How do you know if you suck? ;-)

[seemerun]

I have been a nurse for a good while but 5 months ago I switched from the med-surg arena to L&D. I had 8 weeks of orientation and have been on my own for 3 months now.

I have spoken many times over with nurses who have been around and the thing I keep hearing is that I won't feel comfortable for about 2 years and won't feel good and proficient for about 5. I am OK with that. However I can't shake this feeling that even for only 6 months in I'm just not doing well. I feel like there are some pretty basic things that I know to do but it's not on auto pilot yet and often have others reminding me to do.

The other day I had a pt come in. 5cm. I was only about halfway through her admit process (luckily IV in and labs sent) when baby had a significant deceleration. I did the normal IU resuscitation. Turned one side and then to the other, started fluid bolus and 02 which did not resolve it. I hit the staff assist button because I knew I needed more hands. Coworkers were awesome. Had several people come right and fly into action. My team lead did a cervical check, placed a scalp electrode and got her in knee-chest position all the while calmly talking to pt about what was happening. Other people called the midwife and set up the tray for delivery. All I did was chart at that point - albeit there was a lot to chart in these situations and someone needed to so it but I felt so stupid that this was MY patient and someone else was doing all the hands on/patient care.

If I could have stopped time for 2minutes I could have thought through all the specifics that needed to be done and implemented them but of course you can't stop time. In the chaos I got all scatterbrained instead of focused. Can the "perform under pressure" trait be learned or this just a thing some people have and others don't? Also because the pt went so fast not everything was set to go at delivery. My bag for pit wasn't ready to run after the delivery of placenta. Not the biggest deal ever I guess but with so many other people helping, you think I could have remembered to do some of that basic stuff.

We generally have 2 nurses in at time of delivery. One for mom and one for baby. It seems like I often find the baby nurse jumping in and helping with mom stuff. I.e. coaching on pushing, updating stuff in computer. I don't mind the help - and I am fine if it is done in the spirit of teamwork but I get the feeling it's because they feel like I am forgetting or not doing a great job. I don't know. There's other things too but you get the jist. I have not been "talked to" by management to say I am not performing to expectations but that is certainly how I feel.

This is what I have always wanted to do and I feel so honored that after all these years I am finally able to do it. But if its not a good fit for me I suppose I need to know when and how to bow out gracefully.

In every other field of nursing I have always felt nervous but found things came together just fine and I was "better" than I gave myself credit for. But here it feels the opposite...

[megan005]

I'm still a new grad so I'm somewhat in the same position as you are but when I did my placement in L & D I thought the same thing as you and almost didn't apply for a job because I felt like I wasn't good enough. My preceptor was awesome and reminded me that L&D is completely different from any other type of nursing so you are essentially starting at square one. From what you described it seems to me like you;re doing a good job, you know when you need help and ask for it. I would suggest having a checklist for admission,epidural,delivery,postpartum ect to help you remember things when it gets crazy but other then that if your co-workers are saying your doing fine then chances are you are.

[NurseNora, BSN, RN]

Last night, as my patient was pushing, I was having trouble keeping the baby on the monitor and the baby nurse took over adjusting the monitor from me and was able to get a much better recording than I'd been getting. I felt a little stupid and a little resentful of her taking that over from me. The only difference between you and me is that I've been doing this for forty four years and I'm very confident in my skills. But I still had that momentary "She thinks I'm not good enough" feeling. But I was able to let it go as soon as I felt it, because I know I am good enough even if I sometimes need help.

You learn how to function in crisis situations by being in crisis situations. Like everything else, you get better with practice. And you can't do everything at once. There was no way you could have notified the provider, gotten the Pit, coached your patient and charted all at the same time. Good teamwork involves seeing what needs to be done and doing it. Next time you'll remember the Pit and get it or ask one of the responders to get it for you.

When you have an experience like this, learn from it. What did I do right, what would I do differently next time. Often at about six months, a new L$D nurse starts feeling that she's finally getting it and then has an experience that makes her feel that she really isn't getting it and probably never will. But you will. Just hang in there.

[bagladyrn, RN]

From what you relate here it seems to me that you did just what you should have in the situation: tried the simple measures, then called for help. That's one of the important steps in an urgent situation - getting enough hands in there to do all the things that need to be done simultaneously. In that case each jumps in do do what they may do best - someone starts an IV while another gets a quick exam and a third is grabbing the phone to call a provider, and also important, someone is noting the time and order these things are done for accurate safe charting.

