New Nurse, New Job in Postpartum...Worse Than I Could Have Imagined

thefmgirl, BSN, MSN, RN, APRN · Apr 23, 2015

It can be really hard to transition to a new job as a recent grad. Especially night shift, where you frequently have less support. I have found that patients do tend to remember things differently. It's amazing how you can tell a patient to call the doctor if certain specific things happen--and then they come back to the hospital, don't call the doc, and tell the doc you told them to do that. I see it time and time again. I worked in L&D until a few months ago, and was cross-trained to PP. Cross-trained is a generous term for the 3 hours I received before they took the PP nurse and put her in the ICU and left me with a fresh c-section and two other moms. All I can say, is it does get better. Even if your current job never gets better, remind yourself that the experience you get allows you to go elsewhere. Some jobs will take you after just 6 months of having a nursing job. While it's not ideal, keep a positive attitude and just remind yourself that you CAN move on, and soon. Nurses with the excellent clinical skills your manager says you have will always be in demand. And hopefully, next time, you will have a manager who brings up the good things ans well as the negative ones. Just don't let this one location sour you on the your dream of working with women. And yes, hospitals will always be understaffed...and those ideal ratios they mentioned might not happen (unless you're in a state with mandated ratios), but you will find a job that makes all this worthwhile!

thevez · Apr 23, 2015

Put this on your wall somewhere IT GETS BETTER.

It will. Wait for 6 months mark and see how you have improved.

I bet you're not the only on receiving complaints. Don't be too hard on yourself. You're awesome!!

WoosahRN, MSN, RN · Apr 23, 2015

You only got 4 weeks of orientation as a new grad?!? That's insane and doesn't speak highly of the facility. They aren't setting you up for success. And I hate that the manager seems to not be supportive and instead of building you up puts you in the spotlight. Keep your head up, get some experience but I can't imagine staying in an environment like that. First year is hard. Harder when you have a bad first job.

jadelpn, LPN, EMT-B · Apr 23, 2015

How incredibly AWESOME that your manager calls you in what is akin to the middle of the night to discuss patient complaints. Not.

Night shift is a difficult thing to get used to to begin with. It makes any number of nurses nuts with sleep deprivation. Added onto that patient ratios that are unrealistic (and if a Mom is feeling as if her needs are not being met immediately, then it becomes "my nurse was too busy, there's not enough of them....)

I would ask your manager to not call you until the evenings. That you have to leave your phone on for school purposes and your kids, but otherwise, you will not take calls a few hours after you have gone to bed. That you would like an improvement plan in writing. With measurable goals. And when left with 5 couplets and any number of criticals, who it is you are to call for support. (Her, at 2am??? As this seemingly is what she is doing when she calls you at 10am after a night shift!!)

And be sure you are anticipating needs. ie: "I will put a request for the lactation consultant to come and speak with you" stuff.

The rest almost sounds PICU like with the sugars going all over the place. However, the rest is all patient perceptions. And unfortunately, that seems to take a front seat to safe patient ratios and care.

Put your time in with an end date. Research if some certifications will make you more marketable. Look at the obligations of the certifications, and try to meet them, as it will help you moving forward.

I also would look at some OB/GYN offices, peds offices, home health for well baby checks.....acute care is not the be all and end all. It is a breath of fresh air to work "normal" hours in a supportive environment.

Best wishes!

klone, MSN, RN · Apr 23, 2015

Those ratios are insane and unsafe. 5-6 normal, stable couplets is 1-2 couplets too many. But adding on unstable moms, unstable babies, regular glucose checks? Hell no. If you've got late preterm babies whose sugars are unstable, you shouldn't have more than 2 couplets.

I would start looking elsewhere. I know others are saying "It will get better" but no. Just no. As a seasoned nurse with 10 years of experience in OB, *I* wouldn't be able to handle what you're describing. It's not like that everywhere. Start looking elsewhere.

