New Grad RN on L&D unit. Discouraged and questioning my nursing career.

[RNeileen, LVN]

Hi all,

I really need some advice about a recent turn of events. I graduated as an RN in November 2019 and I started an L&D Residency Program on February 3, 2020. I am scheduled to start taking Patient assignments on my own next week.

Anyway, I was assigned 2 preceptors for orientation. Both part-timers and both had a completely different way of doing things. It threw me off frequently during my training. Anyhow, I would be scheduled Wed, Fri, Sun as those were the only days they worked.

When I first started I was extremely overwhelmed! I had no idea how much responsibility we have on an L&D unit. A lot of autonomy for sure. It is absolutely terrifying when I think about it. It is not until the very delivery of a newborn that the Physician steps in. For this reason, we are only allowed 2 laboring Patients per shift.

At first, I thought it wasn't a bad assignment but I was sooooo wrong. Fast forward 12 weeks into my residency, management was hoping to have all RN residents start taking assignments on their own but my preceptors did not think I was ready. We hadn't gotten much time in actual deliveries and c-sections so they extended my orientation for 1 month.

During this time, another preceptor was scheduled to train me. So now I had 3 different preceptors, 3 different ways of doing things, and lots of confusion. Two preceptors were super rough on me. They would reprimand me as if I were a child out in the station in front of other Nurses for silly things and I felt so small. They would pressure me to work faster and give me time limits when admitting Patients but then embarrass me when I missed something small like an admission question. They wanted me to work on accuracy but they would rush me through my work and I would become anxious and forget things. It was even hard for me to interact with the Patients and make them feel comfortable, otherwise I would be reprimanded for taking too long.

For that extra month of training, I struggled with the documentation portion and I would stay after for about an hour to finish up. One of preceptors pulled me aside and said she didn't think I would be ready to take Patients and said she would ask for a 2 week extension. She made a comment about L&D not being the right unit for me. I went home crying that night. I felt like I was working as hard as could but I just wasn't doing enough. So I decided to work harder.

They kept giving me super difficult assignments for the remainder of the orientation but I worked as hard and as fast as I could. I even helped some of the other Nurses. I was still having to catch up on charting after but my preceptors were NOT happy about it. They would go into my charts and look at every single piece of my documentation throughout my shift and I could almost see them shaking their heads in disapproval! In fact, I felt like everyone on that unit was shaking their heads in disapproval. Even the orientees! I just felt awful.

Then yesterday, my last orientation day, my preceptor pulled the director of education aside and they sat in that office for about an hour. I just knew they were talking about me. After the end of shift, my preceptor basically told me that she did not think I was ready and that I should consider postpartum just to build my skills. She said, "think about it over the weekend and come back with a plan. Don't let management shove you around."

I did admit to her that I was overwhelmed but I did not think I was terrible. I just felt pressured and I don't want to make mistakes. Any she truly believes I don't belong there and I am just devastated. I know I am a great Nurse, my Patients love me, and I have good Nursing judgement. They just keep saying that I am not SAFE and I need more work. I actually started thinking that maybe this career is not for me.. ANY ADVICE?! I'M JUST SO UPSET..

[SmilingBluEyes]

I started in L/D when I graduated. There was a mean girl club there and they made me cry every night. Then one day I decided I was over that and directly confronted them. It eventually stopped. I also had several preceptor nurses in my orientation and none of them particualy liked mentoring me. I just had to find the one who I was comfortable with, to bounce questions off of.

Also don't sell yourself short: It takes at least a year or two to feel comfortable in any specialty, L and D is no different. Can you ask to have your orientation extended a bit? Or at least have a mentor nurse you can go to when working on your own? it's worth pursuing.

I will come back and try to have more for you. I just wanted you to know I feel for you and h ave been there. Don't GIVE UP!!

[beekee]

From what you said, chances are going to postpartum is not a suggestion, but a requirement for any chance of continued employment. There seems to be a big disconnect between how you feel you are doing (“I know I am a great Nurse, my Patients love me, and I have good Nursing judgement”) and what your preceptors, manager and educator believe (“They just keep saying that I am not SAFE and I need more work”).

[RNeileen, LVN]

7 minutes ago, beekee said:

From what you said, chances are going to postpartum is not a suggestion, but a requirement for any chance of continued employment. There seems to be a big disconnect between how you feel you are doing (“I know I am a great Nurse, my Patients love me, and I have good Nursing judgement”) and what your preceptors, manager and educator believe (“They just keep saying that I am not SAFE and I need more work”).

