labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Tuesday, March 11, 2008

I'm So Done, But Not Ready

When I entered midwifery school, I was a little reluctant of thoughts that I will have to let go of my labor nurse identity. I’ve worked hard in nursing school, and then as an RN gaining experience over the past 10 years, and I think it’s only natural to not want to give this up. Becoming a midwife, a new grad all over again, is scary. For so many reasons.

There were so many things that it took years for me to appreciate as a nurse. It took years for me to understand certain aspects of the care I was providing from a multifaceted perspective, so to speak. Coming to realize the importance and value of nursing, as opposed to just doing my job and not screwing up, isn’t something that happens overnight or with the arrival of the license. And knowing this now, as an experienced nurse, makes me fear being the new grad all over again.

However, as I gain more experience in midwifery, albeit as a (sometimes bumbling) student, I look forward to shedding my RN role and stepping into the nurse midwife role. Sometimes. When I started my midwifery clinical experiences, I had a very hard time giving up that RN role. When I was in the office, I felt terrible that an assistant was there to hold my pap smear containers and to hold out the little basin for the used speculum. I felt like I should be able to just do these things myself. And when I started my intrapartum clinical, I never asked the nurse for anything. When I wanted certain medications, for instance, I would just tell my preceptor. She would tell me to tell the nurse since she was the one to carry out the order. I think at first it went something like this:

“Um, excuse me…. would you mind, kindly, if you could, um…. hang some pitocin now?”

I think it may have come out sounding a bit like Oliver Twist asking for another bowl of broth. Even my preceptors were like, “Stop that!” and told me that I was the provider in the room…not the nurse. As I write that I realize that it may come off as “We big midwife…they little nurse!” but in fact that is not the case at all. What I needed to transition to was being the ultimately responsible provider within the team. I’ve been able to ask for things without so much guilt, and have noticed that many of the nurses have turned to me for orders, even with my preceptor there. Yet it still feels weird to say, “Send a culture on that urine, and hand two liters of D5LR over the next 4 hours”.

I’m in the final months before graduation, and I don’t know how in the world I’ll ever feel ready. I am so done with school as far as my mental state is concerned, but nervous as hell to become a new midwife. I fear that, like my nursing career, it will take more time than I’d like to feel like I’m just trying to do my job without screwing up.


Working Girl said...

I sometimes work with new and/or student midwives. I like it when they get to the point where they can order something without feeling weird. The ones who went straight through school without ever working as a nurse? Not my faves. I'm sure you'll be great.

Christa said...

While I don't have the medical experience, I can tell you that the same thing happens on the legal side. I worked my way through law school as both a legal assistant and a legislative analyst and now that I'm an attorney, I find it incredibly difficult to assign tasks to the legal assistants and paralegals. I feel silly asking them to fedex documents or to type something up on letterhead, but as an attorney, that is my role. If I were to do these things, then we would be billing the client an astronomical amount for work that should be performed by someone with a lower billing rate. But it still feels weird and I find myself cringing any time I ask someone to do work that I am perfectly capable of doing myself.

Labor Nurse said...

Christa, I think you hit the nail on the head with your last sentence...I feel totally capable of doing many of the things I am asking the nurses for. I think that is why so much of it doesn't feel right.

RN2CNM said...

I worry how I will handle that transition from nurse to provider and am very glady you are writing about your feelings in your blog, it's nice to see there are others out there who have the same concerns and how they work through them.

Just remember how it was when you started out as a new nurse--"it will all come with time". You are going to be an excellent provider and your clients will be fortunate to have you care for them.

trb310 said...

I am a CNM and graduated in June of 2006. I can't believe it is almost two years. You are goig thru everything normal. The only advise I can give you look for an employer who is going to be a mentor. I love my doc I work with. It is a private practice. I had a hard time consulting with attendings. I would give a really good thourough report and then wait.... Then my preceptors would remind me I am not the RN coming for orders I am the providor coming to collaborate MY plan of care and if he/she disagrees with my management they will let me know that it is still my patient not theirs. That is what my doc has been good with. I would come with a question he would give me 5 different answers... I would get so mad cuz I would say what do YOU want me to do... He would repeat the 5 answers and tell me it was my patient and he knew I would figure it out. He had more confidence in my that I did at the begining.

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