Orientation almost over ...

Mrs.S · Oct 3, 2005

Yep, it's almost that time ... my 16 week orientation just has a few days left in it. Amazing how slow it went at first and then how fast the past few weeks have flown by.
I feel confident in my physical assessment (not just asking if they have epigastric pain but understanding what it means if they say yes), I feel confident in my patient care (physical and mental), I feel confident in charting "normal" happenings, I feel confident doing a lady partsl delivery on my own with a doc that's not a jerk, I feel confident circulating c-sections, I feel confident with most things.
I DO NOT feel confident with FHR variables, decels, tachycardia and the rest ... strips scare me when I'm unsure of what I'm seeing. I always ask for help in reading them and always defer to the experienced L&D nurse. But they still make me nervous. I've treated decels with great outcomes and that gives me more confidence but there's still that part of me that worries I won't "see" something that I should.
And I still don't know when to call the doctor for the delivery. Some docs want to push a few times with the patient, others want the baby to pretty much be all the way out before they get there. I tend to err on the side of caution and get the docs there early. Since I'm new, they don't seem to mind, and I sure don't want to get caught during a nurse delivery! Not yet anyway!
I guess it's good I'm a little nervous going out on my own, my preceptor keeps telling me I'm doing great ... but the responsibility we have in our hands is so immense that sometimes I just feel overwhelmed by it. I am so happy I chose L&D and I love most aspects of it ... all but the high lawsuit rate! :chuckle
Glad to have this place to talk and share ... and to read all of the other postings and learn from each of them. You guys are great!

I hear you, sister! :specs:

I'm just off of orientation myself, and those same two things in particular stress me out as well. My peers keep telling me it will come with time, that it takes a good year to start feeling comfortable etc, but that doesn't really seem to make it any easier, does it?

The other day I had a patient whose baby just didn't look right on the strip all day; nothing horrible but enough to give me that knot in the pit of my stomach. I wasn't always sure what I was seeing and that was a big part of it. What I did in addition to consulting other nurses was had the doc pull up the strip on her computer in the office and take a look at it. I don't know if you have this capability where you work but it's great!! I felt loads more comfortable with what I was doing with my patient when she called back and said, "yes I see what you were talking about back there but the baby looks good now, let's just stay the course"

What I've been doing with deliveries is calling around the time we start pushing to give the doc a heads up, especially if I haven't given them an update for awhile anyway, and they all have seemed appreciative of it so far. Like, "I just had so-and-so give me a couple pushes, and she's really moving the baby down well, I don't think she will be pushing for long" and then they can say either, "Ok thanks, call me for delivery," or, "OK, I will be there in 10 minutes" (or whatever). Obviously a lot depends on where the doctor is and what's going on with your patient. but that seems to be working well for me so far.

I'm sure you will get way more helpful responses from the experienced nurses here. I love this board so much!! it's such a great resource...

RaeT,RN · Oct 3, 2005

I too am nearing the end of my orientation . . . I have 4 weeks left (I squeezed another week out of them because we are in internship classes 8 hours a week and I am losing those floor hours.) Of those 4 weeks, one I spend with our scrub techs, one with our baby nurse, and one on the high risk antepartum unit. So, really only one more "week" of L&D nursing . . . yikes! I just want more practice with everything! I shudder at the next 9-18 months and the tears and harsh learning experiences to come. . . I am such a stress case - one little thing on the strip and I'm pulling consents for c sections :rolleyes: I guess that's a good thing, though, because I watch EVERYTHING. My pt today - DEEP and WIDE variables through majority of labor, can't get her comfortable, get her her new epidural, and baby is sitting right there - pushed for (not kidding) half a push and baby came out with the cord wrapped around the foot! Apgars 9 and 10. Ya just never know up there. I like that because it keeps me on my toes and never allows me to become complacent. I just don't want to be on my own and be attached to my charge nurse's hip for the first few weeks . . . "What do you think of my strip? Should I call the doc now? Can you check her cervix behind me?", etc., etc.

SheaOBRN · Oct 3, 2005

i am only 2 years out and I still go to more experienced rn's with questions about strips-you are a team, don't ever stop asking! you also have to remember, most babies have great reserves, and who knows what has been happening for the last 9 months when monitors haven't been watching. you will get more comfortable, but these babies will let you know when they are in trouble, you will see it! good luck!

