OB RN for 1 month and LOVING IT! :o)

SmilingBluEyes · Nov 16, 2006

Glad you are enjoying it!

chiapet · Nov 17, 2006

So, officially I've been in OB now for 1 month. I'm loving it! I have learned so much! I will be on days throughout December, then I'm assuming I'll be on third shift. (I don't have January's schedule yet). How are the other newbies to OB doing?

Hi jenrninmi:

I started on the floor of a very busy L&D unit -- we do over 700 births per month -- on 10/31. I precepted on this very same unit from Jan-Mar 2006. I am now on nights with a couple of different preceptors, all of whom are very good. L&D is why I went into nursing.

I don't know though -- I am feeling entirely overwhelmed and thinking that I may have made a big mistake. I connect very well with the patients and my nursing skills are fine. The time management is killing me. My preceptor told me last night that I'm "all over the place" and I agree with her. Post delivery when pit needs to be hung, the MD is complaining that the light isn't right, baby needs CBS, need to do my first PP check and chart all at the same time, do bands, admit baby........on and on. I still can't do it all on my own and honestly can't see myself on my own in 6 weeks. I'm only into my third week and want to give it the old college try, but I am having very serious doubts about my ability to handle the pressure.

Also feeling frustrated with vag exams -- during my preceptorship I was right on 95% of the time. Since I started as an official nurse, I have been wrong 90% of the time.

I don't know if it is the night shift - I feel fuzzy all the time. Maybe I should spend some time doing mother/baby and get some time management under my belt and then try L&D again, although I don't know if this hospital would rehire me if I bagged out after my L&D orientation.

while I haven't made any mistakes (other than wrong vag exams) I feel like I'm about to be told that I just don't have what it takes to handle the pace.

Gay

mitchsmom · Nov 17, 2006

chiapet... if I were you I'd at least wait out your preceptorship, you may learn more in the next 6 weeks than you think! Although of course, you will still have a lot to learn.

Various ramblings:

I've been off orientation about a month. I've definitely had my highs and lows (we've had a couple of really horrible days to initiate me... see the thread about c/s's without anesthesia... making myself walk back on the unit the next workday was one of the hardest things I've ever done). Some days are great, some I'm still just trying not to drown. For the most part I love it although those couple of bad days have really been a trial.

I made up a bunch of checklists for myself to use - I have ones for:

-my "brain" cheatsheet; it has the same information on two columns so I have 2 pts vital info at my fingertips (and you could make two sided copies for 4 if you wanted). It has: Date, admission time, name, Drs., G T P A L Para, EDC, intact/ruptured - color/odor, show, last meal, ctx/time began/strength/frequency, FHT, T BP HR R, SVE, Allergies, Breast/Bottle, Ped, Marital status S M W D, education, religion, occupation, medications, illness/pertinent hx, exposure/smoke/alcohol/drugs, reflexes, edema, urine dipstick, epidural, rubella, blood, hep b, HIV, VDRL, GBS, age, ht, wt, tubal ligation, chief complaint, d/c treatment, prenatal class .... that sounds like a lot but it fits nicely on the sheet and it is really nice to have it at my fingertips for calling the doctor, for report, for whatever - plus it answers a lot of questions that I have to fill in on our OB admission data anyway & that way I already have them in my head.

-Labor/ Labor checks (starts out with stuff you do for everyone, then things to do if they are leaving vs. being admitted)

-Delivery/ Recovery

(those first three I use by far the most)

-c-section checklist & proper scrub on the back since I was never taught it (!)

-baby 'catcher'/ Postpartum

-Delivery table setup

-Common orders (I'm still getting the hang of both writing orders and documenting)

-a misc. sheet - the code for calling long distance on the phone, etc.

Everyone has their way of doing things that works for them, this helps me. I have it all in a clear sheet protector and keep whatever list I need at the moment showing on one side and my cheat sheet on the other. It is usually on a clipboard (some people wouldn't want to carry it around but it doesn't bother me, plus I always have a writing surface and something for pts to use for signing consents and stuff).

