When I first became a labor and delivery (L&D) nurse, I didn’t quite know what I was getting myself into. I didn’t have children and I didn’t know anyone who did. I hadn’t even held a baby before! I had quite a long road of learning ahead of me. I loved every minute of my job, but internally, I was terrified and overwhelmed by the vast amount of information that was being thrown at me every day. After almost a year of being a L&D nurse I am beginning to feel confident and knowledgeable with my patients. Looking back, I wish someone had told me what my job would truly entail so that I would have been more prepared. So for anyone out there who is interested in becoming a L&D nurse, or even is just curious about what our job is like, here is a list of things I wish I had known first.
1. Most people (surprisingly) don’t know a lot about giving birth.
You might think that most parents would spend nine months preparing for the imminent delivery of their child, but a surprising number of families do not. So as a nurse, it is your job to explain the nitty gritty of what will happen during labor and delivery. Even the most prepared moms have never felt the intense pain of contractions or pushed a human out of their body before, so they will need some assistance. Over time you will gain a plethora of knowledge about the labor and delivery process, and your patients will soak this information up like a sponge.
2. You are going to see a lot of vagina. I mean a lot.
You will quickly become accustomed to the sight of a vagina, and you will learn that each vagina and cervix are different. The first time you go to check a cervix, it will be awkward, and you may not even be able to find it! It’s not easy (or pleasant for the patient) to do a cervical check, but as you gain experience, you will learn tricks for finding a posterior cervix and how to tell which way a baby is facing. Vaginal exams are your roadmap to the laboring process, and you will learn how to use them to help you deliver a baby successfully.
3. Everyone has a different pain tolerance.
Giving birth is arguably one of the most painful things a person can endure. Some women handle this pain with grace, and others, well, do not. As a nurse, you will see women who quietly breathe through each contraction, and you will also see women who scream and thrash through every one. At first it is alarming and very difficult to see your patients in so much pain, but over time, the yelling will simply become the normal background noise of your shift. One of the most important parts of your job is assuring patients that there is absolutely no shame in getting an epidural. It is not “cheating,” and sometimes it’s actually very helpful for the dilation process (and the nurse and support person’s sanity!).
4. A lot of your job is reassuring your patient that yes, they can and will deliver this baby.
Giving birth is scary. There is no denying that. After 20 hours of labor, even the strongest woman can begin to lose hope and want to give up. This is when the nurse steps in and becomes the woman’s biggest cheerleader. You will give every ounce of your energy to help a patient deliver their baby. You will help them breathe and make it through each contraction, and cheer them on through every millimeter of movement during pushing. One way or another, the baby will be delivered, and it is your job to remind the patient of this!
5. Babies are unpredictable.
On a L&D unit, the babies run the show. Ultimately a baby’s position, cord location, placental reserve, and many other factors will decide when and how a delivery occurs. Nurses have to be ready for absolutely anything to happen….even catching a baby! Within a matter of seconds, you can go from having a routine labor to running back to the OR for an emergency cesarean section. It is always exciting and suspenseful waiting to see what will happen!
6. You will become accustomed to certain sounds.
Your ears become your biggest asset on a L&D unit. When a laboring patient walks on the unit, the nurses can predict (with surprising accuracy) how far dilated a patient is based on her moans and groans. We know when we need to walk versus run toward a patient! Your ears will also become accustomed to the sounds of a normal fetal heartbeat and ominous drops in the heartbeat.
7. Your patients and families will absolutely love you.
Everyone remembers their L&D nurse. You are their source for information, advice, support, and encouragement. They truly could not deliver their baby without you. You have the ability to make their birth experience truly amazing and memorable. Little details and thoughtful gestures like grabbing warm blankets for a cold patient or placing a wet washcloth behind a nauseous mother’s neck can really make your care memorable.
8. Watch your support people like a hawk. They need care, too!
As a nurse, it is your job to utilize your support people and help them get involved in the care of their loved one. They can assist with counter pressure, pillow placement, hand holding, and encouragement. A lot of times, they are so focused on these tasks that they forget to take care of themselves. Ask the family how they are doing, pull up a chair for them to sit down, and make sure they are eating and drinking. During procedures and the delivery process, watch for blank stares and pale skin… Remember that they are not accustomed to seeing blood and may end up passing out!
