Sub-acute training ending, advice needed.

TheCommuter, BSN, RN · Feb 28, 2017

Before you request an extension of your orientation, ask yourself this question: What do I hope to accomplish with the additional time?

While some will disagree with me, be mindful that orientation is not an extension of nursing school clinical practicum where you get to learn all the skills you did not get the chance to learn in school. It is a time to learn the paperwork, workflow, and locations of supplies, etc. After carefully pondering this question, go ahead and ask for the extension.

I worked in subacute for several years...it was one of my first jobs as a new grad. In the neck of the woods where I work, the typical manager will roll his/her eyes if you dare to ask for more orientation in this setting. To be frank, subacute settings typically do not have extensive funds for training and onboarding, so they want new hires on the floor ASAP. I never received more than four days of training in this setting, even as a new grad nurse.

If your request is denied, do not worry. In subacute, time management is a must. As blunt as this sounds, always remember that the subacute patients and their family members are not your personal friends. While we should always be kind, there is no need to chat with the same patient or family for more than a few minutes. In sum, hurry up, pass the meds, change the dressings, and quickly move onto the next resident. Do not allow any single person to monopolize your time.

A 'to-do' list kept me organized. If you wish, keep reading to see one of my old to-do lists with names changed due to HIPAA. I worked 16-hour weekend double shifts (6am to 10pm) on a subacute unit years ago and that is how I stayed organized.

I usually had about 15 residents. At the start of the shift I would look through the MARs and TARs and wrote down all tasks that needed to be done in my notebook to formulate my to-do list. As a result, I wouldn't forget to do anything.

9-23-20XX

DIABETICS, FINGER STICKS: Linda (BID), Nora (AC & HS), Billy (AC & HS), Paula (AC & HS), Rex (BID), Jackie (BID), Evelyn (AC & HS), Marcia (0600, 1200, 1800, 2400)

NEBULIZERS: Marcia, Evelyn, Billy, Jackie, Paula

DRESSING CHANGES: Paula, Billy, Johnny, Jackie, Lily, Rosie, Lucy

IV THERAPY: Paula (Vancomycin), Linda (Flagyl), Rex (ProcAlamine)

COUMADIN: Linda, Rosie, Johnny, Lucy

INJECTIONS: Linda (lovenox), Lily (arixtra), Rex (heparin), Billy (70/30 insulin), Evelyn (lantus), Mary (vitamin B12 shot)

ANTIBIOTICS: Paula (wound infection), Rosie (UTI), Rex (pneumonia)

1200, 1300, 1400 meds: Marcia, Lily, Rosie, Johnny, Merle, Jackie

1600, 1700, 1800 meds: Rosie, Johnny, Rex, Lucy, Lily, Shirley, Louisa

REMINDERS: assessments due on Linda, Jillian, and Louisa; restock the cart; fill all holes in the MAR; follow up on Nora's recent fall, fax all labs to Dr. Taylor before I leave, order a CBC on Rex...

cnisanrnnow · Feb 28, 2017

Before you request an extension of your orientation, ask yourself this question: What do I hope to accomplish with the additional time?
While some will disagree with me, be mindful that orientation is not an extension of nursing school clinical practicum where you get to learn all the skills you did not get the chance to learn in school. It is a time to learn the paperwork, workflow, and locations of supplies, etc. After carefully pondering this question, go ahead and ask for the extension.
I worked in subacute for several years...it was one of my first jobs as a new grad. In the neck of the woods where I work, the typical manager will roll his/her eyes if you dare to ask for more orientation in this setting. To be frank, subacute settings typically do not have extensive funds for training and onboarding, so they want new hires on the floor ASAP. I never received more than four days of training in this setting, even as a new grad nurse.
If your request is denied, do not worry. In subacute, time management is a must. As blunt as this sounds, always remember that the subacute patients and their family members are not your personal friends. While we should always be kind, there is no need to chat with the same patient or family for more than a few minutes. In sum, hurry up, pass the meds, change the dressings, and quickly move onto the next resident. Do not allow any single person to monopolize your time.
A 'to-do' list kept me organized. If you wish, keep reading to see one of my old to-do lists with names changed due to HIPAA. I worked 16-hour weekend double shifts (6am to 10pm) on a subacute unit years ago and that is how I stayed organized.
I usually had about 15 residents. At the start of the shift I would look through the MARs and TARs and wrote down all tasks that needed to be done in my notebook to formulate my to-do list. As a result, I wouldn't forget to do anything.
9-23-20XX
DIABETICS, FINGER STICKS: Linda (BID), Nora (AC & HS), Billy (AC & HS), Paula (AC & HS), Rex (BID), Jackie (BID), Evelyn (AC & HS), Marcia (0600, 1200, 1800, 2400)
NEBULIZERS: Marcia, Evelyn, Billy, Jackie, Paula
DRESSING CHANGES: Paula, Billy, Johnny, Jackie, Lily, Rosie, Lucy
IV THERAPY: Paula (Vancomycin), Linda (Flagyl), Rex (ProcAlamine)
COUMADIN: Linda, Rosie, Johnny, Lucy
INJECTIONS: Linda (lovenox), Lily (arixtra), Rex (heparin), Billy (70/30 insulin), Evelyn (lantus), Mary (vitamin B12 shot)
ANTIBIOTICS: Paula (wound infection), Rosie (UTI), Rex (pneumonia)
1200, 1300, 1400 meds: Marcia, Lily, Rosie, Johnny, Merle, Jackie
1600, 1700, 1800 meds: Rosie, Johnny, Rex, Lucy, Lily, Shirley, Louisa
REMINDERS: assessments due on Linda, Jillian, and Louisa; restock the cart; fill all holes in the MAR; follow up on Nora's recent fall, fax all labs to Dr. Taylor before I leave, order a CBC on Rex...

