New Grad in L&D

[ToHealTheSick, BSN, RN]

Hi!  I am a new grad nurse who has just accepted a position on an L&D unit.  I'm super nervous, but also really excited!  I interviewed for both L&D and Mother/Baby, and although L&D scares me more than Mother/Baby, I had a better gut-feeling about L&D's management and training process for new grads after the interviews and shadowing on the units, which is why I chose it.  I've always said that NICU was my dream unit, but I loved my L&D clinicals during school, and after the interviews for this job, I told my Mom that I felt like Mother/Baby would definitely be a stopping-off place, but that L&D could become a long-term career.

At this hospital, we have the only high-risk antenatal care unit and Level III NICU in the entire region (15 surrounding counties in 3 states), so we're pretty busy! ?  I know that some level of nervousness is probably good, because it'll ensure I ask questions.  My question to more experienced nurses is, how do you keep a willingness to ask questions from spiraling into constantly second-guessing yourself and causing hesitation? 

Also, any advice for things I should go ahead and be reviewing?  Maybe that sounds like a dumb question, or like I'm getting ahead of myself, but I want to be the best new-grad L&D nurse possible, and be prepared to learn as much as I can.  I've been trying to look over common L&D meds (pharm was my worst subject in school, so I want to get a leg up on being prepared), and fetal heat strips and associated interventions.  The unit specific orientation is 16-20 weeks (depending on the needs of the new nurse) with a preceptor, and new grads are also required to be a part of a hospital-wide Nurse Residency Program for their first year in-hospital.

[Idiosyncratic, BSN, RN]

I would say, if they are knowing you’re a new grad and not expecting you to get certificates- everything you’ve done is ample preparedness! Be prepared to learn, ask questions, take advice and learn some more! I’d imagine since you’re a new grad(I could be wrong) they will help you get your ACLS/FHM/NRP. They likely will also train you to the specifics of your department. I know the facility I got hired at does an AWHONN based training program so you can learn current practices. 
 

Just remember - as a new grad - NO ONE EXPECTS YOU TO KNOW EVERYTHING! If you’re confused, ask for help. If you don’t know something, that’s OK! You’re not expected to. ? 

[NurseNora, BSN, RN]

The Labor Progress Handbook by Penny Simkin is really good for physical interventions to get baby in the best position for labor to progress. Rotating the head from OP to OA. Resolving an asynclytic position. That sort of thing. It has the best description of how to find the ishial spines that I’ve run across. See if you can find a copy of Human Labor and Birth by Oxhorn and Foote to look through. It’s really expensive to purchase. It has wonderfully simple and clear drawings of the different positions of the fetus and how to identify. It also illustrates the cardinal movements for delivery from those positions. Then it also has way too much information on the application and use of forceps that you won’t need. 
 

Join AWHONN, your professional organization. You’ll receive their magazines, you’ll also get discounts on many useful books, national and local conferences, and on their Basic, Intermediate, and Advanced Fetal Heart Monitoring classes. The Basic class is online and you may want to take it before you start, although it isn’t necessary or expected. It’s AWHONN that sets national guidelines for many aspects of patient care: nurse/patient ratio for various acuity levels, frequency of assessments for high and low risk patients during different stages of labor, etc. 

L&D has a relatively long orientation period because there’s a lot to learn, much of it physical skills that need practice: assessing cervical dilation, effacement, fetal lie, position, and station, starting IVs, applying electronic external and internal fetal monitoring devices. Things that you have to do in order to learn them. Ask questions, ask for experiences. If you’re having trouble with lady partsl exams, ask if you can do exams on other nurse’s patients (preferably those with epidurals so you’re not causing increased discomfort). Even once you’re off orientation, it’s still OK to ask questions. Nursing is collaborative, ask another nurse to review your monitor strip, do a lady partsl exam that confuses you. We all do it. Ask your preceptor how you’re doing (not every day) and tell her what you’re feeling comfortable with and what you’d like more experiences with. Sometimes two people just don’t mesh and you may need to ask for a different preceptor. Not a request to be made lightly, but is very occasionally necessary. 
 

You’ll do great. Be patient with yourself. So many times you’ll feel stupid and that you’ll never learn it. You’re not and you will. It takes about 6 months to start feeling comfortable with the job, then something will happen and, once again, you’re wondering if you’ll ever get it. You will. In nursing school, I was starting to get worried because I didn’t really like any of the types of nursing I’d experienced. Then I saw my first baby born and knew that was what I wanted to do for the rest of my career. And I did, 45 years in L&D until I retired about 5 years ago. I hope you’ll enjoy it as much as I did.