What other career opportunities can working in L&D lead to?Meg-surg nurse downing L&D

Q. · Jul 26, 2004

I have found my L&D experience has given me many opportunities!

This week I will be interviewing for a position called regional supervisor of Childbirth Education. This position entails designing content and curriculum for all the prenatal education classes that this particular healthcare organization offers, in addition to managing the Women's Wellness classes.

Prior to that, I was a Research Nurse for a neonatologist. My job was to work with various L&D units throughout the city, educating nurses about a research study and recruiting pregnant women. I would draw their blood, obtain a urine sample, interview them, take the samples to the lab and then when they deliver, would obtain blood from their baby and an echocardiogram. I would design brochures and paperwork for the study and work with the NIH who funded the study. It was a great job.

I know a friend who is a consultant for the computerized L&D charting program. She goes around and gives in-services to L&D units.

These are just a few of the jobs I can think of that aren't advanced practice nurses (like a CNS or CNM).

Labor and Delivery/Women's Health is a unique specialty and is a major focus with Healthy People 2010 and other regulatory agency benchmarks. They need people who are skilled in this area of health. Don't let anyone deter you from choosing this field. It is very rewarding and heartbreaking and requires alot of skill. I would expect you not to get bored in L&D any time quickly though, it's a very lively area. Yes it is rolled into one. I can have a diabetic patient suddenly crash and need an emergent C-section; not only do I turn into a med/surg/L&D nurse but also an OR nurse and a PACU nurse. But that's what I loved about it.

Med/Surg nurses who continuously badmouth other specialities simply aren't professional and are ignorant. Please, follow your dream and don't listen to such uneducated comments.

fergus51 · Jul 26, 2004

Amen Suzy! I almost have to laugh when I hear a nurse who doesn't work in L&D talk about how unskilled the job is and how little we know about disease processes or meds or whatever. Go to a high risk L&D site and read about the kind of patients we look after. I have cared for laboring women with various cardiac conditions, lupus, ms, diabetes, asthma, CP, psych conditions, drug addictions, cancer, disabilities, etc. You can see as much as you want in L&D, depending on the center in which you choose to work, just like any med-surg experience you have. It's about what you put into it that matters.

The skills I learned in L&D served me well when I made the jump to neonatal intensive care (which can lead to any ICU area or peds, etc), and I had several offers to train in the OR at my previous hospital (I hate the OR though, a 40 minute section is about my limit with that mask on), so I don't think med-surg is necessary if you want a varied career. A lot of adult icus are accepting new grads, so why would a nurse with experience in L&D not be valued?

Could I go to med-surg and function like that nurse who has been there for years? No, she would have to drag my butt around. But c'mon, do you think it would be any different if she stepped into my world? My previous manager had actually said more than once that she preferred new grads to nurses with med-surg experience, so I think the idea that a few years in med-surg are necessary is outdated. It is very individual. If you think a few years there is what YOU want, then by all means go and learn. It is certainly an area where you can grow as a nurse. If you want to do L&D first, go for it.

CA CoCoRN, RN · Jul 26, 2004

I have NEVER worked Med-Surg...and don't want to. When I began my nursing practice, I went straight into ICU. And I LOVED it. Many of the nurses in that ICU were masters-prepared. Both my preceptors were. Though the facility was not a teaching facility with residents...the attendings LOVED to teach...and would pull you into a procedure to watch or even assist in a heartbeat.

I learned LOTS and I'm grateful for the education.

Now....on to L & D, my current specialty.

I've precepted a new nurse to my arena. I'd much rather she have med-surg (or ANY) experience before coming to my area. While it's true that in L&D our commonly given list of meds is smaller (though, due to the high risk types of pts we have in my area, it's quite common for my pt's to be on anti-hypertensives-IV and/or PO- to insulin or Mag gtts...even the occasional dopamine gtt) we do have to know the pharmacologic effects on mom AND the baby. So while I may only have "two" patients, I actually have four (maybe more if mom has multiples).

