nursing student question: what are the main challenges faced in OB nursing?

cmonkey · Jun 17, 2010

As a prior user of the OB floor, I'd have to say docs, but my bias may be showing.

cnmbfa · Jun 17, 2010

1. Being able to make quick judgments and shift you priorities. You better not be a nurse who likes routine or being able to plan out his or her day. For the most part, there is no such thing in L&D. You need to be a bit of an adrenaline junky, and need to be able to think and act at the same time.

2. Being a good team player and communicating clearly with others.

3. Having some assertiveness AND diplomacy skills so you can be a true advocate for your patients and deal successfully with docs.

3. Dealing with diverse patients and families with varying needs and expectations.

4. Being able to quickly "connect" with women and support them in a trying time.

5. Skills: Labor support; safety with epidurals; reading & interpreting fetal monitors; learning how to do accurate lady partsl exams so you can detect good or poor progress; being able to recognize fetal malpresentations by doing Leopolds and be VE; Knowing what to do to facilitate rotating an OP or solving asynclitism; promoting prgress in labor.

6. Knowledge: maternal physiology, vital signs, lab changes in pregancy and labor; fetal response to labor; stages of labor, and womens' behavior and needs at each point in labor; family dynamics; pathophysiology in high risk OB (gest DM, preeclampsia, abruption, previa, PPROM, preterm labor, etc.); pros & cons of various pain managment strategies; what to expect in Mom and NB in the immediate post-delivery period; NB resuscitation; facilitating breastfeeding

7. Know you drugs: Pitocin, magnesium sulfate, hemabate, cytotec, nifedipine, mehtergine, cervidil, terbutaline, nalbuphine, butorphanol, and more

Bellakaye · Jun 18, 2010

cnmbfa your response is greatly appreciated! it's really great to get input from someone who has experience. i'm in a BSN program and have been lucky to have some really great professors so far. i feel like most of what i have learned has not been from the texts but from experiences our professors have had and share with us. it helps getting real feedback especially since we are getting ready to start clinicals.

i have been doing some reading in a few other forums and wondered if there is any advice for SNs & new OB nurses when it comes to coping with fetal demise?

regarding cmonkeys response, are conflicts with doctors a common problem for nurses?

also, are cultural conflicts a common problem as well?

cnmbfa · Jun 18, 2010

See my response to a post about fetal demise yesterday.

Cultural conflict, ideally, should be rare; it may or may not be. OB is the place where you are most likely to encounter LOTS of people from different backgrounds because all cultures give birth, so it is really important to be culturally aware and open-minded.

You cannot possibly learn all the ins and outs of various cultures; in addition, persons who belong to those various groups are individuals, with all different kinds of hopes, fears, previous HC encounters, etc. In my practice, I had patients from Somalia, Albania, Mongolia, Puerto Rico, Nigeria, Egypt, Jordan, Pakistan, India, China, Indonesia, Laos (Hmong & Laotian, which are different) Burma, and, of course, Mexico. I also had lots of African-American patients. I did well with nearly all of them. Amazingly, one of my non-English speaking patients named her baby after me (middle name)!

Along the way, I learned that what matters is realizing that you hold a certain point-of-view that has been shaped by your family, and by the time, place, and circumstances of where you grew up. You use this to make sense of and explain the world. The eye-opener is when your ealize that YOUR culture's way of doing things is not the only way, and may not be the best way to do things for everyone. And, that other cultures may do things in a way that works BETTER. For example, I had to get used to a few things abolut my Hmong patients. The first was that a key player was the mother-in-law, whose beliefs could trump whatever I said. I aslo figured out (eventually) that Hmong people really value concensus, and will do everything they can to avoid conflict. So, they would seem to go along with my ideas, but then would do what they thought was best. They would never, ever flat out disagree with me; they simply ignored my ideas. I learned that I should do my best to explain why I wanted them to take iron, then negotiate and win agreement in how we would approach their anemia.

So, how might a culture that values agreement and highly respects family and their elders be an advantage? Less conflict, plus LOTS of social support, plus more hands to help raise a child = less PP depression, less child abuse, more cohesive families, better earnings for the family as a whole. In addition, the Hmong version of Social Security is a large, close-knit family with a least several sons, who are obligated to take care of you in your old age. Contrast that to our lonely, depressed, isolated elders who seldom see or hear form their busy children and grandchildren.

One of the hardest thing to adapt to was teen pregnancies. I then realized that many of them truly wanted the baby. That baby represented hope to many with a limited future, and a chance to be a better parent that what they had experienced. It also gave them someone to love, and who they hoped would love them back. Coming to grips with this does NOT mean I endorse it, but if that baby is already on the way, what good would it do for me to be judgmental? Why not make the best of it, and to be able to reach that Mom and (possibly) influence her, she needs to see you as on her side, and as someone who values and cares about her.

By the way, I eventually realized that many of thiose teens lived in a matriarchal culture, and that a whole network of strong, savvy female relatives would help them out. and, many or them did eventually go back to school, or got a GED. They went on to be hairdressers, office clerks, bank tellers, meter midas, etc. Their lives (from their point of view) turned out OK, and they contribute to society. While you & I might think that not getting pregnant and going to college is the best plan, who are we to say it is right for everyone?

I learned how to relate to all kinds of people by 1) being open-minded, 2) realizing that my way was not the only way, 3) being respectful, and 3) being consistently kind. Somehow, the idea that we are all God's children is formly planted in my head. If you remember that, you will be fine. If your not sure what to do, ask them what is important to them; they will let you know.

