I could have done it that fast in my first year in OB!

It was a good year before I started feeling at ease in OB. Most people I know say that. 4 weeks is not realistic or fair.

Good Luck!

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