-Shea

Yep, it's almost that time ... my 16 week orientation just has a few days left in it. Amazing how slow it went at first and then how fast the past few weeks have flown by.
I feel confident in my physical assessment (not just asking if they have epigastric pain but understanding what it means if they say yes), I feel confident in my patient care (physical and mental), I feel confident in charting "normal" happenings, I feel confident doing a lady partsl delivery on my own with a doc that's not a jerk, I feel confident circulating c-sections, I feel confident with most things.
I DO NOT feel confident with FHR variables, decels, tachycardia and the rest ... strips scare me when I'm unsure of what I'm seeing. I always ask for help in reading them and always defer to the experienced L&D nurse. But they still make me nervous. I've treated decels with great outcomes and that gives me more confidence but there's still that part of me that worries I won't "see" something that I should.
And I still don't know when to call the doctor for the delivery. Some docs want to push a few times with the patient, others want the baby to pretty much be all the way out before they get there. I tend to err on the side of caution and get the docs there early. Since I'm new, they don't seem to mind, and I sure don't want to get caught during a nurse delivery! Not yet anyway!
I guess it's good I'm a little nervous going out on my own, my preceptor keeps telling me I'm doing great ... but the responsibility we have in our hands is so immense that sometimes I just feel overwhelmed by it. I am so happy I chose L&D and I love most aspects of it ... all but the high lawsuit rate! :chuckle
Glad to have this place to talk and share ... and to read all of the other postings and learn from each of them. You guys are great!

SmilingBluEyes · Oct 3, 2005

Yep, it's almost that time ... my 16 week orientation just has a few days left in it. Amazing how slow it went at first and then how fast the past few weeks have flown by.
I feel confident in my physical assessment (not just asking if they have epigastric pain but understanding what it means if they say yes), I feel confident in my patient care (physical and mental), I feel confident in charting "normal" happenings, I feel confident doing a lady partsl delivery on my own with a doc that's not a jerk, I feel confident circulating c-sections, I feel confident with most things.
I DO NOT feel confident with FHR variables, decels, tachycardia and the rest ... strips scare me when I'm unsure of what I'm seeing. I always ask for help in reading them and always defer to the experienced L&D nurse. But they still make me nervous. I've treated decels with great outcomes and that gives me more confidence but there's still that part of me that worries I won't "see" something that I should.
And I still don't know when to call the doctor for the delivery. Some docs want to push a few times with the patient, others want the baby to pretty much be all the way out before they get there. I tend to err on the side of caution and get the docs there early. Since I'm new, they don't seem to mind, and I sure don't want to get caught during a nurse delivery! Not yet anyway!
I guess it's good I'm a little nervous going out on my own, my preceptor keeps telling me I'm doing great ... but the responsibility we have in our hands is so immense that sometimes I just feel overwhelmed by it. I am so happy I chose L&D and I love most aspects of it ... all but the high lawsuit rate! :chuckle
Glad to have this place to talk and share ... and to read all of the other postings and learn from each of them. You guys are great!

Congratulations on making it through the rigor of orienting to L/D. NO ONE feels fully confident or 'ready" after orientation. Remember, your colleagues are there to "bounce things off of" and USE THEM. Heck after 8 years' actively practicing as an L/D nurse, I ask my coworkers MANY TIMES to review questionable or "odd" strips, re-check cervices that are somehow "different" or other questions. We are there to collaborate and reach decisions TOGETHER. No nurse is an island unto him/herself in L/D; we do not practice in a vacuum. Observe how MD's and Midwives collaborate, and you see, we all need to do this at times. I see the MD's calling their colleagues for "2nd opinions" and respect them for it------it's always good to get another opinion, or just the reassurance from a respected and well-seasoned colleague when you are unsure.

The same rules apply once off orientation-----meaning, you never pretend to know what you don't. You ASK ASK ASK when a question pops up and never be afraid to be clear about your limitations to the dr, midwives, or coworkers you interact with. No reasonable nurse expects another just off orientation to have all the answers; we expect you to have more questions and to come to us when a problem or question you can't answer arises.

Again, congratulations on coming through orientation. Don't fret that you are still unsure about things. The whole process of learning in nursing is LIFELONG. Be sure you are always reading, learning, growing and you will do fine. And know, it will all "click" sooner or later. It took me 2 years' fulltime practice to feel really confident I was sure of what I was doing.

Become a member of AWHONN, if at all possible. READ READ READ and ask anything here; you have literally 100s of years' experience here to draw on at allnurses.com. No question is too stupid or petty for me, ASK!

deb