I am not sure I have a choice either. Yes there is a disconnect I guess. I mean I haven’t done anything that was unsafe except for giving a patient NaCL instead of LR. My preceptor was upset but I made sure it didn’t happen again. And then there was a time when a patients’ blood pressures were reading low 74/50 and I rechecked it when I realized the cuff was loose and sliding off of the patients’ arm. It was just not good placement and I had to rechecked twice. My preceptor came running in and seemed upset and asked if I was watching the patients BP. I felt very dumb.

Then there are times when we are running around like a chicken without a head and it is hard to watch fetal heart strips on the screens. A baby was having late decelerations during a few shifts and I was slow to catch it. But I was still catching on to how to monitor two babies at a time while performing care. I think I have gotten better at that I am just very slow about getting things done because I want to make sure I do it right. It’s just overwhelming.

[amoLucia]

OP - sorry, but the writing seems to be on the wall already. The postpartum recommendation tells me that TPTB seem to feel you DO have the potential to work out and remain employed at the facility.

Bottom line - pt safety is PARAMOUNT. And they just don't feel you're at that level yet. You seem to be making progress, but you need to be up & running without any reservations.

Your last sentence says it all - "just overwhelming". Is that safe for a newbie practitioner to be overwhelmed???

Please take my next comment in the gentlest intention I can offer, but from what I read here, I would worry about you being MY nurse for L&D. You have your good points, but you're not fully there yet. I DO believe you will be there eventually, but just not right now as your multiple preceptors feel so also.

Give postpartum a chance.

Good luck to you.

[vintage_RN, BSN, RN]

I have to agree with what the others have said here. I understand how it can feel to be overwhelmed, and feel like there is no one supporting you. It isn't a good feeling. Your preceptors, experienced L&D nurses, have had concerns about your ability to provide safe care, after several meetings it seems. I would take this seriously and take their recommendation to start in postpartum seriously. It doesnt mean you won't get there, some people just need some extra time, and thats okay.

[JKL33]

Sorry to hear you have had a rough time.

There are so many variables in a situation like this it is impossible to address them all in a post (personalities, support, expectations, your actual performance, what should/shouldn't have happened, etc., etc.). But I have a few thoughts.

Go to your peaceful and neutral zone and hear me out ??:

14 hours ago, Melissaeileen said:

I know I am a great Nurse, my Patients love me, and I have good Nursing judgement. They just keep saying that I am not SAFE and I need more work.

Guessing it is fair to re-phrase ^ this as follows: "I am well on my way to becoming a great nurse, I've already had a lot of success in developing rapports with patients, and I'm beginning to develop good nursing judgment." These are all excellent (!) -- but they are quite different than the words you have chosen to depict your current stage of development.

As someone with a significant length of nursing experience, I would say this about myself: "I am conscientious and try to provide excellent care to my patients in their best interests. I almost always develop excellent rapports with most patients, and try to respect them and see their point of view even when things are difficult. I have developed very nuanced nursing judgment and rarely feel that I have been completely blindsided by what's going on with my patients, but I am also not afraid to confirm my nursing judgment by consulting resources, including trusted peers." Note that even after years of experience and both personal and professional growth, I would not sum it up by saying that I'm a great nurse, my patients love me and my nursing judgment is good (without further clarification).

That is to say, @Melissaeileen, that you are a novice/beginner. You are not expected to have all of these things in hand! A disconnect from the realities of your stage and situation is a problem, though, because it will prevent you from moving forward--and we don't want that!

I am not going to focus on whether this is an issue of your preceptors' personalities, because doing so will not help YOU all that much. The one thing I will say is that if you suspect there is a real, bona fide personality problem and you are being treated unfairly, you need to address it in a pleasantly-assertive, professional manner at the earliest appropriate opportunity. IOW, nip it in the bud. [Example from your story would be someone acting rude and getting all personal about an errant low b/p that you were actively addressing.]

So...what to do now.

Have you met together at all with your preceptor and the director of education, together? If all discussion of your progress and needs has mostly been through the go-between (preceptor) that is wrong and has made this situation worse. It almost sounds like the only plan to help your continued improvement has been more time(?) Without an actual understanding of what is going on and an actual improvement plan, more time won't help.

Prepare yourself to change units if that's your only option, but also there's no harm in asking for a meeting where you can receive real feedback about both your performance and your own perspective, so that you can better understand how to go forward.

