New L&D RN- New Grad

Labornursepgh · Jul 12, 2018

I was hired in L & D right out of nursing school and I was beyond excited because it was my "dream job." I was very much like you ... I wanted to start and be great on day one. But the reality is that being a great labor and delivery nurse takes time and experience. I still remember my preceptor telling me that it takes at least a year on the floor to feel comfortable and many, many years to be fully competent. At the time, I did not want to hear that but looking back it was very sound advice. The good news is that in a high risk unit you will see a lot in a short period of time. I work in a high risk unit at a level 3 facility; we regularly see patients with zero prenatal care and we get a lot of high risk transfers from other facilities. In my first year alone I encountered shoulder dystocias, multiple hemorrhages, HELLP syndrome, a preeclamptic patient who coded, a uterine rupture, placental abruptions, and much more. I think that the biggest mistake you can make is NOT asking for help when you are in a situation that you are uncomfortable or when you are in over your head. One thing I learned is that in L & D you often work in a team. If a patient comes in that is unstable the room will likely be full of nurses who are working together to stabilize the patient or get them delivered asap. If you are looking to increase your knowledge base I would suggest two books ... Labor & Delivery Nursing: A Guide to Evidence Based Practice by Michelle Murray and AWHONN's High Risk & Critical Care Obstetrics, both great resources. But like it or not, being a competent L & D Nurse takes experience and experience can only come with time. Rest assured that no one will expect you to come into L & D knowing everything. Try to find a couple of nurses (one of them will hopefully be your preceptor) who you can go to with questions and for help in unfamiliar situations. But most of all be patient with yourself. You are learning and one day not long from now you will be a great L & D Nurse.

Lizziepooh · Jul 14, 2018

Hey there! I got into L&D right out of school too and have a little over a year under my belt now. My advice would be to get practice critical thinking when you're orienting. If you see a tachycardia on the FHM, think about what could be causing it and what might be next. This was my way of not only learning what was happening with my patients, but also learning what to do if A, B, C, or D happened next. It was almost like I learned 3 patients worth of information by having one patient. Now critically thinking about all the minor details is something I do automatically, and it definitely helps keep me on my toes! When things go south, I have already thought about what my options for interventions are and I can act that much faster.

Also, pay attention to the lingo your preceptor and other nurse's use in charting. I don't know about you, but how word things in a chart, particularly in strip charting, wasn't something that I learned in school. It was really helpful to learn how to word things to be the most accurate.

Hope this helps some. Good luck!

cayenne06, MSN, CNM · Jul 15, 2018

I've only ever done women's health for my entire career, and my only RN experience was in LDRP. It's a learning curve, very different than other types of nursing. My biggest advice is to take as much orientation as they will give you, and learn from the nurses and providers you are working with. Look up your unit protocols every time you do something new, and cross check with a trusted reference. Don't be afraid to ask for help with your assessments- cervices are really weird and there's a big learning curve there. Review every fetal heart strip you can get your hands on. Drill yourself on emergency meds/protocols and participate in as many of them as you can. When things go wrong in intrapartum, they can slide downhill at a sickening pace if you aren't on your toes. Follow pedi on their rounds and practice your baby evals over and over and over again. Respiratory distress can be more subtle than you'd ever imagine. Isn't it cute when they make that little grunting sound :/

Delay all non-urgent care for at least an hour after birth and until baby has breastfed for the first time (if applicable). Assuming everyone is stable, you can do all your initial maternal/infant assessments without taking baby off mom's chest. And despite what admitting might say, you absolutely can get a baby in the system without a weight- that is my personal pet peeve right there lol.

Delay that bath as long as you can- it has the added side benefit of encouraging staff to continue to wear gloves when handling the newborn, which helps promote healthy colonization with mom's bacteria instead of whatever is on our gross hospital hands.

The psychosocial components of L&D nursing can be just as difficult as the medical care. Partners who are scrolling on their phone while mom is pushing. Mothers in law having a tantrum at the nursing station because the patient doesn't want them in the room. Laboring women who come with their 3 small children in tow because they've got no one to help. Postpartum patients slipping outside to, um, make use of their saline lock. Helping parents cope with loss and less-than-ideal outcomes. Etc