SmilingBluEyes · Jun 19, 2010

Gosh there are so many....the above posts say a lot.

I say:

Doctors/providers and their preferences are a huge challenge

Getting a grip on "suffering" versus "endurance" ....pain in labor is a different animal. I tell my Childbirth Classes, that PAIN is: NOT pathologic, and IS anticipated, INTERMITTENT (not constant) and NORMAL......to help them think about it differently,.

Cultures, yes oh my, they vary. Even among groups, attitudes and beliefs vary. It is a challenge to provide for and help everyone, and to see from their point of view, how things should go....

Knowing what is "normal" versus "not". Having a "sixth sense" if you will, takes time and experience. That is tough....

Administrative and other expectations. They sometimes are SO different from what we try and accomplish and can stymie our best efforts. This is one of the toughest challenges.

Getting along with ALL your coworkers. Personalities vary and some are VERY tough to deal with...

These are a few of mine.

Bellakaye · Jun 19, 2010

thanks everyone! i really appreciate all the feedback! :)

Bellakaye · Jun 21, 2010

another question... do you find working with new nurses (just out of school) have a hard time adjusting on a L&D unit? (i know most nurses come to an L&D unit with a little experience under their belts first - but i have heard many stories about nurses getting hired onto L&D right out of school) do you feel (in general) that the nursing schools could place more emphasis on any specific information that could better prepare them? and if so what would that be?

SmilingBluEyes · Jun 22, 2010

Some do have a tough transition; some adjust better. It has a lot to do with the various personalities of nurses and doctors, as well as ancilliary staff---and unit cohesiveness ---(or lack of it). On a toxic unit where morale is low, or leadership lacking, everyone has a hard time, most especially new graduates. On healthy units, everyone functions better, and new grads tend to be fostered more and better-taken care of.

The hardest times in most careers are the first two years. It takes about that long, working full time, to master your specialty, whether it be OB, Med/Surg, ED, or anything else. That is the toughest challenge any new graduate faces; working his or her way into the culture and routines of nursing.

My advice is try to find a unit where people appear mostly content working there, or have been there long-term. Also, don't be afraid to interview your interviewer, like about nurse-patient ratios etc. If your interviewer is evasive or not forthcoming, chances are, you don't want to work there. If there are LOTS of openings on any given unit, that is also a potential red flag, one to avoid.

Make up your mind to learn, never be intimidated, and grow. Don't ever pretend to know what you do not; we don't expect you to "come out of the chute" knowing it all----we want you to ask questions and get in there and try hard. Find a mentor nurse, one you admire to emulate and ask questions. There is usually at least ONE of these on any given unit; one who is not a big gossip-monger, but is a hard worker and likes to teach others. You won't regret that. And STAY OUT OF THE GOSSIP grapevine! Really, just do your job and have some fun. Those are my best pieces of advice. Good luck.

Does that help?

Bellakaye · Jun 22, 2010

again, thanks for all the really great feedback! it really helps to get advice from experienced nurses! i only hope that when i graduate i am lucky enough to be on a unit with nurses that are as helpful as all of you have been! :)

LDRNMOMMY, BSN, RN · Jun 27, 2010

Some do have a tough transition; some adjust better. It has a lot to do with the various personalities of nurses and doctors, as well as ancilliary staff---and unit cohesiveness ---(or lack of it). On a toxic unit where morale is low, or leadership lacking, everyone has a hard time, most especially new graduates. On healthy units, everyone functions better, and new grads tend to be fostered more and better-taken care of.
The hardest times in most careers are the first two years. It takes about that long, working full time, to master your specialty, whether it be OB, Med/Surg, ED, or anything else. That is the toughest challenge any new graduate faces; working his or her way into the culture and routines of nursing.
My advice is try to find a unit where people appear mostly content working there, or have been there long-term. Also, don't be afraid to interview your interviewer, like about nurse-patient ratios etc. If your interviewer is evasive or not forthcoming, chances are, you don't want to work there. If there are LOTS of openings on any given unit, that is also a potential red flag, one to avoid.
Make up your mind to learn, never be intimidated, and grow. Don't ever pretend to know what you do not; we don't expect you to "come out of the chute" knowing it all----we want you to ask questions and get in there and try hard. Find a mentor nurse, one you admire to emulate and ask questions. There is usually at least ONE of these on any given unit; one who is not a big gossip-monger, but is a hard worker and likes to teach others. You won't regret that. And STAY OUT OF THE GOSSIP grapevine! Really, just do your job and have some fun. Those are my best pieces of advice. Good luck.
Does that help?

That is so true! I have worked 2 L&D jobs one was in a toxic unit and one was not. The unit that was toxic had more to do with physician treatment of nurses, but there were also some nurses who were not team players. When I was scheduled to work with them I knew it was going to be a loooooong day. We are preparing to move back to the U.S. in November don't know where yet, the AF has not decided where it needs my hubby. I am going to be very very selective when it comes to finding my next L&D job.

In addition to interviewing the interviewer see if you can spend a day shadowing to try to get a feel of how everyone works together and the relationship between staff members, providers and nurses.

NurseNora, BSN, RN · Jun 27, 2010

I spent the first 30 some years of my career working in large teaching hospitals. Pregnancy is not a disease and labor is not an illness. Working with interns and resident doctors who have spent a lot of time, effort and money learning how to deal with everything that can go wrong can be difficult. I began to see my mission as teaching the young docs that labor is a normal part of a woman's life and most of the time it goes very well (often better) without a lot of medical intervention.