On a unit with good teamwork we all just help each other as necessary (or even if just convenient rather than necessary) just as a matter of course. If you listen carefully you will hear even the most experienced nurses or even the providers get a subtle "nudge" from time to time for something they may have overlooked. Usually it's in the form of "Do you want me to set up (whatever they feel is needed) for you?" or "Can I get you a (instrument, monitor or whatever)?". We all need that on occasion if we get too focused on one aspect. It's not a put down, it's an assist.

Really, as others have said, give yourself that year or two before you expect to feel confident in the routine OB routine.

[seemerun]

Thanks so much. I don't plan on going anywhere. I just really really can't wait for the day when everyone knows me and trusts my judgement. Heck for that matter I will be happy to trust my own judgement!

[lovemyjoblandd]

I've been doing L&D for about 3 years now, but for the first 2 I was in a LDRP and did a lot of Mother/Baby and triage, but not a heaptons of labors. I was in the army and we didn't do very many inductions and when we did they were lady partsl cytotec and manual dialation with foley bulb, worked with a lot of midwives, did a good bit of vbacs, and very few c/s at night besides crash ones. I managed labor patients on my own, don't get me wrong, and felt pretty good about my skills. I was charge a lot of times and was extremely proficient in that role and mother/baby and nursery. When I decided to get out of the army I applied for a charge nurse position in a L&D unit in a civilian hospital, not knowing ALL the things that I didn't know lol. During orientation at my new hospital, I quickly learned that things were done way differently outside of the army. We do oral cytotec inductions, some cervidils, plenty of c/s, and average pitocin induc/augmentation. VBACs are pretty much a no go. No doctor in house.... I mean a complete change. I went home after every shift and cried feeling completely inadaquate, lost, and embarassed because I was suppose to become a charge nurse. I sucked it up though and continued on because I knew I would catch on sooner or later and regain my confidence. I mean even the equipment here (such as Jelcos, straight cath and foley kits, etc) was completely different so even though ive done literally thousands of catheters I felt foolish the first time I opened a foley kit and it was completely different from what I was used to. My orientator probably thought I was a moron. I've been here about 9 months now and am feeling much better, but still have to ask lots of questions and get second opinions all the time before I call a doctor. Once all those kind of nuances with equipment and different ways of doing things eased, then what I knew about laboring and deliveries came right back to me and I was able to gain some confidence back.

As far as handling the prolonged decel, I think you did everything right. One only has so many hands. You simply cannot do everything you need to do all at once. Getting help is always the best way to go. Many times I've had a decel happen and of course my first reaction is flip the patient now, get O2 on now, start fluid bolus now and get stuck on flipping patient because it takes what can seem forever (but really is only seconds) to get FHT back on monitor so you can determine if flipping has resolved the issue. Everytime this happens I'm freaking outin my head going, "omg, okay baby, show me where u r. hurry up cause i need to grab a FM out of the draw and get some O2 going and i need to pull my tubing out of the pump so I can free flow a bolus. oh man, FHT are still down, i need to call the doc and get the tech to setup for c/s. oh wait, i need to check her cervix, cause maybe we are about to deliver." Of course if no one arrives to help I can get all this done in an acceptable amount of time and the whole time I'm smoothly talking to mom, but in my head i'm screaming for the damn baby to just get better lol. You are not alone my friend.

[Daiseymay]

You are definitely not alone! I was in medsurg for 2 years before going to L&D. I have been L&D for 3 years. I just recently moved from another state and even though I had felt pretty proficient where I came from, I am completely a fish out of water!!! I have been here a few months now... close to 6 now, and every shift I'm thinking about all the things I could have done differently. The culture, equipment, doctors, everything is so very different. I feel like a brand new nurse a lot of times. I know what I should do, but not knowing how others may react around me, where equipment is, or what is completely expected of my role makes me feel very nervous! This hospital I'm currently at is very medicalized and a completely different way of thinking.

[OB-nurse2013, BSN, RN]

I just want to say I left today pretty sure I suck Hoping for better days this week

[seemerun]

Thank you all! Every birth is different and a slightly new experience. But I feel a lot better about things.

Sorry L&DRegisteredNurse! That was my morning yesterday too. :-(

[OB-nurse2013, BSN, RN]

LOL we need a support group hahahah :) It def has good days and bad days

[Little_Babycatcher]

What a perfect thread! I have experience in Med-Surg and Ante/Postpartum/Baby and have been on L&D since April. I'm still in orientation there and will spread my wings in September...

I definitely have days where I feel completely inadequate!! I keep expressing my concerns to my preceptor, and she assures me that everything is fine but still I just feel so stupid sometimes.