LKB82

I don't think we have a policy per se about recovery time, but we have to check moms every 15 minutes for a minimum of an hour, and babies every 30 minutes. We're a very busy L&D department and a lot of times we need the bed or we're going to have a new patient shortly, and the unwritten rule is basically out the door to post-partum in one hour. If their legs are too numb post-epidural sometimes we just straight cath them and put them in a wheelchair, sometimes I give them a little extra time. (Realistically, some of our anesthesiologists give very heavy epidurals and we could end up waiting hours anyway for their legs to come back 100%). As for time for breastfeeding, I will absolutely help my patient if she requests help or if the baby is on an accucheck protocol, but really most of our patients are more interested in visiting with their visitors or talking on the phone in the hour or so after their delivery. I've only been a L&D RN for a little less than 3 years, and the importance of a quick recovery (as long as the patient is stable) was engrained in me from the beginning. Unfortunately, we know which RNs on our unit take "too long" to recover their patients, and a lot of the quicker RNs start to resent it when they end up taking the next patient when they delivered after another RN who is still slowly doing her reovery. (I'm not saying that 2 hours is too slow, but just trying to explain my unit's culture).

I've been working L&D for a year and a half now, but about a year on my own. Did you work in Ante, L&D, PP, or nursery? L&D and Antepartum. Did you have previous nursing experience? Nope, I was hired as a new grad. How long was your orientation? 6 months. And thank God for the long and extensive orientation, because I don't think I would have felt safe being on my own any sooner. How long did it take you to feel comfortable and/or confident? That's a loaded question. There are still some days that I question myself a lot. I think I was working on the unit a little over a year when I really felt like things were falling into place. But I think I noticed a gradual progression over the first year with certain things, my skills improved, my night just went smoother, I wasn't quite as nervous all the time, I felt like I could handle more situations. Don't get me wrong, I still ask a lot of questions, and I have several experienced nurses in particular that are always willing to give me advice or assistance when I ask. Did you ever consider you made a mistake going in this field? Throughout much of my orientation period I really thought I made a huge mistake. I didn't expect learning to be a nurse and learning to be a L&D nurse at the same time was going to be so difficult. Additionally, I had some lousy luck at the beginning. I took it personally when my patient's got sectioned or if the baby went to NICU, and I had all kinds of crazy stuff happen. It took me a very long time to come across a "normal delivery." At the time I didn't find any of it humorous or even appreciate the experience. Looking back on it now I realize how lucky I am to have experienced so many unique things. When I talk to friends that work at other hospitals I realize how much more I have been able to experience and learn than they have I guess it all depends on how you look at it.

SCN = Special Care Nursery

i am a relatively new grad, (just over one year of experience), and i started in l&d. i don't think there is a right or wrong answer to your question, and the right decision ultimately depends on the individual candidate and the unit. when i started, there were three new grads that started orientation together in l&d. now i'm the only one left. i feel that one of the reasons that i'm still here is that i had a good orientation, lasting six months. my first month i oriented to mother-baby. (this provided me with a good foundation, and i became for confident in my assessment skills). then i oriented to l&d and ante-partum. (my unit is set up in a way in which mother-baby is a separate unit, and l&d encompasses ante-partum patients as well). yes, starting in l&d is very difficult, there were days early on that i wanted to quit, and even with the best preceptorship in a sense it is kind of sink or swim, and you just have to be willing to work hard, always ask lots of questions, and hope for the best. fortunately, i'm confident that the experienced nurses around me are always more than willing to help when i ask, and in many cases are able to foresee circumstances when i might need an extra hand. i do believe ultimately that the right new grad can succeed and do very well in l&d if an extensive and supportive orientation is provided, the new grad asks lots of questions, and is willing to work very hard.

I think I wrote a post almost identical to this several months back, and I completely understand your frustration. I don't think it's reasonable to expect you to "get it" after only two SVEs. Someone once told me it takes about 100 exams to really "get it", and a lot more exams after that to get really good. Are you working with a preceptor? Do you have a dilation practice tool on your unit? If not, I purchased a pocket dilation guide that I keep in my pocket, and it is helpful, (although I never use it in front of a patient). http://www.pocketdilationguide.com/ When I first started and was working with my preceptors, I would "practice" on people who already had epidurals beacuse I wasn't feeling rushed or causing them any discomfort while I was trying to figure it out. My preceptor would go first and tell me what she assessed her dilation, effacement, and station to be. Then I would try, and then I understood better beacuse I knew what 2 centimeters felt like versus 5 centimeters, and what 50% feels like and what 100% feels like, etc. After doing that a few times then I would perform an SVE first and my preceptor would check behind me to verify. I've been in Labor & Delivery for less than a year and I still go through slumps where my exams aren't perfect or I just want someone to check behind me. Overall, I do feel better about my exams but there is definitely room for improvement. :) But basically, I wouldn't panic over two exams yet.

