Questions about L&D orientation...

SmilingBluEyes · Aug 3, 2004

Hi all,
I am a new grad/RN who was hired for a night position in L&D. I am so excited. I love orienting so far, but the more I learn, the more I feel I still do not know. I am currently orienting on days - full-time. My questions are for anyone else who was hired to L&D as a new grad...
How many weeks was your orientation/how many hours per week?
Was it only in the labor room or did it include postpartum/nursery?
How prepared did you feel to go on your own at the end of your orientation?
What would be one or two things you had wished you learned or had more experience doing before being on your own?
Did your preceptor have you work with one patient from start to finish or one week do only labor and the next week do only neonate?
I am in the last 4 weeks of my orientation and am extremely nervous about the prospect of being on my own. I am told that I will have a lot of support from the rest of the staff once I make the transfer, but I am still scared! Does this feeling ever go away? What can I do to make myself a better L&D nurse? I guess I am basically trying to get an idea of how other hospitals orient and how the transition was for you. Thanks so much for any and all info! Rose

Hi there and welcome to you, Rose. Congratulations on your recent graduation and entry to L and D nursing. I am glad you could get your choice job right out of school. I also started LDRP nursing right out of nursing school. It was not easy, but I have no regrets.

Here is how orientation went for me into L and D: I worked on dayshift, 5 days a week, 7-3 with the experienced nurses on that shift. I had no "preceptor" ----I WISH!!! So, I had to pick and choose those methods and habits the nurses before me had that worked well, emulate and assimilate those----- and discard the rest. I was on orientation for 3 months, and then believe it or not, charging on weekend day shifts 7a.m. to 7p.m. Talk about a baptism-by-fire! Transition is not easy, and I know there is so much to learn. I won't lie; I was not "comfortable" really, for about 2 years into it. I felt competent at about 6 months, and believe I was, for I saw a heck of a lot in my first months and year as an OB nurse. But it takes TIME to really see all L and D has to throw at you.

As far as being "scared", it never goes away completely. But I believe that is ok---complacency has no place in nursing and OB is no different. You need to stay sharp and on your toes. But DO NOT shy away from new or complicated cases; jump in, get those teeth sunk in, and learn. This is how you become experienced, and therefore, feel competent. Find a couple of nurses with whom you will work on nights that you feel are competent, professional, and caring. Follow them, observe their habits, and try and apply some of those that work for you in your daily performance. Do NOT ever be afraid to admit when you do not know something, especially after you leave orientation. Your coworkers WILL understand you do not come off orientation "knowing all there is to know" and being 100% independent. DO not EVER be afraid to ask for help you if you get bogged down or stuck. Heck, after 7 years, I still bounce things off my coworkers to see if I am on the right track. I am never afraid to show a strip to 1 or 2 others and get a 2nd opinion, or have some check a cervix behind me, if I am unsure. No one expects you to be perfect or make no mistakes. What IS expected is you own those mistakes you do make and learn from them. We all have to.

Best wishes. Hang in there; the 1st year is definately the toughest, and it will get better. You are lucky to at least have a preceptor. Some of us oriented so differently and could have benefitted from such. Do the best you can and reach out for help whenever you need it. That signals strength. HUGS!

If you have more questions, ask; that is what we are here for!

deb

AprilInAZ · Aug 10, 2004

Hi Rose

I am a new grad also training in L & D. I am in the middle of orientation, so I don't have all the input you are hoping for, but here's how it's going so far.

[How many weeks was your orientation/how many hours per week?

I got 6 LONG weeks of 40 hrs/week of "classroom" time. This included NRP, Fetal Monitoring, Circulating in the OR, Fetal Demise and Bereavement, a slew of different classes at local hospitals, lactation, etc... Along with that we "shadowed" an experienced RN doing very little pt care, but observing and asking ?'s.

Now I am 1 week into my 12 week preceptor guided orientation. I am also on nights, and I adore my preceptor. The only thing that seems difficult (aside from learning the job) is that nights are not as well staffed, and sometimes she is needed to carry a heavier load, and we don't get as much time to be "taught" as I think we should, and I feel that I slow her down on these nights, but I think when i can start to do a little more, i can fly solo for the easy stuff (admitting the pt, paperwork, iv starts, reviewing the strips) then she'll have time for my questions, and to quiz me etc...

Was it only in the labor room or did it include postpartum/nursery?

I did "shadow" a few days in nursery, attended births, and had to catch a few babies.

How prepared did you feel to go on your own at the end of your orientation? Gosh, I hope I will feel prepared. I can't imagine it right now. I do know that the night crew has been extremely supportive, and I can't imagine any of them letting me sink, or not helping me if I needed it.

What would be one or two things you had wished you learned or had more experience doing before being on your own?

N/A not on my own yet.

Did your preceptor have you work with one patient from start to finish or one week do only labor and the next week do only neonate?

one pt from admit to end of shift, or recovery. Starting with no complications (i haven't had a mag pt yet)

I am really nervous about being on my own some day too! Best of luck to you.

April

rdhdnrs · Aug 14, 2004

There is nothing I can add to Deb's answer; it was great.

I had 12 weeks of orientation; I felt it was about right.

OB is a great field of nursing. I have felt called to it since I started nursing school. I work in a high-risk tertiary care unit so see a lot of med-surg, endocrine, cardiac, diabetes, etc, etc. I learn something every day, even after 7 years. I absolutely love it!

Please let us know how things go. I go along with Deb; if you have any questions, any concerns, any need for support, let us know. That's what we're here for. And we're trying to stop "eating our young".!!!

