I have now completed three full weeks in the office as a new CNM. Needless to say, it has definitely been a steep learning curve -- and I continue to learn new things every day.
It has been incredibly difficult to go from expert L&D nurse, to novice CNM. Not only am I a newbie, I am in a totally different role than what I was as an RN. Patients look to me for advice, diagnosis, and treatment options. I can't say "I'll ask your provider" about something they are wanting to know, because *I* am the provider! Totally different thinking as a CNM vs an RN.
Yes, schooling/clinicals gave me the knowledge basis to be a CNM, but it's real life that I have to learn now. How to apply the knowledge in clinical applications....keep up with the latest evidence for practice....have a wider knowledge base entirely. It's one thing to read and study, as well as take tests on the material, but it's totally different in the "real world". Just like when I went from nursing school graduate, to working as an RN.
For example: if a woman comes in for her annual exam, she often times has other issues going on. My role as her provider is to get a good history (medical, surgical, review of systems, concerns, etc), do a complete physical exam, PAP testing if indicated, order preventative screenings (Mammo, DEXA, colonoscopy, lipid panel), and decide what (if any) other diagnostic testing should be done, what her diagnosis is, and how to treat it. All in a span of a 20 minute well-woman visit. Needless to say, with some women, I take longer than 20 minutes to do all of this, especially if I am consulting/collaborating with another provider. That time also is to include all of my documentation of the visit.
Do you see what I'm saying, when I say that I have a steep learning curve?
Now, in the office, since I'm new, I have blocked time in my schedule where I have extra time to get caught up and try to stay on time. Sometimes this works, sometimes it doesn't. Just depends on the mix of clients I see that day, and their complexities/issues.
I get frustrated with myself, because I feel like I should be picking up things faster. But I have got to stop being so hard on myself. I'm just learning how to be a CNM for goodness sake!!
I work with great midwives and physicians, who are there to answer my questions (and I have many!).
I know that, two years down the road, I will be able to look back and say that the current me is much more comfortable and knowledgeable in the role of CNM vs the past me.
6 comments:
Long time reader, seven-time mom, trained doula here.
I must say... I have profited from your journal and I can tell you that you HAVE grown since I started reading about your studies. Based on your past record, I know you'll keep on trucking and do great service in your new job. Even though you are a novice, I would love to have a care provider like you. CNMs don't exist in my area and we desperately need providers who offer YOUR kind of care. When you need to be patient with yourself, I hope these words are an encouragement to you!
One patient at a time, one problem at a time, one chart at a time, one day at a time. Just stick with it and soon enough you'll be gaining in confidence. I'm sure you're doing much better than you think! It is hard and humbling being new at something when you've been an expert at something else (L & D nursing) for so long. Hang in there!
Thank you for your honesty with us all because I face these struggles as I begin the next phases in my life but I learn so much from reading about how you handle them. Keep strong and know that we are all rooting for you!
Stick with it, the curve gets easier I've heard. Compassionate care is practically disallowed in today's medical paradigm so it's indeed nice to hear you say that you go over the allotted twenty minutes sometimes with your patients. Twenty mins can go by so quickly when one is involved with a patient and for the patient that twenty feels like less than five, speaking from both sides of the exam table.
Seriously, you took the words right out of my mouth! I'm in my fifth week and I keep feeling like I should be knowing more faster and I am also giving myself permission to be a beginner. It's hard to be gentle with yourself when you want to do such a good job. I am so glad I'm not the only one who feels this way. Thanks for sharing. <3
I went through exactly this transitioning from paramedic to physician. Congratulations! Nothing obstructs personal growth like the fear of appearing inept! So many people will forever stay the big fish in their small pond for fear of the feelings you describe. Way to go.
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