9. When it’s sad…it’s really sad.
Delivering babies isn’t all rainbows and sunshine. Some days we frantically search for a fetal heartbeat, only to have the horrible, gut wrenching realization that a baby is not alive anymore. You will carry each fetal demise with you for the rest of your career. And no, it does not get any easier. But you will get better at coping over time.
10. It is endlessly rewarding!!
Every time you go to work, you get to witness the amazing miracle of new life coming into the world. It doesn’t matter how tired you are or what your day was like, there is truly nothing as rewarding as seeing the joy on a parent’s faces as they meet their child for the first time. It never gets old seeing a child enter the world.
So you’ve been fired by a patient. It’s not pleasant. But the good news is that you are not the only one who has had this experience. Getting fired is a natural part of patient care. Not everyone that you interact with will like you or the experience you provide for them. How you respond in the aftermath of being fired can make or break you as a nurse. Here are five steps to help you handle being fired by a patient gracefully.
1. Don’t fight back.
Chances are that when a patient fires you, they will be angry and maybe even shouting. If you fight back and try to defend yourself, things are likely to escalate further. The best thing to do in this situation is to walk away. Go visit or call your charge nurse and see what your next steps should be. While you are doing this, the patient may calm down and potentially be more reasonable. If not, then hopefully your charge nurse will be able to switch around the assignments.
2. Reflect on the situation.
After you have calmed down and had some distance from the event, try to reflect on the situation and learn from it. Consider the root cause of the event and then think back to see whether there was anything you might have said or done differently. If so, then use this unfortunate event as a learning experience for your future patient care.
3. Try not to take it personally.
You may not ever truly understand the reason a patient fired you. There may be a variety of circumstances beyond your control that are affecting your patient. Take a moment to put yourself in the patient’s shoes. Are they in a lot of pain? Have they recently gotten upsetting news? If this is the case, remember that this could have happened to any of your coworkers. The patient most likely isn’t lashing out at you personally, but rather, they are upset by their situation.
4. Grieve, be upset and vent.
It is completely okay and normal to be upset about being fired by a patient. Take some time to grieve and vent in a healthy way to your coworkers. Chances are, they have been there too and will be empathetic to your situation. If you don’t feel like talking to your coworkers, write down your thoughts, and after you are done, tear the paper into a million pieces! Not only will you get a mental release from the writing, but you will also be able to express your anger or sadness in a healthy way as you tear up the paper.
5. Accept it and move on!
The last step to dealing gracefully with being fired by a patient is very simple: Accept the things you cannot change and move on. If you obsess about and dwell on the event, it can wear you down and cause burnout. Take heart in knowing that this happens to every nurse at some point in their career, and that it most likely won’t happen to you again for a long time!
When preparing for an interview, it is important to not only focus on what questions you might be asked, but also questions to ask the employer. Your inquiries will help you determine whether the job will be a good fit for you and give you insight into what it is truly like to work there. Your questions should cover three main topics: unit basics and training, the working environment, and the employer’s management style.
Unit Basics and Training
A lot of employers will outline the basic job details in the job application or during the interview, but if they do not, then go ahead and ask! It is important to know the unit and training basics such as: patient-to-staff ratio; hours; call shifts; holiday work expectations, scheduling, and weekend requirements; training length; and probationary period. If you would like to go above and beyond to learn more about the unit try asking these questions:
- What is your unit’s retention rate for new graduates and employees?
- How would you support a new employee who was struggling after their training was over?
Most nurses will tell you that the biggest aspect of their job satisfaction is their work environment. Daily interactions with nurses, doctors, and techs has a huge impact on retention rate and overall happiness. Focus on asking questions that will help you understand if the unit uses teamwork and supports one another. Try asking these questions:
- What is the culture of your unit like?
- How do you help new nurses adapt to the unit? Do you have a mentorship program?
Your managers are there to support you and help you succeed as a nurse on your unit. Asking questions about the unit’s management style will help you gauge how well you will fit in and be supported. Try asking questions that reveal how the managers deal with conflict and struggles that the unit faces:
- What have been this unit’s most notable successes and failures over the year?
- What are the biggest challenges that your nurses face daily and how do you help them overcome them?