babynurse73 · Apr 23, 2015

Dear Holdsteady,

Please forgive my cynicism here, but I can totally relate to your situation. I was in LDRP for 7 years, and for the most part loved my experiences. However there were those patients that could not be pleased no matter what. Part of this is our culture of entitlement. The hospitals cultivate this even further with their never-ending surveys, i.e. Press-Gainey and "strive for fives" scoring surveys that essentially ask the patient to "rate" their nurse scattered about the hospital. Room service menu's, "service recovery" vouchers given for unsatisfied patients or family members to spend at the hospital gift shop or cafeteria, etc etc. It seems as if competent nursing care is at the bottom of the patient satisfier list-well except if you have a PPH w/ a breastfeeding preemie. In that case you must bust your hump to keep mom and baby out of the woods, latching on, reassured, cleaned up, VS and blood sugars, etc all while checking in on your other 4 or 5 couplets that need you too. Your patient was unappreciative of your efforts for whatever reason. I often wonder if those "entitled" sorts smell new nurse or "balls to the wall" busy nurse and use it to their pathetic advantage to get something. Family members can also be on nurse patrol. What's driving this healthcare trend is another discussion altogether, but my advice to all new nurses is to develop a thick skin. Especially on such an emotionally intense unit as LDRP. You're working so many providers and their personalities, moms and dads at their most vulnerable and running the gamut of emotions (happy, sad, anxious, hormonal, exhausted). Families watching over your every move (although not so much on night shift)....YOur nurse manager could have handled this with much more sensitivity and professionalism. In an ideal world, she would be shaping you as a new nurse on her unit. She has real issues to deal with, things like sentinel events and employee retention, not piddly "customer" complaints. But the customer is always right, right? NOT!!

You sound like a competent and compassionate new nurse. If this is where you want to be, just hang in there. Eventually your confidence will show and I think patients are less likely to complain about a nurse that exudes confidence....unfortunately I think that's the nature of the game in the hospital.

Disclaimer.....this is not to say that ALL patients have this attitude.... I am quite sure you will have more patients and families that appreciate you to the moon, but they aren't usually the ones filling out the surveys and talking to nurse managers. The ones that like to complain are usually the ones filling out surveys.

Hang in there!!!!!

jadelpn, LPN, EMT-B · Apr 23, 2015

Good point of the pp---I would be oh, so very curious that out of the "bad reviews" you are getting on patient satisfaction scores.....exactly how many surveys were sent back?

New parents have little time. I am not sure that out of 25 patients a month, any more than 25% of them are filled out and sent back.....

And I would love to see what happens when ya'll start calling your manager at 2 or 3am to come in and help with the unstable nature of your patients....perhaps she would stop calling you at around probably 2 hours after you go to bed.......

Get what you need, and move on.

Holdsteady11 · Apr 27, 2015

Thank you so much. This feedback is all very helpful. Applications so far haven't gotten me any call backs, but hoping eventually they will. I know this is not going to be sustainable long term. I certainly don't feel appreciated nor valued as an employee. The CC's and the staff are all really nice, but they are all tired and overworked. It's a tough situation to be in overall..

Postpartum RN · Apr 28, 2015

I'm so sorry to hear it's been such a struggle. Please hang in there, you are very lucky to have landed this PP position so soon after graduation. It's such a hard specialty to get into, just get your experience there and apply to other hospitals, try to find a hospital who is unionized and pt ratios should be better. 5-6 couplets is crazy! That's 10-12 pts to take care of, assess and chart on and your pts were unstable to top it all off.

I'm sorry your manager does not sound like a supportive manager. Women right after birth are so hormonal and you never know what they will say or how they will rate you on a survey! you sound like a great nurse but just try to keep it at the front of your mind to make a pt feel like they are your only one, that you have time for them...when we are stressed and busy sometimes it's hard to do that.. I hope it gets better for you and stay strong! Is there a charge nurse or shift coordinator who can help you out when things get insane crazy like this?

kdkout, BSN, RN · Apr 29, 2015

There is a reason they are so short-staffed. That is too many couplets for primary care, unless you had a CNA, and even then it still would've been busy. The fact that your manager KNEW you had a difficult night and yet still chose to call you in the morning and reprimand you - well that says a lot about her. TURN YOUR PHONE OFF. Guard your sleep! Try to suck it up and do your best, and keep your eyes open for another job. 4 wks wasnt that long for an orientation for a new grad. It's really hard that first year, but many things about this job sound like you were set up to fail. Nursing can be pretty harsh, but this would be undoable for an experienced nurse, and I'd be working somewhere else in 6 months - a year.

winter_green · May 3, 2015

Just read you first paragraph and it sounds like hell.

We only do at most, 3 couplets care.