Tele Nurse now in Postpartum my "dream job"...and I'm not liking it.

[Sophie2318]

 Feel like I made a mistake of changing to OB, has anyone else felt this way? Anyone every left OB to do something non OB related?

Hi everyone! So here's my story and it's a long one. I always thought I wanted to do OB nursing, whole reason why I went to nursing school. I thought I wanted to do Postpartum, NICU, L&D, become a midwife, all of it!l I joined AWOHNN, got my NRP, and took stables while I nursing school/during my 1st year as a new grad. Loved OB in school and loved my ONBclinicals especially my L&D days (I actually didn't like my Mom-Baby rotation but I throught that was because my nurse I was paired with wasn't good match). I was so convince "This is what I want to do!" Also, I was a CNA for 3 years in Long Term Care and Med Surg before I became a nurse so I have 4 years of adult acute care experience over all. I am also 24 years old and have no kids of my own.

In nursing school got my senior internship in Tele not OB which I was very upset about then (though I had an amazing preceptor and experience I would not change it for the world!) I knew I couldn't get an OB job right out of school (though I did try) b/c of that. I ended up getting my 1st job on a Tele unit in a New grad Residency program. For a time I really enjoyed my job, but I had lots of ups and downs of in (had a sentinel event that really shook me at 6 month expereience, but I had an amazing mangager get me through it and I stayed for another 6 months). But still I kept thinking I wanted to be in OB, applied for months and months, never getting a nibble back. On my days off I would study OB subjects to keep my mind fresh with the knowledge. I would resent other nurses I new from school and on my floor who would get on OB job right away while I was practically begging. All the while I was working a night shift Tele position that I would leave me often drained. My floor was mix of everything. MIs, CVAs, CHG, PNA, etcs. I had some seniority, was asked to become a preceptor (though I left right before I could train anyone but I found myself really excited to train someone I love teaching students/new people) and knew my unit's routine well. I was comfortable, not very happy or had much job satifcation at times, but I was comfortable.

I ended up taking a STABLE course at one of my hospital system's sister hospital, met some OB nurses who ended up telling their manager about me and she personally emailed me if I was interested in a job. After an interview I was hired. I thought after all my hard work and dreams where coming true. I studied up my OB during the weeks I was about to start.

Started working on my new M&B floor (no CNAs, 3-4 couplets a night pluse GYN and Antepartums) for the past 2 months.

And I find myself missing Tele.

I find myself missing my med-surg critical thinking/priorities (what I learned the most in school and what I my back ground is.) Having CNAs to work with. Doing IVs and IV meds (drips, abx, TPN), having 4-5 critical patients that I always knew what was going on, always having my eyes on them in one way or another (either by the monitors, my CNA, or by myself going in and out the rooms so frequently.) I miss looking at labs and chest xray and ECHOs to read, drains and tubes to monitor and learn how to while on the floor, giving bedside report where I'm talking about a patient having now controled chest pain that is going down to cath lab in one room to a patient having a CVA and proforming an NIH on the other. I miss my elderly patients. I miss the critcal care nurses I worked with that we would drop F bombs and curse like drunken sailors. I miss the skills I would do on a regular bases.

I do really like OB/my new floor and job. The moms and dads are great 9 out 10 times and I am getting more comfortable with the newborns (I was sooooo nervouse around them before but they still make me nervouse because I'm always afraid I'm missing something new borns are so subtle!) However, I find that my critcal care tele mind and habits are having a hard time with the transition. It's such a cultural shock! The skills and habits that were once essential and necassary at my old job don't apply to my new job. Rather than always having an IV in, we take it out when they get to the floor as long as they can get up on their own and get themselves to the bathroom. I hand out a lot of tylenol and ibuprofen rather than cardiac meds or abx. Rather than giving full bedside report where I would have such a great routine/ method "This is John Doe, 76 yr old, Full Code pt of Dr Phil, here for CVA, HX of DM, HTN, and Prostate CA. Story is family notice his face drooping and slurring his words rushed to the ER. CT was neg but MRI positive for infart. On Stroke protocal Speach has cleared him for a Mechanical Diet. POC to d/c today to rehab. q4 neuro checks NIH a 4 for...Afib on monitor rate control. On 2 L via NC BL RA etc etc. Now, we have report sheets where the next shift writes all the info of pt's down (V or C/s at what time, G?P? Allergies? GBS, Hep, and Rub status, ABO, hx, when last pain meds given, Baby's gestation, wt, last feeding, 24 hour cares done/passed/failed, blood sugars, etc) so my report's are very short and more on "Breast feeding going well" "family issues" "baby had a circ" Take VS on Mom's only once a shift (out policy for low risk moms) and new born VS twice (I'm use to taking BPs every 15 minutes with a pt on a cardiac drip) and helping my mom's get through the night with breast feeding. I'm feel like I'm doing the same thing over and over. Reteaching parents on how to breast feed or how to safe sleep. Some parents want me in their room all the time and be like a nanny or ask "he is hiccuping, is that okay? he is sneezing a lot is that okay? etc" while some parents want me to be in their room a little as possible because they "have had 3 other kids" but then they have poor latch on the breastfeeding that they develop a blister or they let 5 hours go by and baby hasn't eaten because "well they were sleeping." I find myself worried about the newborns all the time, but I'm told by my collegauges to not be going in and out of room so much so they can get sleep. I feel like I am doing the same thing over and over and over again, but it's not familar yet and I have yet to get more challenging cases (like a hemorrhage or a baby with resp depress which I dread when that will happen). When I was on Tele though I hated this at times and made my anxiety worse but I would always expect the worse therefore when the worse did happen I at least felt ready/knew what to do (call a Rapid) sometimes I would like to have a rapid response because it made me feel like I could handle being high stress. They would happen enough on my floor that I was familar when they happen.

