Need Help & Opinions/Orientation Problem

[LaurynRN]

Hello all,

I am orienting to ICU after being on an oncology/organ transplant floor for three years. I started in October and am supposed to be through with my 12 week orientation on Christmas Day. Up until now I have only had one course relevent to critical care, I did take the trauma core.

For weeks I have been asking about the critical care course and a dysrhythmia course and my manager has been not giving me any solid answers. Last week he told me I may not be able to come off orientation until my classes are met in January. I was fine with that.

HOWEVER, yesterday he informs me that I will not be attending the critical care course until Feb/March and he is still not sure about the dysrhythmia class. He basically tells me that I will be off orientation without these classes.

What do you think? Do I have a right to fight it? Is it worth it, the classes I mean.

My gut tells me that I shouldn't let him do this but I am not sure because I don't even know what the courses are like.

[aquaphoneRN]

Every experienced nurse you tell this story to seems to have the same advice. That should tell you something.

[RNPamP]

I think the basic concept here may not be whether she needs the classes or not, but that a nurse who does not feel competent to be off orientation in an ICU probably shouldn't be. Also, isn't being comfortable with your rhythms one of the criteria for being on your own? I certainly think she should have the opportunity to take these classes, but the main point is that an ICU nurse should be proven competent in rhythms and critical care concepts. Lauryn, it sounds like you may not getting the orientation you need. An ICU manager shouldn't want to put a nurse out there who's not ready. It's dangerous, and an orientation should last as long as it takes until both the preceptor and orientee feel that she is ready.

[MKZ]

I have been on my own for four months as a new grad after six weeks of orientation. I am not required to be ACLS certified. I had to pass the EKG course on my own and I was frightened. I was dreaming of squiggly lines. Its good to take a class. I encourage you to talk to your manager and tell him the truth about how you feel. That you were under the impression you would have this class to enhance your critical thinking skills and become an even better nurse/ assessor/ intervener/planner. And if the excuse is no more places in the classroom, ask him kindly to make some room. Good luck and may the force be with you.

[cardiacRN2006, ADN, RN]

Question: Do most of you guys do conscious sedation in your ICUs? I mean, I'm pretty sure my state board mentions ACLS being a requirement for that. And if not EKG certified, who reads your strips? I chart my EKG Q1hr along with my vitals, and I just wouldn't feel comfortable charting someone else's assessment of that.

I couldn't even come on the floor without my CC Class, couldn't come off orientation without ACLS, and although they taught EKGs in my CC Class, I was asked during the interview if I already knew them and had to prove it with a test.

I'm suprised by the differences around the country.

[LaurynRN]

I spoke with my manager today. He agreed that if I do not feel comfortable then I can stay on orientation, which is good news. I think it is only fair that I receive the same orientation that everyone else gets and so does he. I did get a nice big cold sore from the stress of worrying about it but now I am pleased. I feel a bit silly for not feeling ready but I am assured by others that it is my right to get as much orientation as I can and that I should be worried.

Thanks to everyone for their comments and thoughts.

[Colorado Kid]

In my opinion, you should absolutely DEMAND every bit of the ACLS, TNCC, PALS, ECG etc. classes and at least 12 weeks of orientation. You are only cheating yourself out of an education (and possibly a license) if you work without these critical skills. Don't worry about what people think of you when you ask questions, or try to learn everything you possibly can! Here in a Surgical Neuro ICU it is mandatory here to have all of these classes within the first 6 months, until then we are not allowed to work in these situations alone. Thank God!

[bluesky, BSN, RN]

Bluesky,

The class sounds like an excuse to who? An excuse for my manager to let me complete orientation or for me to stay on orientation?

After I talked with my precptor she was appalled that my manager would ask me to be off orientation without the critical care course and dysrhythmia. My preceptor asked around to the senior nurses who are also just as shocked. What happens when I need to take my patient off the floor for CT and I can't ask anyone a question?

Every nurse my preceptor and I have talked to (including charge nurses) said that it is outrageous. Basically it was my mangers responsibiity to enroll me in these classes and he dropped the ball. There are classes in Jan. but they are all full, which means that I didn't get in it.

Some said that they can throw me over to Med/Surg until I can take all the classes I need.

When I am in on Thursday my preceptor and I are going to talk with my manager and see what we can come up with.

I feel like I am a competant nurse but this orientation just hasn't been enough. It really doesn't make much sense to me. Other nurses that came from ICU in other hospitals get 12 weeks, same as me. Then we have to sit in hospital orientation class for the first 2 weeks, then trauma class for a week, and if I were to have the other classes that would be another 2 weeks. That only leaves like 7 weeks of floor time, just not enough.

My biggest concern is that if something did happen it would be my license on the line.

Thanks again to all posters for your opinions.

An excuse to cover up his own failings (i.e. not registering you early enough). I must have misread your original post because my understanding was that you wanted to get off orientation but that he wouldn't let you until you took the classes and that wouldn't be for a while.

[pickledpepperRN]

I spoke with my manager today. He agreed that if I do not feel comfortable then I can stay on orientation, which is good news. I think it is only fair that I receive the same orientation that everyone else gets and so does he. I did get a nice big cold sore from the stress of worrying about it but now I am pleased. I feel a bit silly for not feeling ready but I am assured by others that it is my right to get as much orientation as I can and that I should be worried.

Thanks to everyone for their comments and thoughts.

Good for you!

You have a moral and ethical, if not legal responsibility to ONLY accept an assignment for which you are competent.

You need the education before assuming responsibility for patients.