We get new grads all the time on our busy level 3 unit, and it seems
that they get 12 shifts and then are expected to work by themselves.
And in that time they should know how to deal with a normal delivery,
scrub, circulate and pretty much what ever else may come their way.
To me it feels like we are setting them up for failure. Labour &
delivery is a speciality and a lot of it is not taught in school. I
have talked with a lot of the new staff to find out how they feel, and
they say completely unprepared to deal with anything outside of a
straight forward delivery, but are scared to speak up.
Are you finding this in other hospitals as well?
Oct 16, '06
Agree with you that L&D orientation should be more than a 12 hour shift. That sounds totally unreasonable and extremely dangerous. I can remember after spending 4 weeks in orientation that I STILL couldn't adequately determine cervical dilatation. Can't imagine handling a complicated labor/delivery with only a 12 hour shift.
Have you discussed this with your nurse manager/administration?
Oct 16, '06
I am a new grad hired into L&D. I just finished 12 weeks of orientation. If an orientee is not deemed ready after that time, they get longer (another woman on my unit is getting more time & she wasn't even a new grad... ). We alternate 3 12's one week and 4 12's the next so that's a total of about 42 shifts if you want to look at it that way, plus NRP and fetal monitoring classes. They are also careful to keep a balance of experienced people and new people.
I still don't feel ready (it could be forever before I felt completely ready for any conceivable situation) but I also feel that my coworkers are not going to leave me stranded & if I did I probably wouldn't do this. There are certain "holes" from orientation, things that didn't come up (like I didn't really work with a certain doc who likes things a certain unique way, also I have not worked with IUPC's for example). I already told my preceptor that I would be calling her back up in these situations!
When I asked around about it, I think 12 weeks was the minimum that I heard from anyone, with the range being 12 weeks to a full year. Personally, I wouldn't have considered any L&D position without at least 12 weeks of precepted orientation.
I agree with you that your situation seems like a red flag, FWIW. Do you have a high turnover rate? Is the time in your orientee program very structured? I feel like that is a weakness of ours - not very structured at all.
Last edit by mitchsmom on Oct 16, '06
Oct 16, '06
12 shifts is 144 hours of time with a preceptor, and yes we do have a huge turnover rate. I think part of the problem is a lot of the more experienced nurses are leaving so there is not a lot of people to preceptor our new grads.
3 of the new grads that I oriented just before going on Mat leave, are now orientating new staff. It is sometimes scary when I get report from a nurse saying the patient is fully dilated and they have begun pushing and I check her and she's only 7 cm dilated.
Still, after almost 5 years of L&D, if I am unsure while doing a vaginal exam, I will ask another staff member or doctor to check, just to make sure. But I find a lot of the new staff feel intimidated to ask for help.
I was once there, I know how it feels to be overwhelmed with everything there is to know, but then I had over 4 months training with a midwife. I can't imagine, be orientated by someone who just went through orientation themselves!
Oct 16, '06
I think for new graduates, orientation to L/D should never be less than about 6 months.
Oct 17, '06
I agree with Smiling Blu Eyes. I was unique in our department, in that they hired me at the end of my first year in nursing school as an extern. So I got a full year of orientation as a student, and then another 3 months as a graduate/RN. The good news is that I started as an independent RN *very* well trained for a new grad (which is a testimony to the RN I precepted with for a year, she was AWESOME). Other new grads who start in the department after graduation usually get 5-6 months with a preceptor, more if they need it. Our department also doesn't have any problems with pulling a new nurse BACK into training if she or others deem her not ready yet after a trial on her own.
Edited to add: I think one thing that has helped me is that I'm NOT afraid to ask for help if I need it. I'm comfortable with asking someone else to follow me on a vag exam if I'm not sure what I'm feeling. If a baby starts crumping, I have no problems asking others to come in and help me out, get me more IV fluids, do whatever needs to be done that one person can't do simultaneously.
Last edit by klone on Oct 17, '06
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