L&D Orientation

[LawyerRN2b]

New grad here! I started my L&D new grad program back in October. Maternal health was the reason I went to nursing school and I was ecstatic to find getting hired so easy. I am a second degree student who graduated in summer 19' and have many "working years" under my belt. The hospital where I am is considered "high acuity" and busy, but I didn't think it was unmanageable. The new grad program seems pretty solid and I have a total of 12 weeks of orientation on the floor (although many of my 36 hours a week are spent on learning modules). Anyway-- my preceptor is fine. She's a little older than me and has been working in L&D at this particular hospital for eons. I thought we were creating a bond to be honest, but I am beginning to wonder if she has totally sold me out and threw my under the bus. I am currently on week 8 of my orientation and doing many of my tasks independently. We train with laboring moms, in the OR, recovery of C-section pts and their babies, triage, and antepartum. Hence-- it is A LOT of information all at once. I thought I was intelligent until I started this job. I have trouble remembering the simplest of things-- like what color vials are used for what lab draws and tests. I feel immense stress and pressure and I guess I just don't work well under conditions like that. Anyway-- I know I am slow, but I had not made any mistakes until last week. I forgot to correctly label a lab and sent it off. When they lab called my preceptor, she appeared very annoyed (as well as the nurse just about to take over the care of the patient). It's policy that when labs are mislabeled it becomes a safety incident and they must be redone. I get it. I effed up. Didn't help that we were talking about this particular lab that morning and how it can be confusing. UGH!!! I apologized profusely, ate my pride, and thought all was well. Until I got called into a "check in meeting". This is where I was greeted by my nurse educator, my nurse manager, and the patient care director. I felt sooooooooooo blindsided bc I had no idea what had happened was SO DIRE. The educator asked me how my week was going in triage and I told her I was still having trouble placing IVs on swollen moms. I also said (in all honesty bc we're adults having a conversation) that I found myself having trouble committing small things to memory. Fast forward 30 seconds and I am being told I am not where I am supposed to be in orientation, it a huge concern that I do not know how to place IVs or draw labs, I do not know how to organize my patient visits (?), I do not know how to organize my equipment for IVs and labs, and I am slow. I would have felt just a little better if it wasn't said to me so icky. It felt slimy and there was definite attitude behind the whole tone of the conversation. I am sooooo willing to learn with absolutely zero ego. Please teach me to be the best L&D nurse ever! Please. But some of these accusations seem bizarre to me. I made a mistake with a label, I AM SLOW b/c I am new, but I do not forget to bring anything to my rooms and the patients never know I am new nurse. I have been told to me face that "they are soooo glad they have a nurse who knows what they are doing". Not kidding. So when this conversation happened I was deflated and I have lost every ounce of self-confidence. I was placed with my nurse manager today who is actually very sweet and didn't say much in the previous call out meeting. I did all I was supposed to do and placed every single IV. My charting was impeccable and I didn't forget a thing. She told me I did a great job and managed my time well. Wonderful. But I really feel like there is a target on my back now. I came home and wanted to go straight to bed b/c I was so emotionally drained. I am beyond angry at my preceptor for putting me in this position--- why not tell me to my face what I can do better? Why tell the managers before me? Is it really that bad? Do I suck that much at week 8? My mistake hurt NO ONE...yes...I admit it was a mistake...but it was a label. I don't know how to bounce back from this and move on. All I want to do is quit. But is that silly? I feel like my educator watched me all day long. Bouncing in and out of triage..... not saying anything but just being there. Maybe I am paranoid. Sorry for the rant...but maybe there is someone else out there that feels the way I do as a new grad in L&D. It is sooooooo hard. So much stuff to remember. SO much stress. If I feel the writing is on the wall now, am I right to just cut my losses and go somewhere else?

[L&D4Lyfe]

Don't go somewhere else and don't freak out!

Oh my goodness you sound so much like I did as an orient and on my bad days, sometimes how I sound now!

A few things that may or may not be helpful: (but let the record show I'm trying to be helpful)

1-- Take the lab draw off the table as to why your check-in meeting happened. I don't think those two are related. It's really common (and unprofessional in my opinion) for Nursing leadership staff to call you in unannounced for those check-in's. I never knew when mine were happening and they freaked me out every time. I thought at first it was intentionally like that but watching now, it seems like their job is so hectic that they just remember on the fly. They're not watching you SO intently that that lab draw mistake is what led them to talk with you. It just was time to check-in.

I have mislabelled in just about every way possible (thankfully at my hospital they let us go down and correct it but still). Can't tell you how many times it's happened to me and my colleagues. It's night shift, we are tired, sometimes moving fast, it happens.