Love ya,

Lisa

BETSRN · Aug 14, 2004

It takes a good year to become at all comfortable in L&D. Don't worry and do not be afraid to ask a lot of questions and ask for help when things are uncertain. Everything is always uncertain in L&D. Even those of us who have been in this speciality for years (for me it is 15) depend on one another for guidance once in a while. I can only speak for us but we try and give our new staff at least 4 months of orientation and we never expect them to be completely competant after that. AS I said, it takes years.WE are an LDRP unti and so that means L&D, PP and nursery. Good luck. You're joining a wonderful specialty. I am never sorry to ahve to go to work!

cabbage patch rn · Aug 16, 2004

You have had some great replies so far. I did not start out in L and D right out of nursing school but I have worked with a few nurses that have. The biggest problem that I have noticed is with new grads not admitting when they don't know something or how to perform certain skills. A couple of examples for you, we have a nurse right out of school that came to the unit overly confident, thinking that she knew how to do everything in just a few short weeks and in turn made lots of mistakes which were very scary, placing the patients at risk. She lost the confidence of her co-workers and the docs absolutely dread working with her to this day. It is a specialty area, it takes a good deal of time to learn everything there is to know, and it's okay to say, "I'm not completely comfortable with this yet, would you care to check behind me?" On the other hand, we have another newly graduated nurse that will quickly state what she is not comfortable doing, but she dives in and helps where she is competent. Everyone loves working with her because of her honesty in where she is at with her skills. Don't be ashamed to tell someone when you feel uncomfortable, it only makes you seem human and your co-workers and the doctors will have more respect for you. Just remember that everyone has to have a starting point, and we all learn at different rates so be patient with your own learning curve. Read everything you can get your hands on, especially related to interpretation of fetal monitor strips. Really study your L and D meds that you will commonly give so that you will be more comfortable giving them. One thing that helped me out tremendously when I first started was I made little cheat notes of our routine orders, one for each doctor because they were all different (It was all very confusing in the beginning) and I lamenated them and kept them in my pocket so they were readily available. After awhile, it all became second nature. Familliarize yourself with your unit and know where everything is because you will very often need supplies hurriedly during a delivery. When we didn't have very much going on, I spent much of my time straightening the supply carts and setting up patient rooms just to be able to learn where everything was, and I went through the department policy and procedure manuals which was extremely helpful. You will do great as a L and D nurse because you are already asking for help. And you are going to absolutely love it. Good luck!

BETSRN · Aug 19, 2004

How sad for that" overly confidant" new grad, cabbage patch. Is there any way that you can take her aside and help her?

cabbage patch rn · Aug 19, 2004

How sad for that" overly confidant" new grad, cabbage patch. Is there any way that you can take her aside and help her?

I would love to, unfortunately, we work the same shift opposite from each other so it would be impossible. And I agree, it is sad, I feel very sorry for her because all she needed was a little direction in the beginning and perhaps things would have been better for her in the long run.

emhanojoli · Aug 30, 2004

Wow. Everyone here seems to have gotten a lot of orientation. I got seven weeks. LDRP, so all areas at once. It was full time. When I came in, they gave me a labor patient. Then I stayed with her until I left. That's how they did staffing for all nurses. If she delivered, I'd pick up a couple of other mom/babe couplets.

The hospital I work in now does twelve weeks orientation, after two weeks basic hospital orientation. They do six weeks in L and D and six weeks on the PP unit. We only use the nursery for section babies, so there is no nursery orientation. Baby is done in the LDR room, then moves with mom to PP, so all baby care is incorporated into the other two units.

Oh, and it took me probably a year to feel confident enough that I thought I could handle most anything that walked in. Not everything, by any means, but 90percent...

Stacey

rndani · Aug 30, 2004

When I orientated to L&D (6 yrs ago) you got 21 shifts worth. There was a book/manual you were to study on your own. It was only on days and you were assigned 2-3 preceptors. For the first month back on your "regular" shift you had firsat choice of assignments and you had an assigned "buddy". This was your go to person. Now our facility does 6 weeks or 30 shifts worth. PP use to be 4 days and is now 2 weeks.

There are so many things to learn that first year--and the more you work the more you learn. One of the areas I felt the weakest after orientation was charting. My director suggested several experienced nurses and I read their charting. It helped so much. One of the best pieces of info I got and I use to this day...." Doctor Smith updated on pt status, contraction pattern and repeatitive late decels of fhr and interventions per RN: no new orders given." The no new orders is the clincher. This way you show that the provider is well informed of what the situation is and that they have failed to act. Hopefully you'll never need to use it. And remember--the providers don't sign your paycheck so don't be afraid of them.

RNRose · Aug 30, 2004

For all of your great replies!!! I apologize for taking so long to respond. I feel like I have been going non stop all summer. I officially started nights last week. I will be doing it full-time for a couple of weeks with a preceptor. I have been doing more and more on my own now. It feels great when I actually am able to make the connection between things I have learned and clinical experiences. So far the night shift staff is very welcoming and helpful. Of course I am still asking a ton of questions. My major fear is being handed a baby that isn't doing well. I have been trying to alleviate my fears by becoming familar with all the equipment. Everytime I do a set up for a baby I practice putting a delee together, pretend to use the ambu, etc... I figure at least if I am comfortable touching it all that will be half the battle. Well, I will keep you all updated. I know one thing though... I LOVE OB! Thanks again, Rose:)