On med-surg, one will learn LOTS about multi-system disorders and the drugs used to treat those disorders....but you don't have the acuity...as well as the collaboration with the physicians as to how those diseases will be treated. You get orders and carry them out...it's a learning by doing, rather than learning by collaboration or direct experience. And many times, you only know your pt by the last VS or med or procedure, as written on your report sheet.

The reason that I loved ICU so much is because of that close relationship that was a necessity between nurse and doctor...the same as in L&D.

When that MD is not around, I am the "best" thing that pt has going...and because of that I get to use my skill. I may not call the doc and say, "Pt A has such and such a problem...." because it may be necessary for me to DO first...and then call doc and say what and why I've done and what's the next plan. I find a higher degree of autonomy in ICU/L&D.

For that reason, a new nurse NEEDS to have at least some med-surg experience first. She/he will need to get his/her bearing as a "fully fledged nurse"...the organization, the comfort with his/her own knowledge and how/when to apply it, etc...before coming to a specialty area.

Just as I MAY be lost for a second in a M/S area (especially since, in L&D, I don't work with LVNs) that M/S nurse will surely be lost in my arena.

*I must temper my post by saying this: I work in a metro area, see a lot of stuff some L & D nurses will never see, and do a lot of things many L & D nurses don't do...so if I sound "elitist" on some of my posts....that's why. Heck...through travelers coming through my facility, I've found that many RNs in L&D don't even place internal monitors, let alone have some of the high risk complications we see coming through my place.

I have fun at my job because we do and see so much. If I were at one of the "quieter" facilities...I'd be bored.*

J Lynn · Jul 27, 2004

For me as an LPN, there aren't many specialty opportunities as a new grad. So I'm shooting for Med/Surg to get my foot in the door. During that time, I hope to continue my education to get my RN and then go into a specialty. I would love to go into L&D, since it's why I got into nursing in the first place. God bless you as you help deliver those precious babies.

CHATSDALE · Jul 27, 2004

look no matter what area you first are assigned to, learn all you can and advance..some people can always find something to do..some people can always find nothing to do....if you work hard someone somewhere will notice

IndyGypsyNurse, BSN, RN · Jul 27, 2004

HI Susy I needed to hear that. If anyone has any other career mobility stories from L&D I would love to hear it. What about Legal Nurse Consulting for Example????? Thank you

Adria

I have found my L&D experience has given me many opportunities!
This week I will be interviewing for a position called regional supervisor of Childbirth Education. This position entails designing content and curriculum for all the prenatal education classes that this particular healthcare organization offers, in addition to managing the Women's Wellness classes.
Prior to that, I was a Research Nurse for a neonatologist. My job was to work with various L&D units throughout the city, educating nurses about a research study and recruiting pregnant women. I would draw their blood, obtain a urine sample, interview them, take the samples to the lab and then when they deliver, would obtain blood from their baby and an echocardiogram. I would design brochures and paperwork for the study and work with the NIH who funded the study. It was a great job.
I know a friend who is a consultant for the computerized L&D charting program. She goes around and gives in-services to L&D units.
These are just a few of the jobs I can think of that aren't advanced practice nurses (like a CNS or CNM).
Labor and Delivery/Women's Health is a unique specialty and is a major focus with Healthy People 2010 and other regulatory agency benchmarks. They need people who are skilled in this area of health. Don't let anyone deter you from choosing this field. It is very rewarding and heartbreaking and requires alot of skill. I would expect you not to get bored in L&D any time quickly though, it's a very lively area. Yes it is rolled into one. I can have a diabetic patient suddenly crash and need an emergent C-section; not only do I turn into a med/surg/L&D nurse but also an OR nurse and a PACU nurse. But that's what I loved about it.
Med/Surg nurses who continuously badmouth other specialities simply aren't professional and are ignorant. Please, follow your dream and don't listen to such uneducated comments.

SmilingBluEyes · Jul 27, 2004

Suzy's post says it all.....

See where she has gotten and not a day in med-surg. A savvy quick learner can pick up these things fast AND build a VERY hugely successful career in the path Suzy chose. Thank you, Suzy, I agree 100% OH and good luck on your newest pursuits. I hope they pan out!

