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

[RNeileen]

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..

[TriciaJ, RN]

Take the postpartum position. Sometimes the shortest way to a goal is a more circuitous route you hadn't originally planned. Other posters have already said it: you're lucky they offered you something else. Many new grads find themselves on the street.

You are scheduled to come off orientation and you said you are overwhelmed. That says it all. You aren't ready to come off orientation and they aren't prepared to keep extending it. They're offering you a chance. Grab it.

Some things from your posts jumped out in a concerning way: "I was slow to catch late decelerations, but..." The "but"s don't matter when it's your baby. "I was slow to get things done." It's a very fast-paced environment. They don't have the luxury of letting you take your own time.

They obviously see something in you that they want to keep. Take your hard-won experience so far in L&D and work at being a stellar post-partum nurse. It's time to catch your breath and start building on successes. To continue down the same road will only just keep being demoralizing. When you eventually come back to L&D it'll be a whole new deal and you'll be glad of the way things worked out.

[dracarys bsn, BSN, RN]

I would say that if after 4 months of orientation/residency you still feel overwhelmed, then that L&D unit is not the place for you. I don't think 2 more weeks would help further either. If it hasn't clicked by now, it won't. And if the staff has "marked" you you're already fighting an uphill battle to get respect from your colleagues. I worked L&D for 7 years after a year of med-surg and it was overwhelming at first, but toward the end of my 12 week orientation I was covering my preceptor's assignment 99% and felt pretty comfortable.

If you do go to PP, know that it is not really going to prepare you for L&D. They are two different worlds, but you never know... you might find that PP is your perfect fit. Good luck!

[Nurse.Kelsey, BSN, RN]

Im sorry but its not the unit for you. And thats OK. You need to find a slower paced unit as they are suggesting.

[mmc51264, BSN, MSN, RN]

I am impressed with your organization for giving you almost double the orientation. It seems like they are trying.

I am a preceptor (not L&D) and when you say that having different preceptors is confusing-my thoughts on this. We have expectations and standards of care for my unit, and while I may do something a little different than a colleague, it is not so different that the flow would be disrupted. I don't know you and not sure what the issue is. I have precepted nurses that are extremely literal and it is hard for them to transition from one situation to another.

I have pretty strong feelings about new grads in L&D (and ICU). There is not much room for error (or the perception of error) when it comes to babies. I always have said that along with anesthesia, L&D, and ICU can be really boring, and that's a good thing. Boring means there is nothing bad going on. Not boring anesthesia or the others means bad things.

Take the post partum position and become the best nurse you can and then, after experience, move up to delivery.

Don't give up! It is not personal. It is a safety issue. It sounds like the people you work with are really trying to help. xo

[TriciaJ, RN]

23 hours ago, mmc51264 said:

I am a preceptor (not L&D) and when you say that having different preceptors is confusing-my thoughts on this. We have expectations and standards of care for my unit, and while I may do something a little different than a colleague, it is not so different that the flow would be disrupted. I don't know you and not sure what the issue is. I have precepted nurses that are extremely literal and it is hard for them to transition from one situation to another.

I am always a bit concerned when orientees cite having different preceptors as a source of their problems. This should not be a problem. No two people do everything exactly alike. By the time one finishes nursing school, one's knowledge base and nursing judgement should allow one to look past minor differences and see the principles at work. This is the time to ask questions about the merits of doing something one way or the other.

By the time one is off orientation, one should have a very good idea of which methods make the most sense to adopt as one's own. Being so literal as to be thrown by minor differences in practice is an indicator of unreadiness.

[Katie82, RN]

Every time I read a thread like this my belief that new grads do not belong on Specialty floors is confirmed. Any new grad who believes they are ready for ICU or L&D or ER are not fully informed. School does not prepare new grads to fully function on any floor. Add the stress involved in a specialty floor and you have a recipe for unhappiness. Most hospitals, and particularly Magnet hospitals, are recognizing this. Most require a minimum of 6 months of orientation on a Med/Surg floor then another 6 months of work before allowing transfer to specialty floors. I just wonder how many nurses we lose because they are totally overwhelmed, and conditioned to believe they are less than adequate because they are asked to do too much too soon.

[K Davis]

Serving in Professional Development and managing a regional nurse residency program, I have seen this many times. Please do not be disheartened and please do not contemplate leaving the role you have worked so hard to obtain. We need you!

I view L&D very much like ICU or ED in that it can be intense and turn on a dime. Although we are usually successful transitioning new nurses into practice on L&D, this area is not always the best fit for a new grad. This does not necessarily reflect poorly on you or your preceptors. It is simply a challenging area to begin your career when you are still learning how to be a nurse. Your learning style may require more time to process than is available on a unit where decisions must be made quickly.