I know the biggest learning curve is that I'm going from taking care of sick patients to a well unit. My priorites are different. These are healthly women and healthy babies. But then I feel like my job is all about task and service and making sure all my Is are dotted and Ts are crossed for JACO. And it hasn't been helping that a majority of my coworks have 15+ years working on THIS FLOOR and never have done anything else. They don't get very many new grads (which is what I feel like I am with only 1 year of nursing under my belt and my old job had a 12 year nw grad training program/orienation) and I feel like they don't know how to train someone like me who doesn't know much about OB and newborns past what I learned in school. I feel like an idiot infront of them when I miss something or do something wrong.

What they keep basically telling me over and over "You are not a Tele nurse anymore." I really don't like that feeling, feeling like what I learned as a Tele or habits that made me feel I took good care of my patients and grew a lot as a nurse are not valid anymore. Now I feel like I am doing the same thing over and over and over again, rarely have to look at orders because 9/10s it's the same thing for everyone (though of course I missed an order that was a routine order to remove a foley for a GYN pt who had a lap-hys that my preceport and my charge nurse said to remove at 0600 like usual BUT when you clicked on the routine order they doc wrote in the comments "remove once MD see's pt in am.") THOSE were mistakes I never did on Tele because my flow/routine that served me kept me for looking at details like that.

I feel like my new job is now so routine focus and task focus and "giving the 5 star service" that I miss things now. And when an emergancy does happen will I be ready for it? When I can go a long time without having an emergancy and dealing with routine and low acquity? Like I said, Tele was stressful but it was a chronic stress that you got use to, it kept me alert and know what was going on, and when things went south more often it wasn't that much a surprised and was able to go back on my core knowledge (ABCs, Hs&Ts, etc)

I am also worried that if I don't like it now will I ever? Did I just love the theory of OB but not the realty? If stay too long could I leave OB and go to another area of nursing? I am very grateful and see all the new skills I am learning on this floor (my teaching skills improving, my OB skills over all) but I these skills will not transfer over to other units I wanted to change and I am afraid I will loose the skills I learned on Tele (if you don't use it you lose it and all.).

I feel terrible I feel this way. Again this is what I thought I wanted for so long, worked so hard, and how this job just fell into my lap they specifically ask for me, and I find myself questioning my decision and thinkg that it's not what I want anymore. Is this normal feeling? Am I just missing the familar? Or is OB really not for me? What do you think I should do? Would love to hear your all's throughts!

[AZBlueBell]

Ok I’m going to be honest and prime my response with this: I read it all halfway through, and then skimmed. So take it as you will!

I think based on what you said you miss from tele (apart from the “elderly” pt part!) that you may be a better fit for L&D. I say that as an L&D nurse who routinely gets floated to PP. I started in L&D so I have nothing else to compare to other than my floats to PP. But let me tell you, when I am floated to PP i am bored to death out of my mind 98% of the time. It is a very task-y type job, with the things you described (breastfeeding, the baby is “hiccuping” etc) seeming so dull and repetitive. As someone who doesn’t even do PP on a regular basis, I am consistently far ahead of my other PP coworkers in terms of charting and being on top of whatever needs to be done that shift.

For example, I am starting my 2nd assessments when they are just sitting down to start their 1st. At first I thought maybe I was just doing it wrong? But after speaking to other L&D nurses (most of which started in PP), it just all comes down to time management. I find myself on PP pulling up the L&D fetal strips just to have something to do/look at while at the nurses station! In a way, I imagine those fetal strips would make you feel at home with your tele experience. We are constantly watching strips, even those that are not our own!

Things can change in an instant in L&D. I have run to another nurses room when the baby is down to the 60s only to have the heart tones back up to normal by the time I open the door. And on the flip side, I have ran down that hallway to a baby in the 60s and had to help roll that pt back to the OR with baby tones not coming back up all and we are just praying for a decent outcome.

