Help!

[Jusween]

I just started working in a large psych unit in an acute hospital. Although I have a lot of experience working in behavioral health, this is my first job as a nurse. I passed my boards in April. I attended three days of general orientation with HR and then started in the unit. During my first three days I was assigned to two different nurses, neither of whom are preceptors and while they were pleasant, I never was introduced to patients or staff, shown around the unit or given any kind of direction. I watched the charge nurse count, did rounds with the techs and tried to keep up with whomever I was assigned to. When I walked in today, my fourth day, there was a float nurse from tele, a nurse who started in May and myself assigned to thirty three patients. I was given access to the Omnicel and told I had three patients and then I should back up the float who was, understandably having some issues with the different tenor of the psych floor. The charge nurse, who started in April, had five admits so I was on my own. I had never used the Omnicel, never given meds, I didn't know where the syringes or insulin was kept, and I've only ever drawn up anything in clinicals. When I went to back up the float, she had envelopes of meds all over the counters and she told me she had already scanned them and I should just give them. Then she handed me a syringe and told me to draw up an insulin shot and go give it. I spent the night trying to figure out how to navigate the medication dispensing, how to check and document meds and then giving out the float nurse's meds. Is this appropriate? I have run my share of programs and I don't consider this orientation. I feel like it's a disaster and it's putting my license at risk. What do I do?

[LeChien, BSN, RN]

Did you say anything to management after the first day? Ask questions during your orientation, such as how to use the Omnicel or navigate the system they use?

[Jusween]

I met with the manager the second day and asked for a tour of the unit, which was provided that night, help with the computer system and the unit training process. She told me I would be on an orientation schedule for a month and that I should shadow for a while. Not only didn't I get a chance to shadow, there was no one watching me!

[CryssyD]

Ah, the tried-and-true sink or swim method...I've been in that pool. It's no fun.

Hopefully things will get better--soon. Being short-staffed is one thing, but throwing a brand-new nurse onto an acute psych floor with 1 unit nurse and 1 float is an accident waiting to happen. Insist on a real orientation--you deserve one, and it really isn't safe for you to go without.

Good luck!

[middleagednurse]

All of the above, plus, you should never give meds that have been prepared by another person.

[CrunchRN, ADN, RN]

Carp. Set up to fail.

[HeySis, BSN, RN]

Agreed, That sucks!!

You not only deserve, but need an orientation.

I'd go to management and explain what happened, (in a very non confrontational way, which can be hard when your feeling used, but it's important to be able to get the best outcome)

I'd request

1. The rest of your orientation schedule along with the preceptor you'll be assigned to during those shifts.

2. The skills, policies and documentation that you need to be passed off on by your preceptor (and this should be given to you in a form of some sort, mine's on the computer, and when your preceptor has trained you and witnessed your abilities they sign you off)

3. and Ask in what time period you are expected to pass off all your orientation competencies.

Again, really nicely.... their response will let you know if they even have an orientation program (some places don't.. scary right?), if they are willing to throw one together, or if they are going to really be willing to orient you.

If they are willing to orient you, but don't have a formal program or preceptors, you will have to be very pro-active. You'll need to ask your assigned nurse a ton of questions..request teaching opportunities.. like once you have watched something done, say Can I talk through the steps and then have you watch me do this now so I can make sure I have it right? If you are not comfortable with that, (this is if they don't have a program) then you'll have to decide if you can find something else.

I hope this was a one time weird thing and they will have an orientation program.... but unfortunately not every place is a good place to work, and even people with the best of intentions can fall short. Bottom line, you need to protect yourself and your license. But do it professionally, nicely, going into it with no negative assumptions... Because nursing can be a small world, and where I live, I meet the same nurses again and again at different facilities and units.

Let us know how it goes.

[HouTx, BSN, MSN, EdD]

This is so shady. If the facility is accredited by Joint Commission or provides services that are reimbursed by CMS, there are regulatory requirements for orientation. One of the most fundamental requirements is that a new nurse (experienced or new grad) is NEVER allowed to perform any procedures until that competency has been validated. If there are violations, this is reflected in the Governance standards... which means that the Board takes a hit. So, I'm really surprised if there isn't even any effort towards some sort of "checkoff" process for all the tasks that OP is describing.

Behav Health is a very different environment - with very specific rules & regs that could be easily violated by staff who simply are not experienced in that environment. Maybe their orientation is infrequent & OP simply hasn't attended yet? Even so, a newbie should not be functioning independently without adequate training & supervision.