How much orientation do new grads need?

  1. I work with an RN who got her licence in December. She started working at the hospital in June of last year as a CNA. In August, they started letting her take her own patients, doing everything except meds and an RN counter signed her assessments, etc. She is a good nurse, very knowledgable, very compassionate, etc, but she is a horrible charge nurse. She still has no sense of urgency, does not prioritize, takes a really long time to get assessments done, call doctors for orders, assess new patients, and do the other things a charge nurse is supposed to do. Seven months later, she is still considered "in orientation" and from seeing her in action, very few of us believe she will function without that other RN there reminding her of every move she needs to make. Usually, we give new grads 12 weeks and push them out of the nest and expect them to function in the job they were hired for. We're a small rural hospital, so as an RN, she's either charge, ICU, ER, or OB...we don't use RNs for primary care unless ICU or OB are closed and they float. This nurse continues to struggle with the very basic things a charge nurse does and if things go belly up for the day, she's lost. I don't know if I just need to vent here or what. It just seems like if she doesn't get it by now, she never will. I have know this nurse since we were in second grade and knowing her personality, I really think she is messing with our minds. My personal belief is that she CAN do it, but chooses not to because she knows someone else will jump in and do it if she "can't." She was supposed to go to night shift in February, but still has a coveted position on day shift. Thoughts on this???
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  2. 46 Comments

  3. by   Marie_LPN, RN
    i'm not a nurse yet, but i can sum that up

    7 months she should have been comfortable by now, and not at the level she is at now. even not working with her, i don't see where she's going to 'improve' with more time, and something needs to be done about it instead of catering to her
  4. by   teeituptom
    A LOT
  5. by   SmilingBluEyes
    ya know some people are NOT cut out for charge duty....now or ever....

    and it takes TIME to be a REAL charge nurse! I think we ask a lot of people to suddenly charge when they become RN's. I know, I had to do it at the rural hospital where I used to work. It was tough, to say the very least, especially as we were 2 hours from the nearest level -3 facility and had to deal with level-3 stuff anyhow. I saw some who could not handle it and quit. They were not bad nurses, but not CHARGE nurses. She may not be a CHARGE nurse material. For me, it was 3 months' orientation on our LDRP floor and poof, you are an RN, you automatically charge. It is not for everyone and some cannot ever do it. She may be one of them....
    Last edit by SmilingBluEyes on Jul 6, '03
  6. by   MishlB
    Charge is a position that requires more experience than 7 months on the job. You make the comment that nurses are pushed out there to sink or swim...you don't see a problem with that? Maybe a more understanding attitude would be helpful, and realizing that not everyone is comfortable in the same amount of time. You say she was a CNA for a while, but that doesn't matter. Charge is a HUGE responsibility, and should not have someone thrown in to sink or swim. Was this a test? She may know HOW, but is a little nervous...why so much pressure??
  7. by   Tweety
    Seven months is not enough time to function as a charge nurse. It takes well over a year to become comfortable on the floor IMHO (not that one shouldn't be able to handle things, but you're working on your skills.) (Granted I had to do charge it at six months, but worked with a great staff that was independent and supportive.)

    The best charge nurses are experienced. They know what to do in certain situations, they know what their hospital's policys are in a variety of situations.

    Also, definately agree with Deb, not all nurses make good charge nurses EVER. I've seen awesome bedside nurses do terrible at charge. We all have our gifts.
  8. by   fergus51
    Our charge nurses are required to have AT LEAST 2 years experience at our hospital and take a charge nurse course and orientation. New grads as charge is not ideal, even after 7 months.
  9. by   Marie_LPN, RN
    but seven months and showing NO sign of being capable though? I agree, some people aren't cut out for it.
  10. by   Zee_RN
    I don't think a new grad should be charge nurse with only 7 months' experience. Or even 12 months' experience. Regardless.
  11. by   kimmicoobug
    As a new grad, I also don't think it would be appropriate for a grad of only seven months under her belt should be made charge. At the hospital I work at, they start to wean you into it with lots of guidance after a year
  12. by   jjjoy
    I was a new grad who didn't cut it on a busy surgical floor. I knew I needed to do better but couldn't put a finger on what I could do to improve. I could tell the other nurses weren't satisfied with my progress but vague advice like "prioritize" and "take initiative" didn't help. It came across that I could do it if I just tried harder. I'd go in early to prepare. I'd stay late to review. I'd make lists of things to look up at home. I could accept that maybe this wasn't for me, but I couldn't accept that the other nurses thought I wasn't trying hard enough.

    All I needed to walk away with my dignity was an experienced nurse to validate my efforts and my strengths.

    Be specific and work with the nurse to figure out where she's hung up. I'd get these evals that were a mystery to me. "Lacks initiative." "Doesn't manage time well." I was doing more and more each day. I carefully evaluated each situation to determine what to do. I was busy every minute I was there - I wasn't reading magazines in the break room or anything like that.

    I had to translate the feedback for my situation. I wasn't comfortable performing a new procedure after witnessing it once. I needed to watch it several times before feeling confident enough to jump up and volunteer to do it. That's what the "lacks initiative" was about. Not as useful as pointing out that to work on that floor I'd need to be more comfortable about jumping in to do new procedures. I also was very careful in my assessments and in preparing for procedures, mentally reviewing the steps. But I'd end up without enough time to finish other tasks. That was the "doesn't manage time well." I wasn't comfortable speeding up but the job demanded it. Alright, I can accept that.

    Finally, if you think someone just is not cut out for the job, frame it in a way that says "maybe you'd be better at something else" and "we need you to be able to function at this level and you're just not there" as opposed to "you should've been able to do this by now."
    Last edit by jjjoy on Jul 6, '03
  13. by   MishlB
    It's not enought ime to grasp everything you need to know in just 7 months. For those of you who were placed as charge in 3 months...very dangerous in my opinion. Unless of course, as charge you just sit on your butt and give orders...but to really function as a charge, it takes time...HUGE responsibility. Not something I would give a new grad to boost their esteem or set them up for failure.
  14. by   flashpoint
    Well...I'm not the one who put her in the position she is in, but I am one of the ones who suffer when she can't cut it. It really bothers me that as an LPN, I am expected to say things to her, like, "You really need to go assess this new patient," or "Yes, you need to call about this patient being in SVT, NOW!" I would love it if our hospital would let the new RNs work the floor for a year or two before expecting them to charge, however, that is not how administration sees things. It's a lot of little things too, like taking three hours to assess a new patient because she is calling her son on the phone or just chatting with a patient who live across the road from her...going to lunch before starting a new IV on a patient on an insulin drip or taking an hour to call a doctor for pain meds because she wants to clean out the syringe drawer...taking 45 minutes to to a new admit assessment becasue she gets to chatting about the weather. I would help her out if I could but a lot of the things she is missing are things I cannot do as an LPN, but I still know needs to be done. I'm also not very comfortable saying things like, "You really need to do this IV before you go to lunch," and I don't feel like that is something I should have to point out to her. A lot of our charge nurses did the job straight out of school, right or wrong, they bucked up and made the best of it...she isn't much further along than she was in June of last year...struggles with a lot of really basic stuff...sigh. I hate to say things like that about her because I love her like she was my sister...administration keeps saying they're going to give her six more weeks and if there's no change they're terminate her, but they've been saying that for three months. Just venting here more than anything...

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