I also have a notebook with our unit policies that is easier to get to than finding and printing it off the computer when I need it, and a notebook with helpful stuff from orientation, breastfeeding handouts, and other helpful stuff I come across (all this stuff is also in sheet protectors). The notebooks stay in my bag in the break room where I can grab them easily if I want something.

Something that my preceptor told me that I try to remember, is to get the 'physical' tasks done first - assess (using the cheat sheet of course!), get on the monitor, get a line in, etc.; for the most part, documenting and stuff like that can be done later if need dictates (um, even though it sucks to get behind on it).

As far as vag exams, I started to "get it" right before I went off orientation and not a day before!! LOL! And I still bug other nurses fairly often to check behind me if something feels weird or I'm not sure. I think someone on this forum said "don't come out 'til you find it!" and they are pretty much right... it's there somewhere. And it does help a lot sometimes to get mom to lie on her hands/get her butt up in the air.

In the last week I feel like I've regressed with my IV's!!! I've had to ask people to help me all week!! Ugh!

I'm also trying to learn to bunch tasks together - for example, if I have to get more monitor paper I try to carry back anything else I may need later all in one trip down to the supply room. But I am still learning like crazy! Do you have any tips to share with me? What is working for you?

After reading your post I'm also wondering, do you take care of mom AND baby at delivery? You don't have a 'baby catcher' nurse come in? Our catcher does initial baby stuff, admits baby, and does the newborn assessment then turns baby back over to me.

maledi · Nov 18, 2006

I started orientation on the postpartum unit at a 400 bed community hospital. r had been wokring on the med-surge flood there as an aide for a bout a year before. Anyhow. I love it. Sometimes I sit there and wonder if I am dreaming. Can I really be getting paid for this, and paid well? It's definately something I've wanted to do for so long and being able to do it right out of school makes me so thankful. I LOVE it! I love being with mamas and equally love being with the babies. In addition, the starting pay is the same if not more than most of the Boston hospitals and the incentives they offer are great (reimbursement for NCLEX, tution reimbursement and they also pay my loan payment every month).

HappyNurse2005, RN · Nov 18, 2006

Today was my last day of (official) orientation.

i still love it and am getting better every day, i think. some days i think that really suck, some days i feel alright.

its still a great job i'm glad to have

nurse79 · Nov 20, 2006

I TOTALLY HEAR YOU, CHIAPET..and thanks so much, Mitchmom, for your advice. I am leaving orientation in L/D within the next 2 weeks to be ON MY OWN!! Yikes..there really are alot of things to learn in OB and I too feel compleley overwhelmed at times.. Just remember that you are NEVER alone, and we must use our resources when needed. I think the majority of recognizing certain aspects of our job just takes practice. Vag exams are getting much better for me, except the multip that is posterior and closed/1 cm..so hard to find!! Effacement and station are also getting better for me. And yes, at delivery it is hard to do all at once. I feel like an octapus, with all the tasks needed. I guess the best thing is to make sure delivery time and crucial aspects are charted accurately, but charting for the most part can wait ( if you dont have a helper). At our institution, we call in for someone to catch the baby, while I would chart/attend to mother and MD needs...etc. This forum helps alot. At times I feel like NO on understands the challenges we face and how hard our job is. Overall it is very rewarding and I do enjoy OB. Some days I can pace myself but I am still learning how to balance having more than one pt. yikes!! thanks for you help all!!

xoxoxo

KristinRN2005 · Nov 20, 2006

Hi jenrninmi:
I started on the floor of a very busy L&D unit -- we do over 700 births per month -- on 10/31. I precepted on this very same unit from Jan-Mar 2006. I am now on nights with a couple of different preceptors, all of whom are very good. L&D is why I went into nursing.
I don't know though -- I am feeling entirely overwhelmed and thinking that I may have made a big mistake. I connect very well with the patients and my nursing skills are fine. The time management is killing me. My preceptor told me last night that I'm "all over the place" and I agree with her. Post delivery when pit needs to be hung, the MD is complaining that the light isn't right, baby needs CBS, need to do my first PP check and chart all at the same time, do bands, admit baby........on and on. I still can't do it all on my own and honestly can't see myself on my own in 6 weeks. I'm only into my third week and want to give it the old college try, but I am having very serious doubts about my ability to handle the pressure.
Also feeling frustrated with vag exams -- during my preceptorship I was right on 95% of the time. Since I started as an official nurse, I have been wrong 90% of the time.
I don't know if it is the night shift - I feel fuzzy all the time. Maybe I should spend some time doing mother/baby and get some time management under my belt and then try L&D again, although I don't know if this hospital would rehire me if I bagged out after my L&D orientation.
while I haven't made any mistakes (other than wrong vag exams) I feel like I'm about to be told that I just don't have what it takes to handle the pace.
Gay