OK, to address the post where seeing it all in a huge center makes for better experience: that may be. I have total respect for that kind of experience. I can't say personally how that is true. I can only speak for my own experience.

No, I did not work in a huge medical center in a big city, but in a little one in a rural area, 3 hours from the nearest major medical center. Trust me when I say you do not have to work in a huge center to see "a lot". I saw many people who were too unstable to ship----so guess what, we dealt with it. Some seriously ill and complicated cases came through our doors and you can't ship people too unstable to go. So for me at least, as a new nurse, it took tying things together, throught a rapid yet thorough assessment-----knowing how multiple systems working (or failing) affected each other, and the unborn baby. I did this all the time in my tiny little hospital. We had to stabilize people in diabetic ketoacidosis, renal failure, even heart failure at times, before sending them up to the medical center 3 hours up the road (or a 45 min helicopter ride). Pregnancy really complicates these already complicated conditions even more, as anyone knows. Even med-surg nurses may not be aware how much.

Sometimes, the weather did not permit for transport, and we were stuck keeping them around. We were subject to tornadic activity all spring and some horrendous ice storms in winter...not to mention a good day was when the sustained wind speeds did not exceed 30mph. Helicopters do not fly in foul weather. Yes, it could be very stressful at times. Especially for a fledgling RN. (as I was then).

So I still say, you DO NOT HAVE the requisite med-surg year to succeed in complicated obstetrics...just a huge drive to learn ----and fast. No different than starting out in med-surg in that way. I believe this with all my heart: No initial job for a new grad is "suitable" --- if you worry about things being tough or having a lot to learn. That is ANYwhere, most assuredly in med-surg, ( a speciality in and of itself), where patients are as complicated as they can be!

The moral? Go for your dreams, follow your path, and do NOT listen to naysayers or you are sunk. That is my final word on that. Good luck!

Q. · Jul 27, 2004

HI Susy I needed to hear that. If anyone has any other career mobility stories from L&D I would love to hear it. What about Legal Nurse Consulting for Example????? Thank you
Adria

Oh, yes, legal nurse consulting! Forgot about that.

Actually, yes, I know a nurse who has extensive high risk L&D experience and because of that, was able to secure a job in a lawfirm reviewing charts, fetal strips and other medical information when a suit has been filed. She gives her professional opinion, will often act as an expert witness for the firm, testify and prepare documents. OB is a high litigation area, with a statute of limitations being something like 25 years! In those positions they need someone who knows their OB skills and knows what goes on in a delivery room/OR suite and can interpret fetal monitoring strips.

Anyway, she has an awesome job in a lawfirm, works Monday-Friday, does business lunches, gets extra knowledge about the law and basically enjoys her job. She's well respected in the firm.

Couple others: after some experience in L&D you can do as Fergus did and branch out to NICU or work in a perinatal assessment center. PACs are usually outpatient triage areas for OB, doing alot of outpatient type things (nonstress tests, fluids, oxytocin challenge tests, etc). Great hours and still all the hands-on of a L&D unit (minus the baby, of course!)

Deb, thanks for the compliments. L&D is my passion and when something is your passion and you're dedicated to it, it will take you places! That I have found to be true. Even when I wasn't directly working in L&D or related things (like I am now - I'm a general Education Coordinator now) I have stayed current in my practice area by belonging to AWHONN, attending conferences, reading journals.

profjanmc · Jul 28, 2004

I do some work as an expert witness/chart reviewer, I would not consider that a legal nurse consultant, but I do testify in court cases. You need to have a number of years of experience (the jury has to believe you are an expert), enjoy being grilled by attorneys and a couple of higher degrees and some publications help as well. I have never worked a day in med-surg and really didn't miss it. Labor is so specialized, I think I would have forgotten all my med-surg quickly after cross-training anyway. Your passion for labor and delivery will take you farther than anything, just stick it out, the first year is intense, then it gets better. GO FOR IT!!!!