Tips and advice please! Transition from med-surg to L&D nurse

ashleyisawesome, BSN, RN · Jan 24, 2018

Pros: Less adult poop (there is still some!), 1:1 ratio, mostly young healthy patients (some not so healthy though, but at least their veins are usually young and plump), virtually no patients over the age of 50, getting to be involved in one of the most important times in people's lives, cute babies, generally happy atmosphere.

Cons: Younger patients can sometimes be more demanding, especially if they've never been hospitalized before. Lots of concerned family members that want to tell you how to do your job. Life or death situations can happen in the drop of a hat. It can be insanely stressful. Babies die. Moms die. Babies addicted to drugs. Holding a leg for 4 hours when an epiduralized 400lb woman pushes, and then ends up with a c-section anyway.

The workload is way different. Instead of juggling 6 patients I just have 1 (or two if you count the fetus, which I do!), but that one patient needs a lot of your time (hence the low ratio). I chart q15 mins, I always have my eyes on the strip, I am titrating pitocin, insulin, doing mag checks q2 hours, repositioning often, coaching them through breathing exercises to get through the pain, strict I&Os, etc. I need to be able to flop someone in a stretcher and get them to the OR in 3 mins or less in an emergency and circulate in the OR. In triage I can be balancing 4 needy patients at once (like a mini ER). Fetal demises are tough, tougher than an elderly death in med/surg IMO. Labor can be feast or famine and there are slow days with a lot of down time, or it can be running around like a chicken with your head cut off for the whole 12 hours. My record is 5 deliveries in one shift! That being said I totally recommend it. I will never go back. I have bad days in L&D, but I enjoy my good days way more than I ever did in med/surg.

I do feel like my med/surg skills helped me. I already knew how to start an IV, place a foley, clean a patient, hang blood, etc. I just had to learn all of the labor specific stuff unlike a new grad starting from the beginning. Every once in a while we get a sick mom with something funky like a heart problem who needs an EKG, or a port-a-cath that I know how to access, and I come in handy! We even had a paralyzed patient once and knowing how to reposition her and how to assess for pressure ulcers was helpful. I am also sort of an IV wizard. I worked on a surgical floor previously so I was used to placing 18s and 20s in old dehydrated patients with roly poly veins, so putting them in a healthy young woman is no problem for me! (Most of the time, I still miss sometimes. haha)

AdAstraPerAspera · Jan 30, 2018

I am a new nurse set to graduate and take my NCLEX shortly. I hope to work in L&D/Women's Health and have interviewed several places already. I am curious if anyone has advice for a newbie in L&D or Women's Health that they would be willing to share. I am also curious if anyone has any cheat sheets or tools they use to ensure I don't miss anything along the way or to guide me as I learn the ropes. Thanks in advance!