Yelled At During A C-Section (Among Other Things)

[RN1981]

Hi! I am entering the end of my first year in nursing (on September 4 it will be one whole year since I became a nurse). From October through early July I worked on a critical care telemmetry unit. Now I'm in L&D, which is a Level III unit with a lot of high risk patients!

I just ended the second week of my 12 week orientation today and it was horrible. Some days haven't been all that great buit I've had some good ones too, like yesterday. I felt pretty good about most things I did. But today crushed my confidence. I was taing care of a 36 year old, 39 weeks whose youngest child was 13 years so she was basically considered a primigravida. She was on Pitocin but they had been noticed a long decel so she was a high risk pt. I was doing fine with things like reading her strips every 15 minutes, putting her on her Left side and on Oxygen, charting notes, and putting in her Foley etc but it all turned to hell when she had another prolonged decel. First they were going to do an amnioinfusion, then they tell me to go get turb and I do but as soon as I get back and try to draw it up another nurse takes it from me and gives it (I admit I was taking too long and my hands were shaking).

So we get in the OR and we are trying to strap the woman onto the bed. My preceptor says "Let's pull her blanket up" but I am thinking cover her (because this is always stressed as to preserve modesty) but her belly has been prepped so my preceptor yells "NO!" and grabs it from me to fold it back. Apparently she just meant up to her shins. I just was not putting two and two together.

So everyone's rushing and I'm just basically getting in the way trying to help. The other nurse pushes me over into the corner and says "Stay here and watch. This is too much for you." I have been in a C-Section once before but I didn't really do much. The rest of the day (thank goodness it was only eight hours!) my preceptor was on edge and so was I, plus we were short that day. Everybody was just looking at me like I was the village idiot or something.

I am just not feeling L&D. My preceptor is a nice lady who definitely knows her stuff as she has been doing this for 9 years. But she is very precise and very stern and it seems often when I do something wrong (especially if she has shown me before) she gets irritated and yells which makes me nervous and shaky which is just an endless cycle overall. I always feel her watching over me with an eyebrow raised. I think my biggest issue is my pace. She has said I don't move fast enough and I try to but I just end up doing things wrong and make the situation worse like today so I tend to move along methodically so I don't make a mistake. It's just the way I am. I don't think I have an "ER" personality like you need for L&D, which is basically ER/OR for pregnant women.

So there's my sad story. I really like the hospital much more than the one I was at before and would like to stay there and perhaps transfer to another unit one day (which would not be for six more months anyway). I think I would be much more suited to Post-Partum which is what I was looking for in the first place but they weren't hiring. And I don't know if I can hold on. I am dreading going into work tomorrow and I am not even sure if they will keep me anyway since I don't "think quick enough" on my feet. I don;t want to be a quitter and let everyone down. People keep calling me asking me how I like "working with the cute little babies at such a great hospital" and I want to scream! They think all I do is hold babies all day.

I know it is only my second week but I feel exhausted. And I am sure it gets even more intense from here as next week (tomorrow) I'm supposed to move onto two patients. Anyone else been in this situation and how did it turn out for you?

[nessajune21]

This is your 2nd week in L&D- not your 2nd year! Your preceptor needs to realize that you aren't going to be as fast as the other veteran nurses.

And the nurse in the OR telling you "this is too much for you!" I would have been so mad! That is rude and unprofessional! You are on orientation to learn, not be degraded!

I hope everything gets better for you. Give it time and you will feel more comfortable and pick up pace. Good luck with the rest of your orientation!:redbeathe

[SusanKathleen, RN]

I agree with the poster above. I hope you feel better now that you have your story off your chest. Would you be willing to speak with your preceptor about her yelling? Maybe that would help her find a better way to communicate.

Best to you. It will get better.:icon_hug:

[Jolie, BSN]

I'm sorry you had a bad experience.

I agree that it would have been possible for your preceptor and other staff members to be more tactful in instructing you in the care of your emergency C-section patient, but I'm going to speak from the "other side".

When everything is going to he** in a handbasket, it is not always possible to be kind and tactful. It is also not always possible to take the time to explain all that is going on to the patient, the family and the orientee, even though all of these people need and deserve information.

Putting you in a corner and instructing you to watch may not have been kind or tactful, but it probably was the only reasonable option at a time when every available experienced hand was needed to care for the patient and her baby. I hope that you took the opportunity to observe everything that was happening and took mental notes of what you could discuss with your preceptor and the other staff members later, after the crisis had passed.

In the future, I would suggest that when the poop is hitting the fan in a situation where you lack the experience necessary to take charge, you ask your preceptor what she wants you to do, then do it as she takes over the primary responsibility for your patient.

Part of the learning curve is knowing when to step aside and not let your feelings get in the way.

[allthingsbright]

I'm new to L&D as well and I can so, so sympathize w/you! Many people leave L&D because of the stress and go to postpartum, which I loved as well. I am giving L&D some time and hope I get better/faster but yes, it is overwhlming and frustrating! Hang in there!

[northwestwind]

Oh, this is tough. I hear you, empathasize with you, and at the same time have to agree with Jolie's reply. Let me give you a bit of history to help you out.

