clb6885

I graduated school in december 2009. I started my job in Labor and delivery in Jan 2010. I had 12wks of orientation and have been off orientation since april on the night shift. I have been experiencing so many feelings about my job and I don't know what to do..... First of all, I still have SO many questions....I ask them, but don't always get the help I need. It seems I am always working harder than others, and have more patients than others. I may have 2 pts, another nurse doesn't have any pts, but doesn't offer to help me when I am behind on charting and running my legs off. I come home most days overwhelmed and wanting to cry. I know people say to leave work at work, but I come home dreading the next time I have to go in. I try to go to sleep, but all I do is play back my shift in my head until I find something I did wrong or "potentially" wrong, then I worry all over again. For example, last night I had a pt 36.5wks that came in on the shift before mine. c/o right flank pain BP 106/51 temp 101.5, and HR 127. CBC had revealed elevated WBC and low platelets. Ultrasound of abdomen and chest normal. Dr aware of this and had ordered tobramycin and ampicillin and a one time order of demerol/phenergan IVP for pain. results of blood cultures were pending. FHR in 120s-130s with acels and moderate varibility. At the beginning of my night shift, the dr ordered a repeat CBC and metabolic panel at 0600 the following morning and ordered tylenol q 6hrs. the pt's BPs were 80s/40s all night, but the pt was asymptomatic. My charge nurse was aware of the BPs and said to "let it bump" since the pt was asymptomatic and we'd call the dr when we received the 6am lab results. I continued with the ordered antibiotics all night. At 0600, labs had been drawn but not yet resulted and the pt's temp was 95.4 taken 3 times with 2 thermometers. at 0630, I reported this to oncoming nurse and the oncoming nurse was going to call dr as soon as labs resulted. I came home worrying about the pt and then it hit me that I wonder if the dr meant for the tylenol to be q6h prn fever? She didn't say that, but I was so busy( I had a mag pt also) I totally didn't clarify the order and it didn't hit me until I got home. I called back up to work 2hrs after I left and talked to the nurse that took over my pt. I told her about the tylenol order and that she may want to clarify the order with the dr. She stated when she called the dr, the dr said the pt was probably septic bc sometimes a low BP and temp can be indicative of sepsis. Her orders were to continue the IV antibiotics until the blood cultures resulted. I seem to have a hard time knowing when to call the dr, so I run it by my charge nurse. She had told me to let it ride since the pt was asymptomatic.......I have been worrying ever since that I messed up!!! I hate feeling like this and this is just one example of how I feel normally on an everyday basis......Is this normal or am I not cut out for labor and delivery? I often wonder if I need to find a less stressful job somewhere. Will this get better or do i need to find another job? or am i not cut out for nursing at all????

Thanks for sharing and for being such a compassionate nurse!

arkansas

I am a new grad and have been off of 12 wks of orientation for about 4 weeks. I had one of the worst nights ever the other night. It was so bad when my shift was over I came home and cried for several hours. Here's how my shift went... I was working with 2 other nurses (with plenty of experience). Pt assignments were made as follows: The charge nurse got a pt (33wk gestation) with an infection of unknown origin getting IVPB antibiotics who was scheduled for an amnio the following morning. The other nurse got a pt who was 8cm and had uncomplicated vag delivery and was to the post partum floor by 2300. I had a postpartum pt who had c/s of twins the night before on Mag with BPs 170s/100s and an induction that had been laboring for 10hrs. She was 4cm and did not have a good contraction pattern. Her pit was maxed out. At 2200, the induction's membranes ruptured spontaneously. She started having varibles. My immediate interventions were as follows: Left side, O2, fluid bolus, VE, and notify MD. (I had learned on orientation that you try those interventions and if they don't resolve the decels then cut pit off) Well, I got griped out for not turning the Pit off FIRST! So....I turn off the Pit. Then I see the nurse that griped me out emailing my manager. As I am walking through the nurses station, the charge nurse tells me to go in and assess an outpt who just came up from ER c/o abd cramping and leaking fluids and then she'd come in and take over. I go in and get pt on monitors, no contractions, nitrazine negative and pt was 1-2cm 50% and -2 station. (multigravid) I thought that was "assessing" the pt. I go out tell the charge and she says "well is the pt profile finished on the computer?" I said no i thought you just wanted me to assess the pt for you and she says "doing the profile is assessing the pt sorry you didnt understand what i was telling you to do" So I had to go back and finish the profile on the computer. The MD comes to assess my induction pt and says restart the pit. It would be a "sink or swim" situation. In the mean time I'm trying to get the Mag pt taken care of. Give her 20mg Labetalol IVP and get orders to d/c mag and send to pp floor. The pp floor gets really rude with me, which didn't help my mood. (by this time one of the other nurses doesn't have a pt) I take the Mag pt to the floor and come back and the MD is asking why I haven't gone up on the laboring pt's pit in the last 30min.....Well, I've been taking the other pt out and NOONE else is helping me!!!!!!! By 0400, the MD calls and says since the pt still hadn't progressed, we would go for c/s. At that point one of the nurses decided to get all up in my business telling me I'm not prepping the pt right....I need to have my computer set to a certain screen bc that's how she does it..etc. So I've been dumped on all night with NO HELP and now you want to come in and not assist me but cut me down and tell me all the things I'm not doing YOUR way???? By the time my night was over I couldn't get out of there fast enough..... I am tired of getting all the patients. I know that is partly b/c I'm new, but I am wanting advice from some of you experienced nurses......Was that too much of a pt load for a very new nurse, especially since the other experienced nurses weren't that busy? How do you implement interventions with a pt having decels?

I am a new graduate L&D nurse. I have completed 12 wks of orientation on the day shift and was beginning to feel like I knew what I was doing.....I just completed my 2nd week of nights and I feel so lost. This week I had my first Mag patient. She was a 15y'o G1 P0 being induced. She was not given an enema before the induction began and she had several BM's throughout the night on a bedpan. After her epidural I checked her and she was 4cm and thin. (this was about 1045pm) At midnight, she stated she had to use the bathroom again. I put her on the bedpan for about 5 min. She had another BM. When I got her off the bedpan I checked her again.....10cm and crowning.....I immediately paged the Dr. (the dr's call time is The pt was not in pain, but feeling the need to push w contractions. I was having her breathe through them and I held gentle pressure against the perineium. After several contractions she said she wasn't holding the baby in anymore and pushed the head out....at the very second the dr came in and delivered the baby and all was well. Afterwards the charge nurse was mad at me and said there was no reason the pt should have preciped since she was a G1 with an epidural. I told the charge nurse what I had done and she said I should've crossed her legs and had her reinjected. The next night the Dr asked me what had happened and I told her the story. I could tell she wasn't happy with me either. I told the Dr that I hadn't considered a reinjection bc the pt wasnt hurting, but I would know next time. The dr said that I didn't have to get a reinjection bc she responds to her calls quickly. I feel like such a failure.....what should I have done????

NurseNora, Thank you SO much! That is really encouraging!

I will graduate as a RN in december. I was just hired for an L&D position. I am very excited! Am I also VERY scared....I feel like I don't know ANYTHING! I was also told (by the manager) that the staff nurses on the floor have very "strong personalities" and will try to intimidate the new grads. I would appreciate any advice regarding how to best prepare myself for my first day on the job as well as advice on how to handle the unfriendly nurses. Thanks!