BuckRN

Recently, I have had several upper level OB residents insisting that I increase pitocin on patients who are not changing despite adequate MVUs. They're response when I say that they are more than adequate is that baby is tolerating it just fine and that patient is not changing. The whole concept of saturating pit receptors and increasing the risk for post partum hemorrhage seems to be totally lost on them. Also, I had a multip come in dilated to a 5. We AROM and put in an IUPC right away which is absurd to me. She was only contracting q5min and they were not super strong, but they didn't even wait 2 hours for her next check before ordering pit. I know for a fact multips can dilate to complete with very few contractions and hello...she came it already dilated to a 5! Does anyone else deal with these types of problems?

I worked Tele for 4 years before finally getting into L&D.

I got 16 weeks of orientation in L&D, but we are a large facility and I had to orient to circulating, PACU, and our antepartum/high risk postpartum unit. Before my official L&D orientation started, I also spent some shifts in Newborn Nurser, Postpartum, and one shift with a Lactation Consultant.

I had a hard time with that too, but finally found a large county hospital that hired me. I had to leave the state I was in to find it though.

I work at a large county hospital that does over 300 deliveries a month. We all float through as circulator and a good portion of nurses are trained to scrub as well. On nights we have scrub tech until 11p M-F and then a nurse takes over as scrub and on weekends we only have nurses to scrub.

They do let nursing students take them, but of course it costs quite a bit of money. I am only saying about the certifications because one interview I went to suggested I get those things to make myself more marketable. However, I kind of found that insulting when I interviewed because I had excellent recommendations from managers and supervisors and I thought my work ethic should speak above my lack of certifications that I had no use for unless I actually got a job in a unit requiring those certifications. I guess it all depends on who is doing the hiring.

Most L&D units require ACLS certification. Some want a STABLE certification as well. See if any of the hospitals in your area are hiring nurses aids or unit clerks in any are of the women's department. My unit has only hired 1 new grad lately that wasn't already an employee in the Women's Services department. It can be done, but also know that it might not happen for you right away. My one dream is to be a CNM as well, but I've been a nurse for 4 years and just got hired into L&D in May. I worked as a Tele/PCU nurse first and it was invaluable experience. Don't discount that life can work out better than the plan you have in your head! Good luck!

I went into nursing school knowing that L&D was absolutely what I wanted to do. However, after I graduate, rarely were people getting hired as new grads into L&D. I worked as a Tele Nurse for 3.5 years before I finally landed my L&D job. I can honestly say that I don't regret that I took that first Tele job. I learned so much and it's also a confidence booster to see yourself be successful even in an area that is not your passion. I think it was the amazing letters of recommendation I received from my Tele supervisors that got me my L&D job. L&D is great, but it is HARD and STRESSFUL a lot of the time. I am so glad to have my time management skills honed and my basic nursing skills mastered. It has made the transition into L&D that much easier. Good luck!

I want to come work at your hospital then. I'm tired of trying to keep babies happy on pit!

L&D patients are often considered critical as well just as a side note. It's not an easy, happy place. It can be super stressful and scary.

Let me just preface this by saying that I think Pit is WAY overused. However, I work at a busy teaching facility that does 300-400 births per month and boy do they love the Pit. We start it on freaking everybody and the only explanation I get is that we don't have the luxury of waiting for everyone to have a baby on their own time so we need to speed it along. They want everyone in an adequate contraction pattern. Never mind that plenty of women can make change despite having what looks like an inadequate contraction pattern on a TOCO. Doctors are seriously impatient.

I never get to eat at the same time each night. Sometimes eating a meal just doesn't happen, so I always bring string cheese and almonds to snack on. Also, I can't work out after my shift because then I have a hard time sleeping.

Yes, I believe it says right on the info for the exam that you can have the TX BON website open to use as a resource during the test.

So not necessary to do the prep course. I passed it no problem with just using the website while taking the test.

We get postpartum maggers back into L&D even if it is several days post delivery.

I think both are high stress areas even for seasoned nurses, so especially so for a new grad. However, any area is going to be stressful for a new grad. That's just how it is. However, in critical areas like L&D and NICU, the time it will take you to get comfortable will probably be longer than it would on an adult acute care floor such as med/surg or tele. I was comfortable around 6 months on my tele floor, but in contrast, I will just be off orientation after 6 months on L&D and even though I have 4 years of nursing experience, I don't think I will be comfortable for at least 6 months-1 year after being off orientation. If it is a good supportive nursing team, you will do great whatever unit you end up on!

