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?

[NurseNora, BSN, RN]

In the OR people do tend to snap at you very sharply if you start to do something wrong. It takes less than a second to contaminate a sterile field. The patient's abdomen had been prepped, if you'd contaminated it, they would have had to take several minutes to prep her again, or do a "splash and dash" which puts the patient at increaesed risk of post operative infection.

I don't think that telling you to stand in the corner was meant unkindly. It was a way to get you out of their way and to let you observe and learn. An emergency section is not the way to learn how to do sections. They're for after you've already had a thorough grounding in sterile technique and how to move around in a sterile environment.

L&D is very stressful to learn and I hate to tell you that it will only become more stressful for a while longer. Everyone feels this way. Just when you start to think you might be getting a grip on things, something happens to make you feel like you'll never learn it. We all went though it. Talk to your preceptor about what happened. Not just you feeling badly about being yelled at (if it was the first time, it won't be the last), but also about what she did to and for the patient, the order in which she did things and why. Show your interest and enthusiasm and it will get you a long way.

Good luck

[MarySunshine]

I know it's hard to be certain, but you need to figure out if you think you would really LIKE L&D. Imagine yourself as a competent, confident, good L&D nurse. Would you enjoy it? Or would you just be there because it was the only available job to you at the time?

IF you think you may really like L&D (and it may take time to figure this out) then I think you should stick with it. The first week or two that I'm in orientation in a new situation, I always get a little "shell-shocked." I move slowly, I think slowly, I think my brain is in over-stimulated and in overdrive with the new surrounding and area. But I get over it, and I'm a very good nurse. I'm sure you will be too, if it's a good fit for you.

I don't think you should have two patients so soon, tell your preceptor you need a little more time. She needs to be more patient with you.

And yes, grow a thicker skin. Good luck. Come back and update us.

I wanted to add something. My best teachers in life have been the ones that were really smart but also a little scary to me :) Maybe your preceptor is like this? She will probably respect you standing up for yourself and saying "I've been doing this for two weeks, I WILL figure it out soon."

[cassioo, RN]

Where are you at that you are taking patients on your own after 2 weeks? Do you have set conference times to set goals and evaluate what's gone on over the week?

You shouldn't have been yelled at by anyone anytime very unprofessional

[Sandwitch883RN]

NothWestWind....excellent post! I entered L&D as a new grad and still as a new nurse (2yrs) I struggle with confidence, and developing a thick skin. I still dont know that I would have gone to medsurg knowing what I know now. Some nurses say that it builds a foundation and some say that L&D is so very different that they didn't find it neccesary. Although I will say that preceptors for the most part have to have the patience of a saint because I cant imagine precepting someone that doesnt have ANY background as far as staring an IV, using a pyxis, taking orders. My preceptor did a great job! Also, at 33 I thought I had the maturity and ability to handle the stress level of L&D. I was wrong. I've had to grow and mature over the last two years as a nurse (and a person) and still feel very new. I never pass up the opportunity to learn from others. I've job hopped trying to find my place and have learned that you just have to knuckle down and give it time. I'm starting a new job this week...but with a whole different perspective.

[Salgal08]

I also think that it is NOT ok to yell at or belittle someone, new nurse or not. I've been in emergency situations where communication is done effectively and effeciently without anyone being cruel. In fact, emergency situations go much more smoothly when people act professionally, I think.

Having you observe a crash c/s is totally reasonable so early on in your orientation, but the way in which you were told "Go stand in the corner, this is too much for you!" sounds like you were being treated like a child, or even a dog. I think that was uncalled for.

I think health professionals who treat others like you were treated should be ashamed of themselves.

[RN1981]

Well, today went a little better as I had just a plain old lady partsl, low-risk patient. I was able to chart and actually stand by the bedside and act as the nurse while my patient was pushing, and coordinating that with the charting, assessments, and everything else. It went pretty well and I even started (with a little help) an IV. I did pretty well with the recovery (I don't know how I am going to ever get it down to two hours!) But overall, it was definitely a better day.

Yesterday still leaves a bad taste in my mouth though. I am still a little miffed about being yelled at and put in the corner (by other nurses of all people! The docs were okay surprisngly), but I'm even more upset with myself. I keep thinking I should have known to just stay out of the way but then again it's like she was expecting me to help. I don't know. I just don't feel like I have the right personality for this job as she is constantly telling me to pick up the pace (although I didn't hear that today surprisingly) and how the nurses in that unit are considered "adrenaline junkies." I couldn't be farther from that. And the wierd thing is I have always planned to avoid the OR like the plague because I've always been terrified of contaminating sterile fields by mistake, not hearing people correctly through the mask, and abusive doctors. I know! I should have thought more about that before I went to L&D (which I got confused with LDRP which I experienced in my school clinicals).

Tomorrow, my preceptor says I go up to two patients but she will be there to "help me." I do appreciate her saying that because I am really nervous about it. I am going to give the floor more time before I make my final decision. I definitely feel like it's a great learning oppurtunity. Is it for me? I don't know. But I am trying to hold on for six months so we'll see.

I definitely have my eye on Post-Partum; though I am scared that I will never find my niche and I'll just be skipping around from job to job forever.

Thanks for letting me vent. I really appreciate all the thoughts and support. It really helps me to know that other people have gone through this too. This is the best nursing site on the net bar none. Thanks.

