How can I survive in L&D?

[Jiayou]

Hello,

It is a terrible experience, and I feel so shameful to share, but I really need some advice to help me out of this deep dark hole ---I am so lost in L&D. I didn't have any confidence now...I don't know if it is my problem - am I too stupid or - the environment just not good for me....

Although it was very tough and challenging, I have survived in L&D for 6 months, including 10 weeks orientation. I used to take care of two pts in the night shift, no matter how hard or easy my pts were. I gradually built up my confidence. However, after one day, I lost all my confidence. I feel my knowledge and ability are still in the orientation level. I am totally lost - I doubt my ability, judgment, and knowledge...

I delivered a baby without doctor's presence today. Mother and baby's outcome were good. Apgar score 8-9, Perineum one degree laceration, and the pt and her family appreciated my help and said I was a great nurse. However, it did prove my poor judgment - I missed the best time to call the doctor, especially when the pt was G1P0 and on Epidural. I know it was unforgivable, especially in doctor's eyes, but I did try my best. The baby's water bag was so hard and big that I could not evaluate the fetus's station accurately (I am a new grad, but I thought it is not our scope of practice to break the water bag. Even if I could, it was very hard to break, which was proved after I delivered the bag). The pt's contraction was not strong, and she refused to push because she c/o back pain (she had already labored down for one hour) . I spent most of time encouraging her, changing her position so she could try to push without hurt her back. When I noticed that I could see the quarter size of water bag, I realized that I need to call the MD. However, the pt's contraction suddenly changed to very strong and effective. She pushed the water bag and baby's head all the way out ! (She was on epidural,but she couldn't control her push at that time - can anybody believe that?) I didn't have time to think, the only thing I could do was to break the bag, and tried to pull the baby out, and at the same time, let family to go outside to ask for help! My coworker helped me to finish the rest part. The doctor arrived two minutes later after the baby out... He was very mad at me...He did not remember that I already notified him half an hour earlier that pt had pushed for more than 30 minutes, and push not effective, water bag bulging, and fetus's head low.... I felt like I was totally an idiot - what poor judgment I had! I should have called him earlier. Why didn't I ????

You might be wondering why I didn't call my charge nurse earlier. That is another story. I was scheduled to work in the day shift for couple of weeks. The charge nurse treated me like I was a totally idiot, no help or support I can get from her . I never could find her when I need her the most! When she was around me, all she did was blaming me all things I had done (when I was in night shift, none of my night charge nurses blamed me). I was very stressful when she was around. I already notified her that my pt was complete and pushing, but she never showed up in my pt's room, nor assigned an OB tech with me. When I pressed the call light, nobody answered me, so I asked family to go outside to get help....

I was scared and frustrated. I had talked to my manager before about the issue, but she said that I am not competent and too dependant. She said that the charge nurse c/o that I could not take two pts at the same time. The fact is I always took two pts at night shift, and the days I could not take 2 pts were that I had difficult pts. Once she assigned me the drug abused pt who cried all the time and was in active labor - pt delivered in two hours from the time she came to the hospital); another time she wanted to assigned me a new admission who was already 6-7cm dilation when I already had an active labor pt ( cervix dilated 5-6cm, first baby, on cervidil, and had recurrent deceleration - because the MD refused to take the cervidil at the beginning, I had to contact him again and again - After the delivery, pt had PP hemorrhage!) The charge nurse was very, very angry when she realized that she could not assign me the second pt. She said that I don't know how to prioritize, not competent, not ready to be a L&D nurse, and she would write me up... I know I am not good enough. I am still new and I am still learning. She is right. I am still slow and not effective as those experienced nurse. But am I really bad as a 6 month new L&D nurse?

I never believed her. I trusted myself before today. But after today, I realize that maybe I am not smart... My self confidence was severely impaired by today's incidence and charge nurse and manager's attitude. I began to doubt myself. I could not make a good decision the rest of the day. I even could not give a complete SBAR report. What can I do? How can I survive in this kind of situation? I am also worried that maybe our director will fire me because I am so bad...

I am very sorry the story is too long. However, I will really appreciate it if you can give me some guide.

[Bill E. Rubin]

While I have no L&D experience as a nurse, I can't speak for that. But the way you describe your feelings sounds very familiar to me (and no doubt everyone who can remember their first year in nursing. The hardest part isn't when you're brand new, but in that novice stage when you start getting little inklings of confidence.... that confidence, however, is easily undermined. It would be nice if you had a supportive environment. :hug:

[mamamerlee, LPN]

Sounds like you were doing everything you could, and your outcome was appropriate. No two labors are alike - you know that - and this one became precipitous. Seems like you did very well.

There are very few nurses who even begin to feel confident much before a year - go easy on yourself.

Best wishes.

[netglow, ASN, RN]

Sounds like you are certainly working with people who have "issues". Anyone who would compromise: a mother, a baby, a nurse, a physician, a facility -- instead of just stopping by or calling you on your phone to offer advice are selfish idiots.

[momababyrn]

You are doing just fine! There was no way you could have know a G1 P0 would deliver that quickly in those circumstances. only God knows, not us (doctors and nurses alike) when babies will be born, we can only give our best most most educated guess. The charge nurse you are working with also seems quite unreasonable and her demands in my opinion are unsafe ones. She should be the one who is written up for unsafe and improper assignments. A charge nurse must make decisions based on acuity as well as staff ability. What she was trying to assign wouldn't be safe for even the most experienced nurse on the unit.

Would you be able to back to nights where at least the nursing staff was more supportive? While on nights you could maybe try to stay at least till 1 year then start looking for another position where there is a more collaborative and professional environment

Hang in there and don't let these nurses, doctors, and this hospital steal your love of what you do.

[klone, MSN, RN]

Oh, honey. I'm sorry. First of all, the RN delivery was, IMO, not your fault. She was a G1 with an epidural. How would you have known? RN deliveries happen sometimes to the best of us. Especially since you had already communicated with the doctor 30 minutes prior that she was complete and pushing. He should have made his tooshie down to the hospital at that time, especially since she was intact with a BBOW. A prudent doctor, IMO, would have made it a priority to come in and AROM her, so as to assess the fluid status. Nobody likes surprises like that at delivery.

As far as the other stuff, I always hate to comment because I know there are always three sides to every story. Based on what you've written, though, it doesn't sound like you're being supported. I'm sorry for that. Can you go back to nights?

[Jiayou]

Thank you everybody for your understanding and encouragement. Your warm words really infused in lots of strength to me. I really appreciate that.

No, I don't have choice to switch to the night shift even though I am suffering or torturing in day shifts. I already talked to my supervisor. Because I am new, I have to work on the days they assigned me. I tried to read more books, take more classes, and study more to make up my knowledge deficit problem, but I really don't have any idea how to survive in that environment.

Thank you everyone again for your support.

[redbeads]

All I can tell you is that it takes a long time to feel truly confident and comfortable in a new job! For me, I felt at ease (and this is not to say that I felt that I knew all) after 2 years of working in L&D, and this was with a very supportive group of more experienced coworkers! I am sorry you are having such a rough time. If you truly feel that you have a passion for Labor and Delivery, stick it out. If not, I would recommend trying another specialty.

As far as the doctor not making it to the delivery, too bad, he had his chance when you first called him. And, in my humble opinion, any L&D unit that does not pounce on the call light the minute it goes off needs more staff!! We all know how fast things can change and how just minutes can make a difference.