Newbie advice- Ob 1st job not going so well

Hushi05 · Feb 7, 2012

You didn't provide much information about your unit, how busy it is, etc., but it sounds like the unit's management has failed you. Six months is a good long orientation, but no matter how long an orientation is, if it doesn't prepare you to practice independently, it's no good.

Did you get feedback from your preceptor when you came off orientation? Doctors shouldn't be the ones telling you whether or not you are prepared; nurses teach their own.

From what I've read and talked about with others, most L&D nurses need a full year before they begin to feel comfortable and another year before they feel really competent. It's a very steep learning curve. It takes a while (much longer than six months) to know your role in an emergency. You shouldn't be too hard on yourself about that.

How supportive are your fellow nurses? On my unit, a nurse should be able to function on her own during labors and in the OR, but once off orientation, the new nurse almost always has backup. Functioning alone is an expectation but not an ideal way to work.

I don't know what you should do, though I do think you should always ask for back-up help (and offer it to others). You need to decide whether you have a unit culture that is supportive of asking for help and back-up or not. If not, you might consider finding a new job. I see no benefit to moving to med-surg; L&D is a specialty- you need further specialty training.

Good luck to you.

NuNurse<3 · Feb 7, 2012

Well the doc told my boss I'm not ready. So then she spoke with me and offered me those 3 options. Go to medsurg(oncology), go to casual status so I can go at a slower pace or just do post partum care, or try for another couple weeks with a preceptor and see where I'm at after that time and have a pow-wow then about it. The fellow nurses are pretty supportive and work as a team. I'm a new grad and thought this stuff would come with time, but seems I'm kind of out of time. I feel so shattered I'm not even sure if I want to do OB anymore, or if I'm even cut out for it, or if that's just my fear talking. Thanks for your take on it. I was bounced around to different preceptors, never did the same thing two days in a row, or worked with the same person on a regular basis. Not sure if I'm just not good enough, or if I really just got jipped as far as a structured orientation.

You didn't provide much information about your unit, how busy it is, etc., but it sounds like the unit's management has failed you. Six months is a good long orientation, but no matter how long an orientation is, if it doesn't prepare you to practice independently, it's no good.
Did you get feedback from your preceptor when you came off orientation? Doctors shouldn't be the ones telling you whether or not you are prepared; nurses teach their own.
From what I've read and talked about with others, most L&D nurses need a full year before they begin to feel comfortable and another year before they feel really competent. It's a very steep learning curve. It takes a while (much longer than six months) to know your role in an emergency. You shouldn't be too hard on yourself about that.
How supportive are your fellow nurses? On my unit, a nurse should be able to function on her own during labors and in the OR, but once off orientation, the new nurse almost always has backup. Functioning alone is an expectation but not an ideal way to work.
I don't know what you should do, though I do think you should always ask for back-up help (and offer it to others). You need to decide whether you have a unit culture that is supportive of asking for help and back-up or not. If not, you might consider finding a new job. I see no benefit to moving to med-surg; L&D is a specialty- you need further specialty training.
Good luck to you.

somedayCNM, CNM · Feb 7, 2012

I know what you mean about being bounced around to different preceptors. I kept my scheduled position on a med-surg unit and reduced my hours to take a supplemental position in LD. 24hrs/wk on my home unit, 16hrs/wk orienting in LD. Initially my LD schedule was worked aboard med-surg schedule, resulting in orientation run by 5 different preceptors. Every day I would learn something new, but the next day a new preceptor would tell me I was doing it wrong and I would have learn how to do it her way. It's super frustrating, right! It's no way to learn a new job.

Are you orienting on a full time schedule? Is there no way they can match you up with one preceptor for awhile? I know I would feel a lot better about my progress in LD if I could orient with just one person full-time for a few weeks. Is there anyway your manager can work out an arrangement like this with you? I think it might be your best option. If that doesn't work out, I would go to postpartum. You'll be able to establish skills in monitoring a postpartum patient for stability, assessing the newborn, breastfeeding, etc. All of those skills will be valuable to you when you make the transition back to LD. I think this would be a better option for you than med-surg. If you've learned how to put in foleys, administer medications, do a general assessment and document it than you've already learned all that med-surg would have to teach you. If not, postpartum would teach you all the same things while keeping the focus in the birth-world.

Whatever you decide to do, remember confidence is key! Once you get it, tell yourself everyday "I've got this!" before you even walk in the door. You can do it!

I hope my thoughts are helpful. Good luck!

NuNurse<3 · Feb 7, 2012

THanks. I already feel comfortable with post partum, it's just labor/delivery- mostly delivery that I'm struggling with. I could go to just doing post partum but I'd have to go from full time to casual. Which I just can't financially. The medsurg unit is also oncology. Thanks, I'm trying to just get lots of advice and pray about it a lot.

babyktchr, BSN, RN · Feb 7, 2012

First, any manager worth her salt would realize that it takes a year or two for ANY nurse to get comfortable in labor and delivery. It certainly does sound like management is failing you. It also sounds like your unit isn't busy and even though 6 months is a very ample orientation, if you don't see it and live it...how are you going to learn it? Going casual is NOT your option. You won't see anything. If I were your manager, I would give you to ONE person and have that person be a very strong labor nurse and let you have her as a buddy so to speak. She will be your wingman. While you perform on your own, she would be there to help you with your anticipation skills. After any delivery or event, you would talk about what you did great, what you could do better. This way you can SEE what you need and have someone there to help you when you need it. The post partum job would be second choice ( and a very good choice in either case...would hone your skills)

Shame on the doctor. Why couldn't he just offer to you what could have been done better? I am sure he was not perfect in his first rodeo. Don't take that comment too personally. You will come across this behavior even when you are 20 years into it. Being a new grad is hard. While I am one of those "I want to be great right now kind of personalities", you have to give yourself time to learn. There is a lot to know in labor and you can certainly still learn something new every day. One day, it will all just make sense.

I feel for you. Keep us posted on what happens. Good LUCK!!!

RNLaborNurse4U · Feb 7, 2012

You need to be full-time, with the same preceptor, for at least 12 weeks of births. How many births does your unit do each month? I'm guessing you are not a very busy unit if you were on orientation for 6 months, but only had 5 births. We do about 350-375 births per month, and our low risk L&D orientation is 12 weeks. You get LOTS and LOTS of births in that time. Both lady partsl and c-section. You become VERY proficient in labor care (intrapartum), deliveries, and baby care.

Can you be the 2nd assist RN at births in addition to the births you do attend? That will also give you more experience in the immediate birth experience.

It takes a good two years of fulltime L&D nursing to really feel proficient at it. It takes even longer to get proficient in the multitude of high risk complications.

I've been on L&D for 10 1/2 years, and I still learn new things.

NuNurse<3 · Feb 7, 2012

Well, I decided to go to medsurg for a while. Hoping to get into the oncology med surg. I talked with my managers, and they were so good to me, they said it was my decision, I can just stay on my full time rotation until I get a transfer, and they'll give me excellent recommendations, and will invite me back down the road if I want to come back. They praised me up and down what a great person I am, how they're happy to have gotten to know me, because I'm the kind of person they want working with them and not to be too hard on myself, and that it would be good for me to get a good foundation, then I'll be really ready for anything. They're being very supportive, so I'm so relieved. Now that I feel like I forgot everything medsurg related though I better get out the books and study up again! Oh and I can just serve as staff doing Post partum care until then , and they also gave me the option of staying casual too to pick up shifts there once in a while if I wanted to. :)