Keep your chin up ~

Best wishes ~

[SilverBells, BSN]

I agree with some of the other posters that you may want to consider postpartum, especially while it is still an option. It seems to me that there are multiple concerns with your performance that (unfortunately) likely not be resolved in 2 weeks. Although I have never worked in labor & delivery, I had an orientation experience similar to yours on a different unit. Looking back, and then reading other people's posts as well, it seems that once your preceptors have decided that you are unsafe or not a good fit for a unit it is very difficult, if not impossible, to change their opinions. In my experience, I was encouraged to seek out other areas of nursing, and while it wasn't what I wanted to hear at the time, it seemed to be the right answer. I also have no desire to return to the type of nursing I was pursuing before. In your case, a recommendation of trying out postpartum makes sense; it would seem beneficial to work with moms and babies who are (relatively) stable before adventuring into other OB areas, such as L&D since much can go wrong with mom and/or baby so quickly. Good luck to you!

[turtlesRcool]

Even if we assume you are an amazing new grad L&D nurse, it sounds like your orientation hasn't been very effective. From what you've posted, it seems like it's been a bit scattershot at best, and counterproductive at other times. But even if the problem isn't you, there's not much you can do about it. In fact, the less it's your fault, the less you can alter the outcome. The truth is that some people don't like to precept/teach, and others are just bad at it. For whatever reason (you, them, or a combination), this particular unit doesn't seem to have a preceptor available to give you the guidance you need. I don't think that's going to change in the next two weeks.

Remember that old adage? The definition of insanity is doing the same thing over and over and expecting different results. It seems like the only thing they're doing for you is offering more time doing the same thing in the same way. If it didn't work before, it's not likely to work now.

Unless there's some important change in how you're going to be supported in the next two weeks, dust yourself off, and think about how postpartum can be an amazing opportunity. Because it really can be. If they didn't think you have potential, they wouldn't be offering you a chance on a different unit. I don't know how much you hang out on AllNurses, but there are many stories of people just being fired during their orientation when they don't measure up. The fact that you're being offered postpartum means they see you as a good new nurse, just one who needs to find her niche.

[HarleyvQuinn, MSN, RN, NP]

On 6/6/2020 at 10:09 PM, Melissaeileen said:

I am not sure I have a choice either. Yes there is a disconnect I guess. I mean I haven’t done anything that was unsafe except for giving a patient NaCL instead of LR. My preceptor was upset but I made sure it didn’t happen again. And then there was a time when a patients’ blood pressures were reading low 74/50 and I rechecked it when I realized the cuff was loose and sliding off of the patients’ arm. It was just not good placement and I had to rechecked twice. My preceptor came running in and seemed upset and asked if I was watching the patients BP. I felt very dumb.

Then there are times when we are running around like a chicken without a head and it is hard to watch fetal heart strips on the screens. A baby was having late decelerations during a few shifts and I was slow to catch it. But I was still catching on to how to monitor two babies at a time while performing care. I think I have gotten better at that I am just very slow about getting things done because I want to make sure I do it right. It’s just overwhelming.

Taking the reassignment to postpartum is a great idea. It keeps you in the realm of maternal-child health and gives you a chance to build your basic nursing skills while still focusing on your specialty-specific skills. In the Army, this is actually the progression we followed for those wanting to be L&D nurses. We also have specialty-specific courses and identifiers, however, designed to not only prepare the Officer RN to perform that role (whether ER, ICU, L&D), but to sit for the specialty exam. At least that was the plan while I was in service. I've always felt that it's a shame that hospitals don't put together more serious orientation programs for new nurses, especially for specialty positions.

[Subee2, BSN, MSN, CRNA]

IMHO, L and D is a terrible place for a new grad because when things go wrong, two lives are involved and med-surg skills are useful. Emergencies can be regular or rare occurrences and it's useful to revert to rote, intensive skills because these moments of sheer terror can make your brains go out the window if you don't have a framework to focus on. Post-partum sounds like another tangent you can use to slip in back to L and D. But emergencies happen in post partum also. Sometimes patient has to go to the heart OR to get on the pump so there you are again, having to use ICU skills just a couple of times a year. Don't think of PP as a comedown but a lateral move. Why start skiing on ice when you can start out on snow? You will learn as much as you put into it.

[speedynurse, ADN, BSN, RN, EMT-P]

From someone who has precepted many new grads and nursing student externs.....from someone who has been in a super supportive departments and then not so in others......even if you are doing everything right, if the department isn’t going to be supportive to you, then take the offer to postpartum. Even if you are the best, most experienced nurse but are in an environment that is unsupportive, you will never gain any confidence and will constantly be second guessing yourself. I have a background as an instructor so I guess I have the mindset that almost any new grad can survive and even thrive in their work environment IF their team and environment is supportive to their development as a new nurse. If not.....then a new nurse has no chance. Honestly your work environment sounds miserable. I would say cut your losses and find a better unit because a new grad cannot function under that much pressure.