How do you learn anticipation

nurse4theplanet, RN · Nov 22, 2005

oh Heaven's Yes! And I am not even in L&D, but ICU. Just have to get the experience under your belt...that is where all 90% of your knowledge comes from. Sometimes we put too much pressure on what we think we should know, that we don't slow down and take the opportunity to appreciate our learning experiences. This was definitely a learning exp. for you. You see your mistakes, you analyzed the situation and what could have been done differently, and you learn and move on. Talking helps. Reading other's similar exp. help. You are smart, you know alot already, and you are handling it the right way...sharing and re-evaluating. Kudos to you!

Altalorraine · Nov 22, 2005

As many of you know I am a APU nurse who has transfered to L&D did a delivery today. (not great) actually given the circumstances i think it went fine, Hindsight is 20/20 multip no epidural doctor at the nurses station pt wants to push, get doctor come in room (babies comming) grab delivery cart from outside door (not fast enough hind-sight should have been in the when I knew she was 8cm. Doctor barley gets gloves on I'm trying to fine heart tones and hold leg (no striups no time) doctor tells me politly forget about heartones help with this leg baby comes out (normal for the next couple minutes) mom bleeds (knew she had a tendancy had extra PIT and 1000 cytotec. Well doctor is doing stuff with mom ask do you need anything I have cytotec in room (so I decide to weigh baby I wasn't doing anything at the time but watching) (doctor said not appropiate I can see his point but I was just trying to get a head start) then he wanted methergine, my preceptor was in the room so she went and got in I gave it. Then I'm standing around again anyway we also gave her hemabate and the cytotec before she finally calmed down. He spoke after the fact to my preceptor I needed to anticipate better and prioritize better. I can't disagree with him either I just felt useless standing there without anything to do I kept saying can I get you anything????? Anyway I am just feeling bumbed. I start to feel comfortable then something happens where i don't think I'll make it. Does anyone else feel this way???

It sounds to me like the doctor is taking his anxiety out on you. You did anticipate reasonably well by having the extra pit and the cytotec in the room. Hemabate and methergine are expensive and need to be refrigerated; it's questionable whether that should have been in the room already. We always keep our delivery carts outside the room because there's no space in the room until it's actually needed. And believe it or not, stirrups aren't necessary for delivery of the baby. It's true that weighing the baby isn't a priority- well, live and learn. It sounds like it was a precipitous delivery and wasn't smooth as silk; that's not your fault, and don't let other people blame you for things that don't go perfectly.

Altalorraine

SmilingBluEyes · Nov 22, 2005

I think Altalorraine spelled it out perfectly. Don't be so hard on yourself. We can't anticipate EVERYthing. I do have things like Hemabate and Methergine sitting on ice in the room, at the ready "just in case"-----as you know, even an uncomplicated delivery can go bad-------and we have "tackleboxes" with suture, pitocin, blood tubes, needles/syringes etc that we take to every delivery so we are ready w/those things. The rest? Well it's not a huge deal----you get to it when you can.

Don't be hard on yourself. You can't anticipate EVERYTHING!!!! You just learn from experience and still will get caught "unawares" now and again. I think you must be outstanding, just from your posts here. Really!

Dayray, RN · Nov 22, 2005

I agree with those above. You did fine; you had the cytotec there. When things looked okay it was fine to weight the baby. If things weren't fine at that point he could have told you.

He was probably just frazzled and maybe a little upset because he saw you struggling with the leg and heart tones. Those are things you get better with over time. I remember doing the same kind of thing when I first started L&D. It becomes natural after a few hundred deliveries. Hold leg with this hand, tones with other, listen for heartbeat and watch patient, talk to patient, feel for contractions, have warmer ready... there is allot to it so don't worry you will pick it up.

You handled this fine. The first time you see a new kind of complication you are supposed to watch and ask what you can do to help (which you did). You can't be expected to anticipate things you have never experienced and that's why you have a preceptor. Your not supposed to be the all-star you're supposed to learn.

I came to this area from a critical and emergency care background. You would think that coming from that background I would have handled emergent situations in L&D well. No, I was like a dear in headlights every time something new happened. I remember the feeling of losing all critical thinking, skill and judgment. All I could do was stand there and say "tell me what to do". I was like a robot following other people's commands.

Once (during my first shoulder dystochia) I remember praying quietly and all I could think was that the baby was dead. I couldn't remember the interventions I just did what everyone told me and after what seemed like an hour (it was actually only 3 min) the baby came out. I leaned heavily on the more experienced nurses on the unit. Now when I have a dystocia I know what to do. It's just me and the doc in the room, no one has to tell me anything and unless it's bad we don't usually even have to say a word we just both do our jobs and the baby comes out fine.

The ability to anticipate these things comes with time. Don't beat yourself up too much but do keep an objective view on your skills. Review everything in your mind and figure out what you can do better next time. Admit to yourself the areas where you are weak and work on them. It's okay not to be perfect as long as you keep getting better.