New OB Nurses, Grads and Students, Please Feel Free to post your questions here:

[SmilingBluEyes]

Mugwump had a great idea offering services to new grads as a mentor (thank you for that!)

So, I thought having a "sticky" for new grads, OB nurses, students, and others with questions who want to post these can do so here. We also seem to see many of the same questions over and over, so perhaps this would help serve as an ongoing discussion of common issues/questions we all seem to have on our minds. This could serve not just for those asking directly, but others who may be "lurking" and looking for information or considering a career in OB, newborn, GYN nursing, or midwifery, doula services, childbirth education, lactation consulting, or other related work.

So if any mod thinks this is a good idea, mind stickying this?

Let's give this a go and see how it works out. We have many potential "mentors" here among us who, I am sure, would LOVE to help a new nurse/midwife/doula or student on his or her way to a rewarding career. I know I would love to help out!

[LAROSILIERE7]

When there are no babies to deliver, what do Rns do during those days? second question-how long does it take to specialize in ob-gyn unit?

[SmilingBluEyes]

When we have nothing going on, we get low-census release (meaning we dont' work). Some places, OB Nurses float to other units to help out when OB is slow. It depends on hospital policy and whether a unit is "closed" or not.

Also, it took me about 2 years to feel really comfortable and competent in OB/GYN nursing. It is not easy to "specialize" any place. Plan on a year or two of intense learning and work to attain competence in your chosen speciality.

[SmilingBluEyes]

Hi everyone,

A friend of mine was in labour and an epidural was put in place. What exactly do they do with an epidural? administer medication? not exactly sure......she ended up loosing the baby.

Any answers would be greatly appreciated.

Thanks!!

wow I am so sorry about this loss. Truly sad.

[SmilingBluEyes]

Hi all-

to you experienced OB RN's out there - do the experienced ones get to do things without orders - such as dc'ing IV fluids post c/s, or advancing a diet - like if you knew a doctor would let you get away with it? The facility that fired me was furious that I did such a thing -UNDER THE ADVICE OF THE PRECEPTOR- which did not help my defense. I have moved on and started working in M/S at another facility where I've been assured a job in OB after 6-12 months, but I can't help looking in the rear view mirror on occasion. At my former employer, this kind of thing was just an everyday occurence that was done by mainly the 15+ yrs nurses. Also, what is "normal" behavior for a new grad? Is it ok to be relearning things that we've seen once upon a time in nursing school? Is it supposed to be like being a student again?? I feel so stupid and slow with everything I do, and I just can't picture myself being as confident and proficient as these nurses I work with. Just basic things, I go in there to take vitals and flush an IV and I'm so busy with the tasks that I am trying to do that I haven't even asked the patient how they're doing! I think I'm a good nurse, and I love being a nurse, but I feel so defined by having been fired. Like It's a scar I can never cover up. I went to graduation and walked this weekend (I "graduated" in december without the rest of my class - I walked with the class behind me) - I couldn't feel proud of myself like everyone else was - I hoped no one would ask me what I've been doing since december. I finally got my depression and anxiety under control with the help of accupuncture (I am finally med-free!! :) ) - so I feel ready to handle working again despite being unsure of myself. I know it takes that magic "year" to feel ok about being a nurse, but every day I ask myself if maybe they were right, and I am not a good nurse? What do I know about whether I'm a good nurse or not?

Sorry I'm going on an on. My family thinks I'm pretty much over it, but the scab got knocked off this weekend at graduation.

Thanks for your advice, and thankyou to anyone who prayed for me when I originally wrote about losing my job.

-L.

Well hello there. WOW long post, I will try to address your concerns as I see them.

We don't generally do ANYTHING w/o an order. Our standing orders cover for advancing diets, d/c'ing IVs etc. They state "advance diet as tolerated" for example. They also discuss early ambulation etc. So, it really leaves it up to nursing discretion when a diet is advanced from clears to regular, and when an IV is saline-locked or discontinued, as judged by patient condition. It becomes very routine and easy to know what to do when, as you gain experience. You know those who are tolerating PO diets well, and the ones who are not and you adjust your care accordingly. I advise you to become familiar with all your policies/procedures and standing orders. Often, the concerns you raise can be answered by looking these things up.

I also want to say I totally relate to your insecurity and being unsure about yourself as a new nurse. We all have been there. Really, it took me 2 full years to feel confident and competent in OB/GYN nursing. It's not something that comes "overnight". Your preceptors and other nurses know your limitations as a new/student nurse. IF ever they do ask you to do something you are uncomfortable with, you need to be in the habit of saying so. Just never pretend to know what you don't. If you are unsure, ask! We expect you to ask questions and don't expect you to "fly on your own" at this point. Don't let anyone assume you are comfortable when you are not. No question is stupid or petty, ask. If you don't know a procedure or policy, ask to be shown those and look at them. Don't ever be afraid to question those things that seem wrong or new to you.

As far as depression goes, been there. I have suffered it on and off for years and years. I have found limited benefit w/meds and more benefit with psychotherapy. I feel for you. I hope the accupressure does really do the trick. Also, knowing about depression as you do, remember it can be "set off" by new and stressful situations (like nursing school, new job, etc). If you feel yourself sinking, be sure and recognize it and stop it before it gets too bad. DO things that relieve stress for you, taking a walk, spending time with good friends, reading a good book, going to the beach, etc. Make sure you find "me" time and take care of yourself. BE good to yourself in this very stressful and challenging time. And never forget, you are NOT alone!\

Hope I helped you feel better! If you anything else you need, please post it here or feel free to PM me. I wish you all the best. Keep plugging away!