The Texas Board of Nursing website is very informative. I had no problems endorsing my RN license from CA to TX by just getting the information off of the website.

Unfortunately, there is just not enough breastfeeding education out there. Even nurses are so misinformed and it's disheartening. There is no reason a baby needs a bottle for breastfeeding difficulty in the first few hours of life. It's not even necessary in the 1st 24 hours of life! Giving baby a bottle just makes breastfeeding more difficult. However, you can only really influence your own practice. Just make up your mind to be as educated as possible and give your patients the absolute best care. They will appreciate it!

This doesn't really answer your question, but before you go paying for NRP or FHM, it is required for your position so your facility might pay for those. A lot of L&D units also require ACLS. AWHONN has a perinatal book that we use as the gold standard at my job, but that will also be expensive.

AWHONN has a basic fetal monitoring class online that provides a certificate of completion at the end. This could be helpful in a portfolio to present at an interview. I am an experienced nurse so the situation isn't exactly the same, but when I recently interviewed for the L&D position that I got hired for, my portfolio included the AWHONN Basic Fetal Monitoring course completion certificate, BLS, ACLS, and NRP certifications, and 3 letters of recommendation. S.T.A.B.L.E. is another certification that a lot of L&D units require for their nurses. However, be aware that doing all of these things will cost you a good deal of money. I have always wanted to be an L&D nurse. It's the reason I went to nursing school, however, I have been a nurse for 4 years and just now got my L&D job. I truly believe that my experience as a cardiac nurse is invaluable as I start in L&D. Don't get discouraged if you can't get your dream job right out of school. Sometimes things work out better than you could have planned!

We use ASCOM too.

I recently moved from San Diego and left Scripps Green DOU. It's an awesome group of nurses. The preceptors are great and the night supervisors are the absolute best. I hope you will enjoy it and you can learn a TON there. Good luck!

I oriented a new grad a few years ago I can thankfully say she actually turned out to be a pretty good nurse, but boy did she scare me! She couldn't keep her patients straight and she couldn't prioritize properly. One night we had a patient going downhill fast, but she was caught up on who knows what task. The charge nurse and I went in to insert an NG tube on the patient and we ended up having to call an code on the patient and she didn't even hear the code being called overhead on HER patient. I had to go hunt her down after the code team arrived and I had given history and background. Then, another night when she was almost off of orientation, I was not following her super close because that's how I do things near the end. Better way to gauge how ready they are to be independent is to let them be independent. However, she was super behind, so I went to check blood sugars for her and I found one of our patients unresponsive. His vitals were 100% normal as was his blood sugar and tele rhythm. We had gotten in report that he was really lethargic, but responsive. I called her in the room to ask her if this was a change in condition and she told me "We got in report that he was lethargic." OMG! Lethargic and unresponsive are two totally different things. Got the MD in to assess the patient and even though vitals, EKG , etc were stable, I convinced him to send the pt to ICU and he coded 4 hours later. Dodged that bullet. Needless to say, her orientation was extended for awhile.

Remember your drivers education class? Was it invaluable to have the class so you learned the rules of the road? Of course. But did you really understand driving or really "learn" how to drive until you actually got behind the wheel? Also, didn't you learn even more once you got behind the wheel ALONE and were totally responsible for yourself? Nursing is like that to me. I had an instructor say that nursing school taught valuable information, but mostly it taught you how to pass the NCLEX. Her favorite phrase was "This is how it works in the NCLEX world, but this is how it works in the real nursing world." You are learning wonderful and amazing things in nursing school, but the only way you will learn to be the best nurse (and trust me, I understand that desire completely. I think my husband gets sick of me saying, "but I want to be the best nurse on the floor.") is to be an independently licensed nurse. And once you are an RN, the best people to learn from are your fellow nurses. Now, that doesn't mean reading goes out the window. Research articles written by nurses are some of the best material for learning. And oh the things you can learn from other nurses on your floor. Good luck in your journey!

I am generally not an emotional person, but I absolutely cried when I saw a birth in nursing school. To be honest, that is the only actual birth I have seen. I am sure I will cry many times as I embark on my new job as an L&D nurse. Also, I have cried every time one of my patients has died in my 3.5 years of nursing experience. I always tell my husband that when I stop crying is when I know I shouldn't be working anymore. It means I have lost my ability to connect with my patients and their families.