ALSO don't worry about IV's either. You will get it, it sounds like you are getting it, it just takes time. And with IV's you kinda go on a streak of getting every single one then missing a few. Try not to take it personally if you can (thats hard for me to do). Those tasks are definitely important but I remember as a new grad those were like LIFE AND DEATH to me when really they're not as important as the big picture-- caring for and monitoring the wellbeing of a pt and baby in labor. I'm not saying don't care about whether or not you can, if you can quickly, etc. Just trying to say it's not the main thing. Do your very best, if you miss once or twice you call in someone else to help.

Bigger focus= Do you get the big picture? Can you read your FHR strip? Do you know what interventions are important when? Do you know where you're headed in terms of the plan of care (mag/csec/ laboring/epidural) and what you need for those steps? Do you know how to keep someone safe? That's what's most important. Tasks and speed come with time and experience. Just do your best every time. Review, ask for feedback. Keep showing up and showing that you care and fight for competency in this because it's where your heart is at, you can do it!!

2-- the whole "organize your patient visits" stuck out to me. I'm thinking that means that maybe your organization in terms of what you do and when you do it is a little off. I had some trouble with that to start out. Do you have a set way of doing things for each kind of scenario (ex: labor check= put them on the monitor/set of vitals/ moving/leaking/blood/ contractions questions, then maybe a cervical exam if appropriate). Its really important in my experience to do things the same way most of the time, it prevents me missing any of the steps. Maybe take a minute and write out your flow for each scenario and go over it a few times. It's not going to click overnight. Everyone I know tells me around the two year mark it clicks. Some people it takes longer. I'm almost at 2 years myself and I feel like things are coming together more everyday.

3-- Every positive comment you get repeat to yourself. I play the negatives on repeat and had to change my focus in order to succeed. Being hard on yourself is not going to be what gets you through this orientation. You need to hold yourself to high standards but also cut yourself a little slack. You are LEARNING. And when you do well, allow yourself to believe you're doing well. Accepting it won't make you lazy and it won't snatch away your progress.

I literally got into the habit of repeating the kind compliments three times.

"Hey Erika, good job on that."

"Hey Erika, good job on that"

"Hey Erika, good job on that."

DO. NOT. QUIT. It doesn't sound to me like these people are being unfair, doesn't sound like they're creating a toxic space for you. If that's the case, RUN. I had to do that my first RN work experience. Kick that shame and despair to the curb. Do the best you can each day with ears to hear, eyes to see, and a heart that cares and you will get there!!

Keep on keeping on, girl! Don't take things too hard. We need more people in this like you!

[mi_dreamin, BSN]

^What she said. Also, their meeting doesn't necessarily mean your preceptor "threw you under the bus." What you are describing sounds like an error that requires an official report. Where I work an incident report goes to your manager who addresses the incident with the appropriate parties. Since you are still in orientation it makes sense they talked to your preceptor first to get her take on what happened and evaluate your progress.

I am not saying she didn't make comments that sparked the concern, however, as someone who has precepted new grads and even seasoned nurses in a new specialty, I can tell you that it is easy to vent about someone who is new and slow(er) and doesn't have the hang of everything yet, even if you think they are doing a great job.

All that is to say don't automatically assume that she is out to get you - that attitude will color all your interactions and take your focus off of what it is you are supposed to be doing, learning how to be a labor and delivery nurse.

Focus on learning, volunteer to start other people's IVs/draw labs. Be your own cheerleader when you do something right and when you do something wrong ask for feedback, "what can I do differently so that doesn't happen again?"

Mostly don't panic, nobody is perfect, do freak out when you're not. You can do this ?

[Graceisland, BSN, RN]

My advice - keep on learning, try to have the best attitude possible, if you find yourself being called in to more of these meetings, start looking around for other positions. Sometimes it's true that a preceptor decides that you're just not cutting it. I've had that happen to me. Luckily, I'm now in a place that truly values me and my patient centered skill set, while teaching me every day to be a better L&D nurse. It sounds like L&D is where your passion is, and we need nurses like you, so I wish you the best!

[Hoosier_RN, MSN]

Always learn from your errors. If you look at it from the angle of a learning experience, it'll take the sting out.

But, I do want to direct something I noticed in your post. You said it was only a label. The lab can't run that lab without proper identifier. If it was ordered, it was needed for some info. In the dialysis clinic that I manage, staff often forget labs or labeling and then say it was no big deal. My answer is this: what if the lab has a critical result that needs attention now. You've just held up care and that may have disastrous results. On the other end, it may not. But why risk it? Just be careful in the future, and understand where the managers/educators are coming from.

I'm sure that you're going to learn from this and things will start moving in the right direction. Chin up and good luck!

[Natalie513]

Are you a lawyer? I was too :). It’s a big change. 12 weeks doesn’t sound like enough L&D training to me for a new grad.