:heartbeat:wink2: :redbeathe

[RNmama05]

Do Not Give Up. *Everyone* was new at one time. It's painful and sometimes humiliating to be the new kid on the block, but that's how everyone starts out.

While no one deserves to be yelled at or humiliated, nothing is going to change that kind of thing (except maybe people who remember what it was like who deliberately choose never to do that to someone else). L&D can be high stress and many people manage their own stress and anxiety by lashing out and barking at other people. After you have a bit more experience you will no longer personalize other people's bad behavior and may even be able to speak up for yourself. Meanwhile, a thick skin and a resilient ego is your best protection.

I promise you that in a year or two, you will be one of the ones in the OR who is moving fast, knowing exactly what needs to be done while some other poor new nurse looks confused and scared. (Remember how you felt so you can be supportive.)

[mom2michael, MSN, RN, NP]

I was an ER nurse prior to coming to OB. I've seen emergency situation one right after another and we (meaning co-workers, doctors, etc) never really got upset. I've only witnessed one almost yelling situation and that was actually justified because the person was being an idiot. Most of our high stress situations were learning situations for us all and teaching opportunities for those that had never experienced something like that before. I was NEVER yelled at in ER, never - ever. I was never made to feel stupid and even if I did something stupid, the doctor or a co-worker might *gently* remind me to not do that again. I would hang my head down for a moment and think...duh....and then we were all right back in there doing the job 5 mins. later and no hard feelings.

I'm going to add the following disclaimer to the remainder of my post. I love my job and I love *most* of my co-workers. I've had some great teachers where I work, I've had some not so great teachers. I've had some that are totally willing to help me work thru my mistakes and I've had some that have ripped my butt apart for something totally stupid.

It must've been "get yelled at in a section week" because I had an scrub tech scream at me from across the room last week over something STUPID that I didn't even do, she just thought she saw me do something. And really, not her concern you see as she should've been attentive to her patient on the table & the doctor, not what I was doing (or what she thought I was doing) to the baby. Thank heaven the doctor wrote her up for that incident because it was totally uncalled for and thank God the parents didn't speak a lick of English so they didn't understand what she screamed from across the room.

Anyway, I've struggled a lot since coming from ER to OB. Remember, I worked in a constant high stress area so stress is nothing new to me but these ladies I work with take stress to a whole new level and they can get very demanding, very nit picky and very nasty in the drop of a hat which is highly frustrating to me as I don't learn well in that situation.

I start L&D this week (I work in an OB unit where we do it all) and I'm very scared. I have 22 weeks of orientation in L&D if I need it - so I have much time to learn and experience what I need to experience - I just cringe at the idea of a few of my co-workers being my preceptors. They demand perfection and they demand it quickly. There is little room for error as far as they are concerned and many of them take the attitude, I've shown you once now GET IT RIGHT THE NEXT TIME. They are also very high strung and high paced all the time and I'm the type that likes to sit back and take in the whole situation first and get an idea of the big picture.

I can not wait to go to my final shift (nights) because the stress level on nights is so much lower. We don't have the constant sections and inductions coming thru the door. The night shift gets along with each other, it's far more team approached and it's more laid back. But they want me on days for the obvious reason of learning so here I am.

Anyway, I know how you feel. I'm struggling too and I've been an RN elsewhere. It's tough to do this job regardless of you experience and if you are a new RN or not.

I wish you luck, keep your chin up and keep looking and experiencing all you can. Give the job time sometime, eventually it's got to get easier for us right??????

[zahryia, LPN]

RN1981, I feel your pain. While I haven't been yelled at, I've been snipped and I've had to just get over. Thicker skin is definitely key.

Give it 4 more weeks and assess how you feel and just take it one day at a time.

[Dayray, RN]

nurses who dont feel overwhielmed in L&D during orientataion (and for a while after) are scary. if you dont realize how scary it is you arent gettign it. the fact that you feel stressed shows that you are learning and that you do get how important your role is and that you dont know everything. keep it up and talk with your preceptor abotu your feelings chances are she is waiting for you to show some sighn that you are overwheilmed and can help you with it.

[tmulder]

I am sorry that this happened to you.

I just finished my 12 week orientation in May. I honestly used to come home and cry just about every day. Every pt I was assigned always had crazy things like prolapsed cord, preeclamptic seizures....you name it. If it was scary, it happened to me.

Now I am just starting to feel a bit more comfortable at work. It has taken in my opinion a long time and a lot of work but I am so happy I stuck it out. I also had people be snippy with me and often felt I was "in the way".

I think you need to assert yourself and tell your manager that you are not comfortable w/the load that is being placed on you. I think it is best to be honest and your boss will be glad that you aren't taking on too much. No one wants an unsafe work environment and if you are stressed out and taking on too much pt care this soon something bad could happen. Don't let anyone pressure you into taking too much on. Take your tiime.

[DoulaJane]

Jolie is absolutely right. What mattered at that moment was the mother and the baby, not tact. I have been there; new and green in the OR. My problem was, I was so scared I would miss something I lost sight of the big picture. I needed to relax and let it flow! My priorities got all screwed up: I would stop everything to take care of a minor detail cuz I was afraid I would forget if I didn't do it right that minute. In the meantime, more important things were ignored. Prioritize! It will come if you just relax and believe in yourself. Don't give up!