Need Encouragement!

mombabyrn · Apr 6, 2008

First off I'd like to say 90 views and no replies, guys??!!

Congrats on landing in L&D, secondly.

It takes at least one full year to feel comfortable in L&D. There is tons to learn! It can be a very stressful place. And even when you have done it for 20 years you are still learning because there will always be something new in the field. Also, the minute you think you know everything, you become dangerous. No one knows it all, to have that mindset puts you and your patients at risk.

That being said, one week to learn to circulate is a short time. So to not feel completely comfortable is understandable, for sure. Depending on your set ups, they can be pretty straightforward or a plethora of instruments, most of which you are going to use and to look at them initially and try to memorize them all can seem overwhelming. Are you learning to scrub, too? I think learning to circulate and scrub in one week is not really possible.

Plus I would hardly think you are spending your entire shift in sections, right? So it's not like you had 36 or 40 hours straight of surgery.

It is your preceptor's job to train you appropriately so that when she signs off on you, that you know what you are doing. If she is taking it seriously (sounds like she is) and she feels you aren't ready to be on your own yet, then she is obligated to say you need more time. Not everyone is ready in 12 weeks. I think it's a bit crazy to think you should feel ok in L&D after such a short orientation. And a week to learn to circulate with no OR experience... I think that's pushing it, too. Don't be hard on yourself. It's much more important that you be competent than you be a fast learner!

Good luck!

jodyangel, RN · Apr 6, 2008

Well thanks for replying.

I did have one week straight of 8hr shifts doing the CSections. Its just; as you know; an art of doing many things at once. Watching for the first incision and calling out. Waiting to hear slurp of suction and knowing thats whey you pop down to the bottom to see the actual birth for time THEN running back to the pc to get actual time. Its tons of paperwork lol. I've done Med surg and believe me there is Soo much more paperwork in Maternity. I had no idea! Bad thing is; we do pc charting AND paper charting for some reason.

I do feel good about my week. But do I have my routine down perfectly? No. So I don't have a problem with a few more shifts. In fact I'd Love them to prove I am competant and safe there. I just wondered if others had any similiar experiences.

Well tonight I start High Risk lol!! Wish me good learning and good luck!

nurturing_angel · Apr 6, 2008

You are doing fine. It does take a bunch of time to feel competent in OB and if C-Sections are not a several time a day every day occurrance, it WILL take more than 1 week to learn it all and feel comfortable. Don't be discouraged. It will come with time. You are doing GREAT! :yeah:

:saint:

jhhrn68 · Apr 6, 2008

I oriented to L&D for 6 months, then the nursery and a couple of days in PP. When it came time to learn to circulate (after I had been working for awhile), I got 2 days. It took me years to decide I was ready to learn to scrub. Being the scrub nurse is actually easier ( alot easier!) than circulating but I still prefer circulating. It took me a long time to get it down. My learning curve is longer now that I am older. I had 2 days of orientation to scrubbing and have scrubbed 2 or 3 times. I am not sure if I could remember the instruments now.

StudentToo · Apr 7, 2008

Boy...do I know exactly how you feel!!!! I had a week of OR training too..I agree it is not nearly enough time! That said..after only a week..I realize that the OR is not where I want to be. This poses a problem for me because we have a high c-section rate, which means I could end up in the OR at any point during the day. I got totally flustered one day, and the nurse who precepting in the OR told the nursing educator,who thinks one more day would do me good. I agree, except I hate the OR so much that I can't even fathom going back in. If you love your job, then don't let it get the best of you! You can do it..take that extra time they are giving you!! I..on the other hand think L&D is not for me..too many adrenaline inducing moments! LOL Good luck to you!!

LDRNMOMMY, BSN, RN · Apr 7, 2008

One thing that helped me to learn the instrument names was volunteer to count trays before they needed to go down to CSS for processing. When I worked nights and we had a busy night there were sometimes 2-3 trays to be counted. Volunteer enough and before too long you will know all the instruments names and how many are supposed to be on the tray. Have your preceptor do this with you.

It is tricky to get the hang of C/S with circulating, and charting on the computer. It takes time. Maybe your preceptor can arrange for you to be back in the OR's on days when they have a pretty full schedule. If that is not possible maybe your preceptor can work assignments so that you will be in the OR for a c/s if one is happening at shift change, or if a c/s is anticipated during your shift.

Congrats on working in L&D. It does take time to feel confident in L&D.

NurseNora, BSN, RN · Apr 7, 2008

Just because your preceptor thinks you need more time, does not mean that you are a slow learner. Everyone has different strengths and you will probably pick up other things more quickly than average. Just be glad you and your preceptor agree that you need more time in this area and that you will be able to get more time (from the way it sounds).

All of L&D involves thinking about several things at the same time. No matter what else you're doing, you always hear the fetal heartbeat in the background, are aware of the sound of the mother's breathing, the posture of her body. You'll pick up the circulating stuff too.

One of the problems of learning instruments, is that the names are a little arbitrary. What we called a Kelly on the east coast, we now call a Mayo here in the southwest. What we call a Kelly here, was a Jones back east. And so many of them closely resemble each other. Handle them, feel the differences and you'll learn them.

I remember the first time I scrubbed a section when I was a young nurse: A patient came in with a cord prolapse and we couldn't wait for the OR crew to arrive. The charge nurse looked around, pointed at me and said, "You, Go scrub now!" I hadn't even circulated because the OR crew came in for all our sections, I'd only been in sections to catch the baby. But I went and washed my hands and tried to get my gloves on without contaminating anything. (Do you know how hard it is to get tight gloves on damp hands that are shaking badly?) I grabbed some instruments that looked familiar to me from the delivery sets and a disposable knife (I wouldn't have been able to load a blade onto a reusable handle even if my hands hadn't been shaking). I remember he did a vertical incision and everything went so fast I wasn't sure what was going on, but he would ask for an instrument and I'd give him something that approximated what I thought he wanted. He asked for Kellys and I gave him what I thought were great big Kellys, but they had this big tooth on the end. He asked for pickups and I gave him a pair of rat tooth forceps, he asked for sissors and I gave him the first pair that came to hand that happened to be sharp and blunts. Once the baby was out and crying, and things were calming down, he asked for something else and whatever I gave him was again not quite what he wanted and he raised his hands up in the air and cried out, "Points! Points! Everything she gives me has got points!" Years later when I learned to scrub, I learned that you don't want to pick up peritoneum with Kockers or try to sew the bladder flap using rat tooth pick ups. Mother, baby, physician and nurse all survived, so it really did turn out OK in the end.

cherokeesummer · Apr 7, 2008

I don't have much to add as I'm a PP nurse and not L and D but the struggle of being a new nurse and prioritizing and multitasking is one I'm still working on too. Just wanted to offer a good pat on the back!