[oldiebutgoodie]

Originally Posted by christvs

I'm a new grad RN and I recently finished my 12 weeks of orientation on my med/surg unit. One important suggestion I can make to you: please, please do not give preceptees more than a couple different preceptors. I had nearly every single RN on my unit (to be exact, I had 15 of them!!!!) & even some float pool RNs acting as my "preceptor of the day." It got very confusing trying to do things the way my preceptor of the day wanted them done, since I had so many of them! I feel like I'm a competent new nurse now, but I didn't like being passed around like that. Not very organized-it basically showed how uninvolved my nurse manager is. I never sat down with her to discuss how I was doing during or after orientation-again, sad. I feel like there is no point now, since I'm very good at asking questions if i need help. And I work with very supportive nurses. It's just the nurse manager who basically follows a "laissez faire" nursing management model-not recommended!!!

I totally agree with this poster! I also had at least 10 or more preceptors, including some who did not want to precept. Some were great, and some were unbelievable micromanagers. I would learn how to do something for one preceptor, and then get ripped by the next one. So, I would suggest one or two preceptors, give the orientee some SPACE, create a safe atmosphere where the orientee can ask questions without hearing answers like, "I don't know what they teach you new nurses in school anymore". Catch your orientee doing some things right, not just wrong. It might help to train the preceptors, and only hire as many nurses as you have decent preceptors for.

Oldiebutgoodie

[oldiebutgoodie]

More thoughts on orientation:

1. Use the nursing process as a basis for orientation. Assess the skills and experience of the new nurse, find out what kind of learner he/she is. Plan out how you will work together, and get together to evaluate how it is working for both of you.
2. Don't say, "Good job!" Say, "Good job doing xyz..." If you criticize, it's always easier to hear it along with something the new nurse has done right. Orientation should build a new nurse's confidence, not tear it down.
3. Have "skills days", where you spend time learning things like IVs, phlebotomy, etc. Don't be so tied to the schedule of the day that the new person doesn't have the opportunity to try out new things (wound-vac, EKG machine, etc...)
4. I felt that it would have been helpful to have "emergency training". For example, quiz your new orientee: "You find patient xyz in bed with these symptoms, ... what should you do?" Yes, I know we should know this stuff, but real life scenarios from the unit would be helpful.
5. Have patience. New people can be slow. Telling them, "Faster! Faster!" does not necessarily make them faster, it only makes them crazy. Speed comes with time. However, time-saving tricks are very helpful.
6. If new person has just started nights, it is probably not productive to expect them to be functioning at top level right away, unless the orientee is a night person, in which case, orientee may not be functioning well during days. See point #1, on assessment.
7. If there must be multiple preceptors, try to standardize, so that the orientees are not totally confused.


Oldiebutgoodie

[Daytonite]

I was part of a committee in a hospital that ran a 10-week new grad orientation program. The way we were set up was that the grads worked Monday through Thursday on their units with preceptors. Occassionally, there were inservice programs set up specifically for them to attend. Every Friday was a classroom day. The grads were in nursing education and had group discussion about how their week had gone. We encouraged them to bring up questions and concerns and discussed them. We also brought in nurses from the various units and people from other hospital departments to talk with them. We reinterated various hospital policies that they needed to know because people will forget that stuff if they don't use it. We provided a lunch for the grads and each week we got take out from different restaurants around the area. This was budgeted in to our program.

I think our grads had a very nice easing into their jobs. One of the biggest problems with grads is helping them get over the realization that they aren't going to have an instructor by their side continuously and they must start making some judgments on their own. The other, of course, is time managment and prioritization. You need to keep in contact with the preceptors of the new grads all the time to make sure all is progressing as it should. Our preceptors were put through an 8 hour seminar on how to precept. The preceptors were required to sit down with their orientee once a week and do an evaluation of what had been accomplished, what needed to be done still, and discuss goals. This generated a written report that went to the person running the orientation program. This continual feedback for new grads is essential! They are a fragile, emotional group. Most want to please their employer and beat themselves up if they feel they are not making the grade. You need to get out and observe the preceptors doing their job just like any other employee to make sure they are doing it correctly.

Be very watchful of the new grads and protect them from being bullied by other more experienced or less-patient nurses. This has to include a period of time after their formal orientation as well, so have a plan for follow-up evaluations. Have flexibility with your program to account for the grads who are a little slower catching on. Encourage other staff to give the grads continual feedback as to how they are performing and to always say good things as well as the not so good. Bullies and impatient staff nurses will undermine all the good you've done for new grads and are the biggest cause of new grads leaving a workplace, so keep an eye out for this happening and give the new grads a way to deal with this, even if it is on how and who to report that behavior to. Some review of assertiveness may be OK. The most important thing is to help establish "life lines" for these grads, so that when they are off orientation they know exactly who they can go to for advice or just a shoulder to lean on. It is very important that they never feel alone or abandoned. You need to look for preceptors who are willing to give this kind of nurturing. Orientation, as you are probably becoming aware, is a very expensive endeavor for a facility, so you want to make it as efficient, pleasant, and successful as possible. Final line is retention. That's what it's all about.