None of this is your fault. It is what happens now with putting new grads, and early nurses into specialty areas. I want you to understand very clearly what your initial post is all about - just ending the first year of nursing. I graduated from nursing school in 1986. No one, no one, was allowed to enter a specialty area without at least 2-3 years of med surg experience. In fact, you could not go to a tele/critical area as a new grad. And the last place you would qualify for after only one year or less is L&D.

Because of the nursing shortage, early nurses are put into positions simply because there are no other nurses to fill those positions. Nursing schools are not about to tell you what you will face. So you wind up in places for which you are not qualified, because you do not have enough years behind you. Once you get there, the few experienced nurses who are still around can't train you, because they are too busy getting emergencies done on their own. They are EXTREMELY frustrated that they have no experienced nurses working with them, and they have to do what they have to do for safe patient care. No one wins.

It's not that you aren't L&D, or any other specialty. It's that you have no available full time preceptors. They are too busy working on their own with the shortages; and in a high acuity area such as L&D, they will express their frustrations to you because what they really need is a few more experienced nurses working along side them, so they have the time to train you.

I think you need to become more clear about what type of nursing you want to do. If you really want L&D, just hang in there. You will learn. If you don't like it after a few months, figure out what area you might like.

You will figure it all out - but because of the nursing shortage, new nurses are overwhelmed with things to which you are not prepared. Just bear with it....

[moongirl]

why are they having you take TWO pts tomorrow when you are not ready to care for one alone??

and I agree, yelling is not good. How are you supposed to know what to do when you have never been there before? When I oriented to OB, my preceptor SHOWED me what to so, then the next time I did it, with her by my side every step of the way. I was never expected to be the "real" nurse in any situation until I was "checked off" for each skill. And to have you push terb?? did you even know why or what its for or its side effects?? terribly unsafe and way to stressful for you.

You can do this if it is what you want, but you need to advocate for yourself to have a proper and safe orientation. What is happening you you is not ok, not for you or the patients

[Halinja, BSN, RN]

Ask for specific training in a c-section. When I started in L&D we did a week where we went to every single c-section done (the scheduled ones mostly). The first day or two we observed. The second and third day we did....under instruction. By the end of the week, I was doing everything myself, with the preceptor only stepping in if I missed something. I felt MUCH more confident in c-sections after that, and felt that a week was a minimum. When it's a crash c-section, that's not the time to be learning.

[sjp2]

Every personality is different, and many nurses in specialty areas are "TYPE A". Sounds like your preceptor is typical type A. What you need most is time. Take your time, don't let people rush you into making mistakes and give yourself at least 2 years to feel even somewhat confident. If you're in a sticky situation ask your preceptor/charge nurse/other experienced nurse for a hand when speed is an issue.

If you are that offended by your preceptor then you need to talk to your charge nurse about it or look to someone that is more nurturing for help. And I hate to be negative, but grow some thick skin, and tough it out.

[bagladyrn, RN]

I'll have to agree with Jolie here - it was the situation, not any fault in you or your preceptor. During an emergency - in which a few minutes can determine whether a baby lives or dies, or suffers permanent damage, there simply isn't time to explain, be tactful or wait for someone to perform a task in a slow deliberate way. I've been on both the giving and receiving end of snappish remarks during the crisis, and when on the receiving end I don't take it personally (when I've given it, I feel guilty for a long time). Usually, we can discuss it later as we decompress.

Your best bet is to ask to be scheduled for a couple of weeks to work with all the scheduled c/sections - from prep through c/section and recovery. That way the basics will come automatically when it "hits the fan" and you will feel more confident.

Give yourself time - it takes a good year of working full time l&d to even start to feel competent.

[potatomasher]

I hate preceptors and clinical instructors yelling at me. It's a sure sign of an unprofessional conduct. One time I was in the CCU taking care of a patient on strict monitoring. I was doing a procedure and then my clinical instructor comes inside the room and then observes me. Instead of helping me doing the procedure, he just stared at me and then yelled bad things...like "Do you want to go back to your fundamentals of nursing classes?" Such an insult...and in a plain but stern reply, I said: "Sir, this is my first time performing this procedure." And then he came out of the room and had another nurse help me out.

[crystal013]

I am a long time L&D veteran and I so agree with all the above posts.

I can see both sides of it...

And veteran nurses get yelled at too at times, especially during stressful situations.

L&D is tough.

A lot of new nurses want to go into it because they think it is fun-then they get into it and see that it is hard hard work.

You are on your feet for 12 whole hours, rarely get a meal break or even a bathroom break...it is overwhelming at best.

Those of us who keep coming back, I guess it's because it's in our blood. I've tried other areas and always come back to L&D.

The best advice I can give you is to just try to learn as much as possible while you are on orientation. The hospital I am at now, they are training 2 new nurses. I had a patient getting ready to deliver and I asked the one new nurse if she would like to come in my delivery and she said "That's ok, I've already seen enough lady partsl deliveries"

She's been there 2 weeks.

All you veteran nurses.....How many deliveries were you in before you were comfortable with it?

Hang in there. You should give every new job at least 3 months before you decide it's NOT for you...

And in nursing, any area you choose is going to have it's bad days.

I would imagine even the Walmart greeter has a bad day and gets yelled at sometimes.

Good luck!