New Grad LDRP - pocket guides & advice?

estrellaCR, BSN, RN · May 23, 2013

Congrats! I started in OB (LDRP) last month. I had no OB experience working besides volunteering in postpartum at another hospital (not affiliated with my current one) for a few months. My previous job was in pediatric homecare and clinic. Is your hospital giving you orientation? If so you would learn all needed skills then with your preceptor. In terms of lady partsl exams, RNs are not responsible for this (not in scope of practice)...it is the Attending or Resident MD that does manual lady partsl checks for centimeters of dilation, etc. You would only check for bleeding or discharge/water on the outside and also as per patient report, but not physically looking inside.

In OB Inpatient unit my hospital has: NSVDs, C-sections and also Antepartum patients (those with complications, for example pre-term labor, cervical cerclage, etc) and the postpartum moms' newborns. Our postpartums, also have IVs, need monitoring for diabetes, hypertension, etc in addition to post partum recovery before discharge from hospital. In Labor and Delivery unit, there's Triage, Non-Stress Testing and Recovery Room. At the hospital I am at, nurses are assigned to either Postpartum (OB Inpatient) or to actual births (NSVD or C Section). RNs in OB Inpatient sometimes coverfloat to Triage or Recovery Room when needed but not the deliveries.

In terms of books, I would advise AWHONN's Perinatal Nursing, Maternity and Newborn Nursing (by Perry et al, Elsevier Mosby Publishers) and Davis' OB/GYN Peds Notes a Spiral-Bound Pocket Guide.

aktome · May 27, 2013

Congrats on your new position! I started in L&D about a year ago straight out of school. I also had no experience and was so sacred. I read my books from school, researched online, and even posted on this site asking for advise, but really the way I learned was by being on the floor. The best advise I can give you is: be willing to try. If there is an IV to start, start it. If there is a cervix to check, check it! It certainly is within the scope of an OB RN's practice to do cervical exams. Always be willing to ask for help from a senior nurse! I remember someone posting on this site that OB nurses eat their young. In my experience this is so NOT true. The nurses I work with are the most supportive and caring people you could ever meet.

As far as reading material or classes to take, I'm sure where you work will be able to point you in the right direction. If they hired you with no experience they are expecting to train you. I would take this time before your job starts and just relax. Trust me! I really wish I would have.

Good luck and remember, it takes time to feel comfortable. I still have nights where I feel like I know absolutely nothing and I'm an awful nurse, and other times I feel like I'm great at my job.

estrellaCR, BSN, RN · May 27, 2013

It may depend on what area or even hospital you are at, but in NYC in clinical rotation and at my job, the RN Never does the cervical exams. The only type of nurse that can do them is the Certified Nurse Midwife (CNM), who is sometimes takes over the role of the doctor for a significant percentage of NSVD births. RNs are to monitor patient's condition in triage and advise the MD or CNM of progress and then the MD or CNM does lady partsl/cervical exam to determine dilation, effacement, and station. May be your hospital or area of the US is different in this area. But as per observation and what I have been told in education and practice, the cervical exams are done by as few people as possible to reduce the risk of infection from the invasive exam. Even the MDs and CNMs are to limit how often they do the cervical exams and do them only when there are clues based on monitoring that the woman has progressed in labor since the previous exam.

obrnlacey · May 28, 2013

Do everything you can to learn! Read books, ask questions to your preceptor, and have fun learning! During my orientation as an OB rn in an ldrp unit- I took in every opportunity I could. In my state and specifically facility we are relied on for vag exams - every cervix is different but the only way to gain confidence is do perform as many as you can!! Good luck!!! And congrats!!

DIVINELY FAVORED · Nov 24, 2014

Even though this post is a over a year old, OP and estrellaCR how are you guys doing now??? I bet you are pros:yes:. I am a new grad and am going into my fourth week on L&D. I to have never put in a catheter or started an IV, I am still frightened. Time is going by sooo quickly and soon I will be on my own. This makes me feel better knowing that I am not alone in feeling this way in this journey. Most of the people on the unit are nice some nicer than others, but this was to be expected. I just try my best and try to learn or get better at something new everyday. This way when I leave I have some small victory. Can't wait till this time next year when I can offer someone who is feeling the same way some reassurance that they are not alone.