[SmilingBluEyes]

BandE before I forget: I think you sound like a caring, competent and conscientious nurse. Keep up the good work. There is always an "edge" in OB nursing---never get "too comfortable" and you will do ok!

[Lady_Rebel]

Hi I have a couple of questions. Please don't think I am stupid for asking this I am a pre-nursing student but is a Doula a nurse midwife? My second question is the hospital I want to work at does not allow grads. to go start into L/D until we have experience has a nurse so what department do ya'll think would help me get prepared for L/D? I was thinking of working on the med surgery floor. Would something like ER be better.My third question is how do you get certified to be a mide wife?Also any tips for a beginnig student.

[BETSRN]

Hi I have a couple of questions. Please don't think I am stupid for asking this I am a pre-nursing student but is a Doula a nurse midwife? My second question is the hospital I want to work at does not allow grads. to go start into L/D until we have experience has a nurse so what department do ya'll think would help me get prepared for L/D? I was thinking of working on the med surgery floor. Would something like ER be better.My third question is how do you get certified to be a mide wife?Also any tips for a beginnig student.

A Doula is a labor support person who is there totally to emotioanlly (and physically) support the laboring mom and her partner. She is NOT usually a nurse and has NO medical or legal resonsibility at all. She is not allowed to do anything along those lines at all (even if she has years of experience).

Med-surg is a good basis for any kind of nursing. However, another good place to start (with the intention of moving to L&D someday) is on a busy post-partum unit where you will get loads of experience taking care of new mothers and babies. Along the way, you will also have to get certified in neonatal resuscitation (a requirement to work in L&D) before you can move on into L&D.

A certified nurse midwife (CNM) is a Masters prepared registered nurse. You ahve to be an RN first. It is usually good to have some L&D experience under your belt before tackling that road. It is svery demanding and you would want to make sure that's what you wanted before pursuing that tract.

It takes a good couple of years to even begin to feel comfortable taking care of a labor patient. You have to have extensive training in fetal monitoring and depending on the type of facility and acuity level, vag exams, labor management, decision making, etc.

Start by getting your RN and go from there. Best of luck to you!

[Lady_Rebel]

Thank you for answering my questions.

[Carolyn Hepp]

The hospital I'm interested in is offering a Labor and Delivery Internship for a 20 week course. Has anyone out there ever attended such a course? Also, in order to be chosen for this internship, you have to go before a panel of eight (8) people for the initial interview!!!! Has anyone out there ever been before a panel of eight for an interview for an internship?... I'm currently a psych RN and looking to change my field. Can you believe it....eight.... I'm scared out of my wits!!!! What type of questions could they ask?? I don't think I've ever been asked eight questions in a normal interview for a job let alone EIGHT people on a panel..

HELP!!!!

[RNnL&D]

The hospital I'm interested in is offering a Labor and Delivery Internship for a 20 week course. Has anyone out there ever attended such a course? Also, in order to be chosen for this internship, you have to go before a panel of eight (8) people for the initial interview!!!! Has anyone out there ever been before a panel of eight for an interview for an internship?... I'm currently a psych RN and looking to change my field. Can you believe it....eight.... I'm scared out of my wits!!!! What type of questions could they ask?? I don't think I've ever been asked eight questions in a normal interview for a job let alone EIGHT people on a panel..

HELP!!!!

Yep, that's how I started in L&D. It was a 20 week internship that rotated through L&D, PP, SCN, and GYN. But, the internship was just for new grads. Our experienced nurses from other units just go through an 8-12 week L&d orientation. And yeah, my interview was with the director of Women's Services, the nurse manager, the internhsip manager, and the supervisors for L&D, SCN, GYN and PP. So 7. It wasn't too bad.

[crystalbluern]

Just a question...OB L&D nurses working on LDRP units...how many of you are regularly circulating in the operating room during C-Sections. How do you manage staffing, especially when you have to have at least one other nurse for the baby, if the Pediatrician is there also. We also manage any "sick babies" in our Intensive Care Nursery on the unit, and we are doing our recoveries on our unit also. We recently combined our L&D and post partum units to LDRPs and we lost several nurse positions at that time.

[SmilingBluEyes]

Just a question...OB L&D nurses working on LDRP units...how many of you are regularly circulating in the operating room during C-Sections. How do you manage staffing, especially when you have to have at least one other nurse for the baby, if the Pediatrician is there also. We also manage any "sick babies" in our Intensive Care Nursery on the unit, and we are doing our recoveries on our unit also. We recently combined our L&D and post partum units to LDRPs and we lost several nurse positions at that time.

LDRP unit nurse here. We all circulate csections as well as manage labor/delivery and PP/newborn care. We also care for post-op GYN patients---we are jacks-of-all-trades, as you can see.

It can be a juggle, if an emergent/urgent csection is needed. What we often do at night, is have the house supe send up a person (or he/she will do it)---- to manage phones and help the other nurse(s) manage the floor/answer call lights for the 30-45 min it takes to do the csection. It's a challenge, to say the least. If there is a baby in the level-2 nursery, once the csection baby is delivered, the baby goes back to the nursery with the nurse in there. If not, the baby goes to the LDRP room with the dad/ significant other, if stable. That then frees up the nurse who "caught" the baby to go back to the floor to help out, while the circulator finishes up the case and recovers the mom that first post-op hour. The cirulator also monitors the baby in the room, with mom, if both are stable.

Needless to say, All of this is MUCH simpler to do with scheduled csections-----sometimes quite hard when an urgent/emergent case presents unannounced or is going on. If it's a change-of-shift deal, usually at least one nurse from the prior/coming shift jumps in to help out. It takes a lot of teamwork to make it all work, but we generally handle it very well.

I would love to know more about your staffing patterns to see if there is more I can suggest to help you. Hope what I posted here helps some.