I always thought I wanted to take the path of school> PP > L&D. And many people argue this is the best path to go! But my own experience is that of being so thankful that I went straight to L&D, where my heart is, and where I am constantly being challenged.

Now, if you’ve made it through reading my whole response (and not skimming!) I’d say give it some time and then decide. Give at least 6 months before deciding anything major. Ask if you can shadow L&D. Ultimately, then you can figure out where you will be happiest!

[DrMissitRNfixit, BSN]

I am a PP RN and have been for almost 13 years. I did L&D for 3 years and it was not for me. The awesome thing about nursing is that people with different strengths strive in areas where others may not and vice versa.
If you are not feeling OB, I would say change it up. The above poster’s recommendation is a great one, L&D would be for you. You could also join a high risk OB team and transport if your facility offers it. It sounds like your background would make you an asset ?

While I feel like my critical thinking skills and Med/Surg skills have peaced out, I can bust out 5 (while I’d rather not) couplet assessments & get them charted. I LOVE sitting and educating my new parents about their baby, answering questions and helping them understand what is going on with their post-baby body.
The above poster is correct, it’s task-oriented & you are correct about the orders. They’re often copy-paste (at our hospital). I am a terrible preceptor because I have my system down-I don’t write anything down, that’s what the report sheets for! ?
To each their own, but life is too short to not love what you do! Good luck!!!’

[SteelGrey]

It's cool to let go of OB and do something different! The beauty of nursing.

If you still feel like you want to be in OB though, consider L&D, high risk antepartum or NICU ( if you have a higher level one) for some more action. I liked L&D cause it was like ER for pregnant people. Depending on how your L&D is set up and the acuity of the hospital, ever single shift is different and sh*t hits the fan fast. Also, the boat loads of monitoring and documenting keeps your brain sharp. Plus, if you do triage, you get to see all kinds of complications, emergencies, labs, scans, monitoring, diagnostics, multiples, genetic disorders, etc, again depending on the level of care your L&D can provide. Plus, you get to use your NRP, at deliveries and fetal monitoring interpretations & interventions. I like the autonomy of when I see X occurring on my strip , I just start doing my interventions. Lots of great team work in L&D too.

Most every nurse on L&D who ever got floated to mother baby hates it, because it is generally very routine, and with all the key points you mentioned. But some people love it, and I can totally see why too ?

You will find your way back to something you are happy with!

[passionflower, BSN, MSN, RN]

You sound more suited to L&D

[hazel30, BSN, RN]

You either love pp or hate it. Hopefully by now you're back in tele, or have switched to labor. 

[rac1, ASN, BSN, RN]

Sophie2318 said:

I feel terrible I feel this way. Again this is what I thought I wanted for so long, worked so hard, and how this job just fell into my lap they specifically ask for me, and I find myself questioning my decision and thinking that it's not what I want anymore. Is this normal feeling? Am I just missing the familiar? Or is OB really not for me? What do you think I should do? Would love to hear your thoughts!

I think that you should stick it out. I think there is a combination of things happening. First, you are learning a new job that is really completely different than what you were doing before and that is SO HARD to do when you know your previous job really well. So much routine, and normal in that - and now you have to work to think about everything you're doing because it is all new. Luckily, you have time management, charting and assessment skills already. The newborn assessment will come as you work, and the worry will go away somewhat (but those babe's can be stinkers! I never trust them!).

I think that you are going to be a L&D nurse. You need the BUSY. It sounds like you need the constant change, and there is constant change in L&D. Even on "slow" days - they are just welcome because they are so few and far between! I think that you should do your year in postpartum and then try to transfer to L&D. I think you will be great. Work hard to focus on educating those moms/families. Get your lactation counselor certificate if you can. Busy your mind by focusing on educating your patient's and going above and beyond for each one. There is always something to educate on. And then go to L&D when you can. It really does sound more your speed. I say this as a former trauma floor nurse. I went to L&D and did my training, and then my second shift on the floor out of precepting, they floated me to postpartum. Gave me 5 patients (which is really 10 right!) and I was like oh ohhhh, this is going to be awful. But it was the easiest day I had had in weeks. It made me comprehend how much I really love L&D, and the crazy busy that it is. It is constantly something new. Find something you love about postpartum - like educating your patients, or learning more about breastfeeding so you can help your pt population....and learn it like a pro....put yourself into it so you can come out the other side - and then try L&D out!  ? 

[Sarah Casas]

That’s theI just had to chime in here. I transferred from tele to postpartum in December. I feel like I could’ve written your post. Well I do like postpartum it is just too slow and I feel just like you did about the critical thinking skills and not liking the feeling when being told you’re thinking like a tele nurse you need to think like postpartum or you’re not in tele anymore. My gut tells me to go back to tele. And that’s what I’m doing! That’s the beauty of nursing right?