New Grad RN Orientation

[mollie.v]

I've only had experience working at a LTC facility, but I did have 3 semesters of clinicals at the hospital that I am currently employed at. It's been exciting and frightening, all at the same time.

My first day orienting, I was 'shadowing' my preceptor.

On my second day, I took on one patient and she wouldn't let me get into the charting until after we had given report off to the night shift. I offered to go ahead and chart and she could look over it once the shift was over with, but she kept telling me to wait to do it with her. Every time she went to do something, she asked me to go administer her meds or hang a bag of IV for her. So I felt, like I was missing a lot of the things that happen 'behind the scenes.' That second day, we did not leave until 9.

The third day, I took on 2 patients, but we still did not leave until 8:30. I've always been 'on top' of my interventions/assessments/charting when in school. And this bothered me a lot. I've always been thought 'real time' charting was the best (for the patients and for myself). The following 2nd and 3rd week passed pretty much the same. I would go about thinking that I was doing alright, but she would notice that I didn't do something and 'teach/criticize' me. That was the only time that I actually learned.

I understand that she wanted a 'hands-off' approach to let me learn the ropes. But I thought that she was there to help and guide me.

Routines were never explained to me. Correct charting/acknowledging of new orders weren't discussed, until she actually saw me doing it wrong. Most of the time, I am asking another nurse where to find equipment.

After 5 days working on the floor, the unit secretary finally told me why the charts are placed in certain cubby holes and why I can find them there (new orders, orders need to be placed in, new orders need to be acknowledged, everything is 'up to date' and 'acknowledge'). She has never gone with me to do an actual assessment!

If I ask questions, she tells me what I need to do, but leaves me to figure out how exactly I should go about it. Almost every time I ask her for help or to actually show me, her reply is usually, "I need to go hang/give this med/antibiotic and you're going to have to wait." I understand the patients come first. But honestly, if I'm taking 2 or 3 patients of the 5, wouldn't she have time to show me a few things?

My last day there, I took on 4 of the 5 patients. They were a set of patients that were very complicated. I had one on heparin drip, in status epilepticus, encephalopathy, and a guy that had to be transferred to tele unit because he was going to need a cardizem drip. I was drowning even before it was noon! Sadly, I did not do any charting until I reported off and did not get home until 10PM!

And here is my big question, is it me? I've wondered if it's all in my head or not! She isn't ugly to me, and very intelligent, as well as great with the patients. But the entire time I've been with her, I've felt like I'm just 'winging it.' And by no means, do my patients deserve that! I'm really frustrated and feel like I've been thrown under the bus. I would just like her to take the time to explain the policies and procedures before I dive straight in and attempt to do something. It would make me infinitely feel better if she would just watch me do something once, before assuming that I know how to do it. I'm deathly afraid of harming my patients, simply because "I didn't know."

Sorry to make this so long, I just needed to vent out my frustrations. I hope that I'm not the only one who has gone through this!

[canigraduate]

As a preceptor, some things you posted are bothering me. I think the current approach that you are taking is a little self-centered and very passive. I have had preceptees with similar attitudes to the tone of your post, and had to almost shock them with a cattle prod to get them to do anything without me holding their hands.

At this point, you should definitely require lots of guidance. I am NOT saying you should be super nurse and know how to do everything. However, you should also be very assertive by this point and able to get help on your own. Use your resources. If your preceptor isn't available, ask the charge nurse or another nearby floor nurse. If no one is available, get out your unit references and policy and procedure manual. If you don't know where they are, ask someone and find out. Get comfortable with speaking up.

Make sure you are communicating, communicating, communicating. I had a preceptee once who was extremely passive aggressive and I only found out that she needed extra help when other nurses told me after hearing her speaking behind my back. Make sure your preceptor knows that you need help. Discuss your concerns with her. If this doesn't lead to a resolution, then speak to the person who coordinates preceptorships, then kick it up the ladder.

Your orientation is up to you. If you passively sit back and let it be crappy, it is on you. If you assertively (NOT aggressively) take control of your orientation, you are more likely to have a great experience.

Best of luck to you!

[MEINstudent]

How long is your orientation?

There is something to be said for having a good fit with your preceptor. And it's not inappropriate to ask for a new one. But before you do that, you should talk to your preceptor about your struggles.

I did a three month new grad orientation program, and I was charting on my second day. My preceptor and I were a great fit and I learned so much without feeling like she was breathing down my neck all the time. But... my preceptor was instrumental in getting two other new grads dismissed before they got off orientation. You really do want to make a good impression with your preceptor.

[kvfrancisco]

yeah true, Iv'e been on orientation for the past five weeks and ive been freaking out about getting off orientation in a month. The problem is i'm also in the float pool new grad program. So after the end of my orientation, i'm moving a to a new unit again:( I have been asking a lot of questions, although sometimes my preceptor gets frustrated sometimes, i dont really care. I make sure I ask a lot of questions

[gigi918]

Having a preceptor that doesn't tell you things is just as bad as having one (or a few) that tell you too much! In my experience orienting, it seems as though it is a competition between them who can convince you that they know best! It is a hard transition and hard to know what to filter as helpful, accurate information and what is just their own self satisfying advice. You will get your own rhythm and confidence---be patient!

[gonzo1, ASN, RN]

It's not true that all nurses hate to precept and hate to have students. Where I work, orientation, education and precepting is taken very seriously. All new grads get a 6th month orientation in our ICU. I for one love to precept and help train the nurses of the future. There are only a very few nurses in our unit that refuse to precept, and all things considered it's a good thing they opt out cause they are "icky" people to be around anyway.

[JessMun]

I completely agree with kayem. How can you learn if no one shows you? I am an experienced nurse and have had great orientations and horrible ones. Every hospital is different and it takes time to learn the ropes. Not only is every hospital different, but every doctor is too. Some want things done with their patients a certain way and there is simply no way to know that unless an experienced nurse is there to explain it. When did what is in the best interest of patient go by the wayside?

[banarna]

you will want to train where they will show you the right way to do things since it will mold you for the rest of your career. on the other side of that, you want to accept any job you can these days. unless they are putting your license at risk or you are absolutely miserable that it affects the care you provide.