Our Maternal Child service line has a fine tuned process in place for moving new grads from L&D to mother baby during orientation because this is not an uncommon occurrence. I have worked in organizations that require cross training to both areas and they always begin orientation in mother baby before progressing to L&D for the reasons mentioned. The plan when we transfer new grads to mother baby is to eventually progress back to L&D, however, I have not had one new grad that has chosen to return to L&D yet because they often find that mother baby is actually a better fit for them.

Before questioning your decision to be a nurse, ask yourself if you enjoy taking care of patients and if everything was going smoothly would you still be unhappy? If you have a love for nursing don’t give up until you find your niche. You will find it. I know it feels disheartening at the moment but I would try to embrace the opportunity in mother baby - you might find you love it and be grateful you didn’t give up.

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

3 hours ago, Katie82 said:

Every time I read a thread like this my belief that new grads do not belong on Specialty floors is confirmed. Any new grad who believes they are ready for ICU or L&D or ER are not fully informed. School does not prepare new grads to fully function on any floor. Add the stress involved in a specialty floor and you have a recipe for unhappiness. Most hospitals, and particularly Magnet hospitals, are recognizing this. Most require a minimum of 6 months of orientation on a Med/Surg floor then another 6 months of work before allowing transfer to specialty floors. I just wonder how many nurses we lose because they are totally overwhelmed, and conditioned to believe they are less than adequate because they are asked to do too much too soon.

Honestly, I disagree. I started as a new grad in the ED and remain in the ED. I actually thrived in this environment because it worked well for me, my paramedic background, relatively short attention span, and I had a fantastic team. I know I would have been miserable as a floor nurse.....I struggle with admitted “hold patients” because it’s just not my interest.

I have also met nurses who started as new grads in the ICU or L&D and loved it. I do think that a supportive environment and an excellent residency program can set up a new grad for success- it’s not everything but is a big part of the success of a new grad.

[JKL33]

4 hours ago, TriciaJ said:

By the time one finishes nursing school, one's knowledge base and nursing judgement should allow one to look past minor differences and see the principles at work.

That would be ideal, but I'm pretty sure the way nurses are taught in reality doesn't facilitate this. You examine a patient only in this order. First you do this, then you do that. When you create a care plan you write this here and that there. If you write that the sky is blue you'd better cite that in APA format. For goodness' sake, there are clinical instructors who think the world will end if you don't inject air into a vial before withdrawing fluids and if you need to withdraw 1 ml you better not inject only 0.9 ml of air first! Something bad will happen! ? Then they go to the workplace where employer policies, workflows and preferences are held out as the way things must be done, as if any amount of variation is inherently wrong.

Preceptors tend to want things done certain ways and they're the ones deciding whether the orientee is doing things the right way or not.

It also doesn't help that the new nurse doesn't know who they can trust or when it's okay to use "nursing judgment," which is something that either should or shouldn't have been used according to how MMQs see things after the fact. ??‍♀️?

I give orientees a pass on this; I think being subject to numerous nurses' various practices (early in the preceptor/orientee relationship) is not helpful at all. It's a major distraction from the bigger picture.

(Along with everything else that is wrong with having multiple preceptors IMVHO).

[TriciaJ, RN]

Yes, JKL, I see what you mean.

[Nunya, BSN]

Whatever you do, PLEASE tell L&D that having three preceptors didn't help, and why. Be specific with situations where one preceptor told you one thing and the next time that situation came up the other told you something different. And if you go to PP then start off that way, tell the manager you prefer ONE preceptor, and why. I've only ever had one (other than very very occasionally if they were sick or had to change their schedule last minute) and that's really the best way to go. Any unit that doesn't understand this is just bass-ackwards.

Edit: and btw, PP can be crazy busy especially if you're doing couplet care so you'll get some great time management skills there.

[mmc51264, BSN, MSN, RN]

23 hours ago, Katie82 said:

Every time I read a thread like this my belief that new grads do not belong on Specialty floors is confirmed. Any new grad who believes they are ready for ICU or L&D or ER are not fully informed. School does not prepare new grads to fully function on any floor. Add the stress involved in a specialty floor and you have a recipe for unhappiness.

There are circumstances where it can work. There was a program in place when I started my job, on an orthopedic floor. It was a program that gave us extended orientation. I had 6 months of orientation. With a preceptor, for the entire time. I was ready to take my certification test, almost. It was an amazing experience. Unfortunately, it was expensive and once the two year commitment (another issue) many nurses left. I was sad to see the program go. I really learned a lot.

I know that for ICU, ED, and OR, they still have extended orientation but nothing like we used to have ?