There are certain aspects of every job that are, well, mundane. You know them, the repetitive and seemingly boring tasks that we are required to do but might not necessarily enjoy. It’s easy to get bogged down by these tasks or to even dread them, but it doesn’t have to be that way! It is possible to find joy in your everyday nursing tasks, from scrubbing the hub to priming IV tubing. Here are five suggestions.
1. Focus on the task’s purpose.
You may find yourself going through the motions at work while doing certain tasks that require less brain power. It’s easy to get frustrated by these tasks or have the desire to skip them on a day you aren’t feeling motivated. The next time you find yourself feeling this way, try reminding yourself of the purpose of the task. Why is it important that you do this? Who would be affected if you were to skip the task? Finding an underlying purpose will help you feel motivated and give you a sense of pride when you are finished.
2. Find a buddy.
Everything is better with a friend around! Working through the same routine tasks with a coworker can make things much more tolerable. For instance, if you dislike your morning charting, find a friend and do it together. Time will fly by when you have someone who can distract you and help you have a good time.
3. Change your mindset.
Apply the saying, “change your mindset, change your life” to your mundane work responsibilities and you’ll find that your entire day can be transformed. For instance, if you know that you dread the set up required for a certain procedure, make a mental choice to be excited and positive about it. Forcing yourself to think this way will improve your attitude about the task. It will be hard at first, but gradually you will find yourself feeling more positive and happy while at work.
4. Make a game out of it.
If there are several tasks at work that you dread doing, like patient admission paperwork, try making a game out of it. See how quickly and efficiently you are able to finish it. Each time you do a new admission, try to beat your last one. This will not only help you save time, but also help you feel a sense of accomplishment. Try creating a physical checklist of items that you need to chart; you will feel rewarded as you are able to check off each item on your list.
5. Savor a job well done.
Remember to enjoy the completion of every task that you perform. It doesn’t matter how small, large, easy, or hard the task was. No matter what, you finished the task and you did it well. Take pride in your work. Feel a sense of accomplishment and don’t be afraid to compliment yourself on a job well done. Thinking to yourself, “Wow, that was the fastest IV start of my career!” or “Man, I just did the best dressing change!” will help you appreciate the importance of these everyday nursing tasks.
At some point in every nurse’s career, they will experience a traumatic situation such as a hemorrhage, code blue, or even the death of a patient. It is important to know how to deal with the aftermath of this type of event so you can begin the healing process. Failing to take care of yourself or pushing away emotions could lead to burnout and potentially end your nursing career. Here are a few tips on how to process and recover after a traumatic situation at work.
1. Debrief with your coworkers.
During an emergent situation, your perception of the events that took place may be skewed due to adrenaline and anxiety. It is important to take time to debrief with others who were involved in the situation with you, so you can begin to process the situation. As you discuss how everything unfolded and begin to understand everyone’s role in the event, you will be able to process what happened. Be sure to address any questions or concerns you have about how or why things occurred the way they did.
2. Take time off from work.
After experiencing a stressful situation at work, ask yourself how you are feeling about returning to work for your next shift. If you are feeling anxiety or dread, it might be a good idea to take some time off. Talk to your managers about these emotions and see if they can help you to arrange some time off. Having time to process your emotions and refresh yourself will help prevent burnout.
3. Spend time with loved ones.
It is important to spend time with the people you love most after a traumatic event. You may not be able to discuss the details of what happened due to HIPAA, but you can express how you feel emotionally. Your loved ones will be able to comfort you and provide you with the support and space you need to begin healing.
4. Practice self-care.
It is always important to practice self-care, but it becomes absolutely necessary to do so after the emotional and physical stress of a traumatic event. Check in with yourself about the emotions you are feeling and what could help you to process and relieve them. For example, if you are feeling overwhelmed or anxious, try going on a walk or doing a workout you enjoy. If you are feeling physically or mentally exhausted, try getting a massage or taking a nice, warm bath.
5. Seek professional help.
In some cases you may not be able to work through the aftermath of a traumatic event on your own. It is perfectly normal to need additional help from a therapist. Ask your employer if they have reduced cost or even free therapy sessions for employees needing assistance.
It is important to remember that you are not alone and that at some point, every nurse has struggled in the aftermath of a traumatic event. Every day it will get easier and one day you will wake up and feel completely healed.