New Grad in L&D-

[shebrannew]

Hey All!

I just graduated and received an offer to work in a lower income area hospital that scares me a bit (being totally honest). I was told that this hospital leads the state in patients with syphilis and second in the state for infant mortalities due to drug use during pregnancy. ? The area is high in crime and drug use, so it was no surprise that the unit is considered "hard to fill, hard to retain" for staffing purposes.

As you can imagine, I have about 34675237 questions, but I honestly believe I can do this (previous background of 12 years in military trauma) with a lot of training and guidance. I turned down a few other jobs in OR, ER and PCU because I really wanted a challenge- and I'm pretty sure I got it.

So does anyone have any wisdom to impart? My biggest concern is doing cervical exams and deliveries with infections, can anyone shed some light on that for me? Or dealing with psych patients on the unit? Or dealing with Moms when CPS takes their baby away? Lol I have ALL the anxiety even though I'm excited!

Thanks a million and Happy Nurses Week to all you amazing nurses!

[Skips, MSN, RN]

Congratulations! I love OB nursing. I hope you will, too. It sounds like you know you are getting into a challenge, and that is the first step here.

I do have a question. Is this a teaching hospital? The residents will do their own exams for the most part. At my facility, we are just starting with residents this year, so we do cervical exams behind them. Some places don't. So I am just curious!

As far as exams on someone with an infection, I have never personally encountered that. However, you're gloved anyway. It doesn't always smell great even if the person does not have an infection. However, smell is part of your nursing assessment. If someone is ruptured, is the fluid malodorous? etc. You get used to everything and anything in OB. Blood, urine, vomit, lady partsl fluid. It's all part of the job and you don't notice it after awhile.

If the mother does develop an infection, the doctor will prescribe antibiotics. The main infection I have dealt with in OB is chorioamnionitis.

Psych is everywhere, including OB. We have had our fair share of them. Use therapeutic communication, set clear boundaries, and get help if you need it. We have had to call security before, but it really doesn't get that far very often. It sounds like you have skills in this area, so that is a good start.

As far as CPS goes, the moms will have an idea about that before delivery. They have a clue that CPS will probably be around to do an assessment or take the baby. It isn't a surprise (usually). I have never been in an instance where the mother became violent due to CPS involvement. If there is, there will be extra hands available to help. I'm sure your hospital has a strong social work or case management presence due to the nature of the clients.

I am excited for you! Update us on your next steps or how you feel at your new job.

[Monkey Nurse, ASN, RN]

I don’t think Ive ever known someone to take OB positions for the challenge. Most of us have a passion for the field. IMHO being in this field and being good at it takes a certain amount of love for the genre of nursing. Do you have kids of your own or any experience in OB? What do you know about breastfeeding? I feel knowing or learning to teach that skill is essential. Birth is beautiful but when it goes wrong some of the most heartbreaking experiences you’ll go through.

Infections? Like any other field of nursing- proper precautions need to be taken. I think also many L&D may have uniforms to wear from the hospital. If not take an extra every day.