I mean I would like more time to learn the patients and apply the stuff I learned in nursing school. For example, some of the patients on the other sub-acute unit have trachs and I've never done trach care or suctioned one in nursing school. So I dont want to be overwhelmed if I haven't done one yet when I'm on my own. It also took a week for me to get my computer log in information so I feel like I should get to know the charting system as well too. It would also be nice if I could use a few days to learn to work quicker and do everything on my own to kind of gauge where I'm at in terms of time management instead of just going off what my nurse tells me to do next. During my preceptor, I organized my time by looking at the patient's chart, but because I wasn't able to get my computer information until now I haven't been able to do that. So in general, a few more days at least would be nice.

HeySis, BSN, RN · Feb 28, 2017

It would be nice to have worked the shift yourself with a preceptor shadowing you and just acting as a resource. I'm surprised this hasn't already happened. My orientation to sub-acute was three days. I watched the first day, helped the second day and was watched the third day then thrown in.

So I dont want to be overwhelmed if I haven't done one yet when I'm on my own....... It would also be nice if I could use a few days to learn to work quicker and do everything on my own to kind of gauge where I'm at in terms of time management

You will feel overwhelmed! You're a new nurse, and no matter what the job or patient ratio or how long orientation/training is... being on your own at first is always overwhelming. If you can expect that, it may be less frustrating when (not if) it happens.

Time management takes a while to get down.. and you won't get started on that until you are on your own. You can expect to stay after giving report to finish up paperwork and such for awhile (make sure you stay punched in). Sub-acute is it's own type of hard, but has it's own rewards.

That being said don't be afraid to ask for what you need. They are not going to fire you for asking, They are already short staffed and firing you would not place them in a better position.

If you have been unable to get on the computer until now, then I believe requesting a few more days is appropriate.

There should have been some sort of competency check list in which you had to demonstrate that you could do the skills necessary following facility protocols. But often in this setting it just doesn't happen.

I would talk to your manager and site exactly what you need.

Example: I need two more orientations shifts. I need to complete electronic charting and do trach care (and any other skills expected that you are not comfortable with) before I'm on my own.

If you are able to pick up a shift (or partial shift) to complete this training before your first scheduled shift alone, I'd offer to do that.

Libby1987 · Feb 28, 2017

Do they not initially give you a reduced assignment or do you get the full load that an experienced nurse manages?

cnisanrnnow · Mar 1, 2017

Do they not initially give you a reduced assignment or do you get the full load that an experienced nurse manages?

They're giving me a full assignment right away. It would be nice to start off slow, but I dont know if it's my place to ask that.

cnisanrnnow · Mar 1, 2017

Update: I ended up asking my boss if I could have more orientation time, but it was denied because we're currently short-staffed. But my boss did say that the Nurse Supervisor will be there on my first day and will provide help if I need it.

It would be nice to have worked the shift yourself with a preceptor shadowing you and just acting as a resource. I'm surprised this hasn't already happened. My orientation to sub-acute was three days. I watched the first day, helped the second day and was watched the third day then thrown in.
You will feel overwhelmed! You're a new nurse, and no matter what the job or patient ratio or how long orientation/training is... being on your own at first is always overwhelming. If you can expect that, it may be less frustrating when (not if) it happens.
Time management takes a while to get down.. and you won't get started on that until you are on your own. You can expect to stay after giving report to finish up paperwork and such for awhile (make sure you stay punched in). Sub-acute is it's own type of hard, but has it's own rewards.
That being said don't be afraid to ask for what you need. They are not going to fire you for asking, They are already short staffed and firing you would not place them in a better position.
If you have been unable to get on the computer until now, then I believe requesting a few more days is appropriate.
There should have been some sort of competency check list in which you had to demonstrate that you could do the skills necessary following facility protocols. But often in this setting it just doesn't happen.
I would talk to your manager and site exactly what you need.
Example: I need two more orientations shifts. I need to complete electronic charting and do trach care (and any other skills expected that you are not comfortable with) before I'm on my own.
If you are able to pick up a shift (or partial shift) to complete this training before your first scheduled shift alone, I'd offer to do that.

But I do agree that I won't truly know how to time manage until I'm on my own.