Struggling to Transition to L and D

[pikachu715]

I've been a med- surg nurse for 5 years.

My sense of confidence changed when I started transitioning to labor and delivery. I suddenly went from expert to novice again. Initially, I was even scared to talk to expectant moms and fathers. Soon, I got a reality check that L and D isn't all rainbows and sunshine. It requires detailed observation and sometimes QUICK action.

After 3 months of preceptorship, I feel that I am still struggling to transition to L and D. I think part of it has to do with my anxiety. I have anxiety when I make small mistakes and it spirals into something like a panic attack, which effects my performance. Another part is that I am finding it difficult to work with my two preceptors. One has OCD and wants me to do everything her way. She tells me how to chart and what to do before I have a chance to think on my own. My other preceptor is more lay back. She lets me complete my shift on my own and gives me pointers on when to up pit/ intervene with my pt. However, when I have questions, she appears irritated and occasionally condescending.

The areas that I need help in are: completing recovery in 2 hours, remembering to turn off epidural after laceration repair, determining if I should turn patient base on FHM (sometimes I over react when there are small variable decels), and react in emergency situations.

Do anybody have suggestions on how to over come anxiety at L and D?

[Hannahbanana, BSN, MSN]

As groups, the nurses most likely to seek out continuing education are ICU and L&D. Broaden your sources of information. Join the professional group for perinatal nursing, check their standards of practice, get their excellent journal, buy a book. Knowledge is power. I’ll bet your preceptors felt the same ways when they were newbies.
Get over the idea of “appears irritated and condescending.” If it’s uncomfortable in the moment, discuss your concerns and things you want to learn about over coffee, maybe a few days later when you’ve had a chance to process it better. “Can you tell me how you learned to recognize the difference between X and Y?”  “I’m learning how to react in an emergency when …. Are there hints you can share c me?”

[Michellelizz]

Honestly, it takes a lot of time to get comfortable working in L&D.

In terms of tasks, when I was new I found carrying a tiny notepad with checklists really helpful. 

For emergencies, it will take time to get confident and know how to react and how you can help. In emergencies, pick one thing you can do - whether it's moving the patient to the OR, watching the FHR strips, getting drugs etc... I know older nurses who are still not great in emergencies or when things don't go exactly as planned and I know fairly newer ones who are amazing, it just depends.

[NurseGuru]

When I was new to L&D, I thought my preceptors were so mean-borderline nasty because they nitpicked at every little thing I did, I felt awful when I couldn't finish tasks within a certain timeframe or did it a certain way but the reality is that they are so hard on us because this is a highly specialized area with high rates of litigation. It is for the best. 

Keep your head up!

L&D is similar to any other critical care /trauma or urgent care environment in that your own body is physiologically under duress. So, naturally if you are experiencing anxiety and stress that is interfering with life (sleep/ emotional health) then L&D might not be a good fit for you and there is nothing wrong with that - postpartum or antepartum may be better (maybe temporary) thats OK! You literally have hormones, adrenaline, cortisol running through your body and spiking really high at random times in L&D which is not normal or sustainable. Actually, the best way to do OB if you love this specialty is to rotate as often as you can. It helps keep your skills fresh, make you well rounded, and also help prevent serious personal health issues later on. 

You should be proud of what you have done so far! It is like learning a new language. Unlike physicians, who get a nice residency and fellowship to hone in their skills -nurses have to perform within a shorter period of time. 

Even the most experienced nurses can make mistakes or forget something- but the best thing you can do is to find a mentor. If you can't find someone at work who is willing to be a resource, then seek someone outside someone who can talk you through the care as a debrief or go over case studies or review strips. 

Look up the AWHONN and ACOG practice bulletins, read your SOPs, make yourself a nice timeline or spreadsheet with notes on when you do each task. The NCC has an EFM tracing game that you can practice reading strips. 

Good luck to you!

Feel free to PM if you have any other q's.