New L&D Nurse--Stressing!

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Hi!

So, just looking for some advice/reassurance! A little background, I worked in a Level 1 Trauma Center ED for my first year as a new grad. I always knew I was interested in women's health, and after my family decided to move, I decided to pursue it, and accepted a L&D job. I have been there now for about 4 months, and have been off orientation and on my own for 3 weeks now.

I have really enjoyed it! I love educating mothers and just being part of such a special day for the patients and families that I care for. The most overwhelming part of the job for me is the enormous amount of charting! In the ER, we had nowhere near the amount of mandatory charting, on top of updating their vitals/strips, in most cases every 15-30 mins. How do you stay on top of your charting and make sure that everything has been taken care of and documented after delivery, while trying to manage your recovery and document that as well? I know it is so important, especially in litigious situations, so I want to make sure I'm thorough but it's just so difficult when you're trying to actually take care of your patients. Does anyone have any helpful resources, specifically on L&D documentation, or just documentation in general?

Also, I'm a worrier. I have the tendency to go home and ruminate over any mistakes I made or could have made, or things I forgot to chart, etc. How do you deal with mistakes and allow yourself to learn from them and then leave them at work, instead of worrying over it at home? All nursing involves huge levels of responsibility, but labor and delivery just feels so intense! At what point did you begin to feel confident, fully competent, and able to stop questioning everything?

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Specializes in L&D, OBED, NICU, Lactation.

If you ever get truly, truly comfortable where you aren't questioning things and you feel fully confident and fully competent, I'd say it's time to retire. L&D is scary and amazing and 4 months is nowhere near the time you should be thinking about being completely comfortable. Yes, there is a lot of charting and time management is key. If you have identified mistakes that you have made or are making, work with your educator to identify where in the process the error is occurring. A mistake that happens once is one thing, but multiple times is an issue. My advice is to work on one thing at a time, you will have a difficult time tackling all your weaknesses in one swoop. Identify the one that is impacting you the most and fix that. 80% of issues are caused by 20% of problems, use that to your advantage and take care of the big things first.

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I have found that a lot of nurses over chart. They everything chartable--even if it's redundant.

For instance, if you chart the baseline FHR as 125...why are you then clicking on NORMAL? 110-160 is NORMAL right? Do this q15 (among other things) and it really adds up.

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Specializes in L&D.

Always chart in the room if possible while your doing 15-30 min checks, patients understand that u have to chart & doing so at bedside in real time makes you be done with said task when u walk out of the room! And then if u have multiple patients for sure chart at the bedside as much as possible to prevent mistakes/charting on the wrong pt etc.

Hope this helps!

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Thank you so much for posting this!! I am a new grad in L&D as well and after work yesterday I couldn't help but cry. It was one of those days where I felt like the amount of information I need to know and the amount I actually do were two totally different things and it is super overwhelming! I'm also having a hard time with the charting! There is just so much and its hard to remember when I am supposed to chart what.

I'm glad I stumbled on your post. It made me feel better to know I am not the only one to feel this way!

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No problem!! I still feel like a new grad at times and I've been out of school for over a year. Being a new grad is overwhelming in and of itself, but being a new grad in a specialty is even more overwhelming. Just keep learning and growing from your experiences...even on the days that you go home and cry. They are all making you a stronger, more experienced nurse! You can do it!

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Auson 16, you have a number of great suggestions that can help with your situation. Thank you for asking for help. That helps all of us. I would like to suggest three additional strategies for you to consider as you move forward.

First, even though you worked in the ER for one year don't think that you should be any further along than you are. The situation is new and entirely different. Charting in L & D is more extensive than in other areas and it will take some time. You are asking the right questions.

Second, since you recognize that you are a worrier, I would highly recommend you begin some journaling after each work day. Write down everything that bothers you and continue to write as new thoughts come to mind. Set a goal that you will not worry about what you have written down. The day is done; the only thing you can do is prepare for the next day. Also think about and write down one thing that you see you have learned or improved upon. Once you have done that you can review what you have written and have a better objective sense whether or not there is an ongoing issue that you need help with. Ruminating actually creates "tracks" in the brain and nervous system which makes it more difficult over time to be objective. Reflection and journaling are proven ways to reduce rumination, improve learning and support problem solving.

Third, see if there is someone at work that you trust who can support you and provide suggestions that might help you learn ways to manage more efficiently. Choose someone who you consider to be a role model and ask for assistance.

I wish you the best and am grateful you have chosen to be a L & D nurse.

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I like the journal idea Sharon !

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