I realize how frustrating things must be for you. I have come to the realization with stat deliveries and the like that there is prioritization that must occur.... For me, it was realizing that all paperwork can be done after delivery. Not that I suggest waiting until after delivery to do all paperwork, but look at what is most important. In order to deliver, there are a few things I HAVE to have. A delivery table set up, a warmer, pitocin (for after delivery) baby and mom bands, and a sensor for the baby's ankle. I also know that in my room I need to have IUPC and FSE as well as amniohooks, gloves both sterile and non-sterile, Oxygen set up for mom, and IV Fluids. So as long as those things are at the bedside, I should be OK. I sign consents first, so I know that I have permission to treat baby when s/he comes, And of course I want to have moms vitals (including temp) and a head to toe assessment. That takes only 5-15 minutes, depending on the strength and frequency of mom's ctx. The things that can wait are charting. We use watchchild and you can document in that system. Also, I carry notecards and write shorthand notes. I document any decels and interventions in watchchild. I have realized after a few stat deliveries (I mean mom arrives on unit at 0316 and delivers at 0334 that all documentation can be held off until recovery. That is a full hour that I have with mom and baby to just be in the room and make sure things are going well and everything is happening the way it is supposed to. That is also an hour that I can use to get everything caught up. When I first started I had cheat cards in order to guide my documentation for deliveries, admissions, recovery, c/s and placenta delivery. I also had cheat cards that guided my actions at admission, active stage, immediately before delivery, and immediately after delivery. If there is anything else I can do to help you get some ideas, feel free to PM me:) Hope this helps.

Kristin

chiapet · Nov 20, 2006

Thanks to all for your advice and encouragement. I've had a couple of days off to rejuvenate and have made up my own lists that I plan to carry with me to help me organize.

I am going to hang in there at least through orientation -- hey they gave me 12 weeks for a reason right??!! Of course three of those were not spent on the floor so I end up with only 9........ah well.

This forum has been a great source of encouragement through the NCLEX, job search process and now life as a new nurse.

Thank you all!~

SmilingBluEyes · Nov 21, 2006

Just remember: 12 weeks is a very short orientation to OB for any new nurse. If you feel at all uncomfortable in your day to day work, PLEASE speak up and be very vocal about it. Don't be afraid to ask for additional orientation, if at all possible.

Trust me; 12 weeks is nothing. You need more like 6 months' minimum. I am very sad to see so many people short-shrifted on orientation in so many places. Just be sure you ask, ask, ask any questions that come up, no matter how small.

MamaMadge, ADN, BSN · Nov 21, 2006

I am SO, SO grateful for this website!! I have posted on other threads about this same topic....I have been an RN for 1.5 years. I've been in L & D for one year and on my own for about 6 months. Our hospital has a 6 month training for new L & D nurses. Our Nurse Manager insists on it!! We are very lucky in that respect! So, to add to the discussion....I STILL don't feel competent or comfortable most nights! I have talked to many seasoned RN's about this and they say it takes a minimum of about 2 years before you start to feel completely comfortable. I, too considered leaving L& D:sniff: (my entire reason for becoming a nurse) but have told myself I WILL NOT do that until I have given it 2 years on my own to see if I start feeling more comfortable. I have faith it will happen.

As for the vag exams....don't beat yourself up about it. I've seen experienced nurses do an exam and have a midwife or doc come in and say something completely different. They are subjective! I have also learned that I need to take my time when doing the exam. I've noticed that experienced RN's take a few moments to get a good exam. Don't feel rushed unless the baby's head is right there, of course!

Good luck to every one of you and remember, we have been blessed to be invited to be a part of the miracle of life!!