a sams pack is a self-administered medication pack. at my facility it contains things like tylenol, ibuprofen, colace, tucks pads, and dermoplast spray. since these are otc items, and as a whole, our patient population is accustomed to taking otcs on their own on as an as needed basis, we allow them to do the same in the hospital. they are given written and vebal parameters as to what acceptable dosage is. they are given a sheet to record what they are taking and when. the main thing the nurse has to watch out for is the amount of tylenol the patient is taking because many of the prescription pain meds we give have an acetaminophen component to them, and we want to avoid any acetaminophen toxicity. overall, it seems to work out well, and the patients like to have some independence, and not have to wait on the nurse to bring them an over-the-counter item.

i'm a relatively new ob nurse, and i've spent a fair amount of time in search of reading material or even seminars to attend regarding ob, documentation practices, and litigation issues. so far, i haven't been able to find anything. i've just heard enough horror stories regarding ob nurses having to go to court, and i just want to learn about ways to perfect my charting and protect myself as an ob nurse. any recommendations would be appreciated!

the docs won't come in a night for epidurals (some not even for their patients!) and currently, anesthesia won't do them without a doc in house. just curious, but what is the rationale for the ob having to be in house for an epidural? we do epidurals all the time without the patient's obstetrician being in house. on the other hand, we always have a level iii ob in house just for emergencies, so maybe that covers us.

I'm a L&D nurse from Illinois, but I am looking into endocrine surgeons due to some parathyroid issues. I'm not looking for medical advice, but I'm just wondering if anyone is familiar with Tampa General Hospital, Dr. James Norman, the MIRP procedure, or this website: http://www.parathyroid.com/about-Parathyroid.htm This website looks legit and it's very informative, but I'm kind of leery about finding a physician via the internet. If anyone has any experience with these topics I would greatly appreciate your input, or if you would rather, PM me. Thanks!

i didn't realize that. thanks for the tip!

thanks deb. i know i just have to keep practicing. i guess my biggest concern is that if i continue to be off in my exams i may lose credibility with my patients, the other nurses, and the physicians. thanks for the advice!

so, i'm a new grad and started in l&d in march. i've been off orientation for a couple of weeks now, and things have been going relatively well. when i was learning vag exams at the beginning of my orientation one of my preceptors would check behind me, and i was right on target 99% of the time, maybe with the exception of determining effacement. my preceptors trusted my exams enough that after a little while they didn't feel the need to check behind me unless i had a weird exam that i was really unsure of. so fastforward to now, and i am a few weeks off of orientation, and i am suddenly feeling very unsure of my vag exam skills. i'm on target for the most part (or so i think), but last night i had a patient i was calling 6-7 and then we had shift change and i was talking at the nurse's station for a bit so the oncoming nurse went in to go check my patient because she was feeling pressure. she came out of the room and i asked her how she was doing, and she said she's a 4. :imbar i trust her exam because she definitely has a lot more experience than i do. she wasn't mad and said that it didn't matter. a lot of my co-workers tell me that closed and complete are all that really matters, but i want to be accurate. i don't know if this sudden uncertainty with my exams is just nerves due to being on my own now. i guess my question is how do i ensure that my exams are on target without constantly asking someone to check behind me? i want to improve my exams, but i don't want to become too dependent on my co-workers. any advice would be appreciated. thanks!

i really hope 12 weeks is enough. everyone is different, and the fact that you had a preceptorship there should be helpful. there is a lot to learn in l&d, and even with six months of orientation i still sometimes get overwhelmed when difficult or unexpected things happen, or if things just start moving too fast. i definitely feel like i still have a lot to learn! like you said before, even once orientation is over, i can't imagine that the other staff would just leave me hanging if i really needed help. although since i'm at the end of my orientation, my preceptors frequently let me go do my thing, and they watch my strip and charting from the nurse's station, and come in the room if it's apparent it's getting to be too much, too fast, or if i call them and ask them to come in. just remember that your unit is spending a lot of time and money to orient you, so they should be willing to work with you to insure your success. although it's scary and frustrating at times i know that the other nurses on the unit are doing everything possible to make sure that i am have a productive orientation because ultimately, they're training me, and it's only to their benefit to mold me into a competent and efficient nurse to work alongside of them. good luck with your orientation, ask lots of questions, and don't be afraid to tell your unit if you're not getting everything that you need to have a well-rounded orientation.

i started in a l&d unit at the end of january. my six month orientation will be coming to an end in late july. the majority of the time was spent in l&d, some of the time was spent in a classroom, and a few weeks were spent in post-partum and the newborn nursery. i am very thankful to have received such a lengthy orientation as a new grad because i don't think i would have been ready to be on my own any sooner, and i've had the opportunity to see and do a lot of unique things with a preceptor nearby.

i graduated from the university of st. francis relatively recently. the nursing program is very different from the rest of the campus. the majority of the students in my class were non-traditional students, and age was never really never a factor for any of us. if you have any specific questions, feel free to pm me.