A Reasonable Orientation??

Fiona59 · Oct 2, 2008

They hired you as an experienced nurse, right?

In all honesty, you have had more orientation shifts than I ever got. My unit gave me five.

Are you expected to assume charge duties on the dayshift?

Rural hospitals usually are much easier to work in than urban. The patient acuity is different with the heavier medical and surgical patients being sent to larger hospitals. So your overnight load isn't unrealistic on a medical floor. I've seen our surgical floors have 12 post ops among the 28 patients for a staff of three due to shortstaffing.

If you are feeling stressed, request more orientation shifts. Your LPN will help you, do you understand what their scope of practice is? They will be responsible for their own patients, meds, etc, so on a medical floor their patients will be their own assignment. Teamwork is required for the turns, etc.

madeleine · Oct 5, 2008

Not very sympathetic Fiona! To be the only RN after only 3 nights orentation in one's first job in Canada must be incredibly stressful!!

I would be assertive and request several shifts on days and nights to be fully au fait with the hospital and the systems. NEVER work beyond your own personal levels of ability.

Jaggy Thistle · Oct 6, 2008

I did ask but they have quite a few new starts and feel they can't accommodate me unless I come in on my days off for additional orientation and even then not for too many (ie one or two). Other than that I am expected to be on as charge on the nightshift.

Yes the LPN's are very good but most of them are also new and I don't feel I should be asking them a million questions as they don't get paid to be helping me out at the end of the day. I feel i'm not being fair on them.

All I'm going on is the other international nurses advice and since posting this I have spoken to some of the new and experienced "canadian" RN's (I should note i'm also a GN as not yet sat the CRNE). They are also very nervous about the situation and they have canada experience, so I did ask for additional experience/orientation and didn't think I was being unreasonable. UK nursing is different in many ways. On day shift I can ask the nurse manager if available for advice but that's as far as it goes. Other than that it's just me and LPN and we do have a heavy workload of post op's, acutely medically sick people and also palliative.

I did dayshift last week and I managed things ok, but I feel I am still asking a lot of questions and unsure about certain processes, etc. as things are very different, documentation, etc. I left feeling like I didn't give the patients as good care as they deserve. I know the other new RNs are feeling a bit the same and it's just a shame because I think a few of them aren't going to stick around so the unit will be back to square one.

Anyway, I'll just have to do my best, keep asking questions and also do a few extra shifts when I can fit it in I guess.

Thanks for the advice.

JT

allnurses Guide · Oct 6, 2008

Hi Jaggy - I work in a rural hospital in far Northern California. I don't know much about the ways of nursing in Canada so can't help you there but I do think you are being woefully shortchanged in the orientation department and should stand your ground for more orientation.

In order to be our patient's advocate, we have to advocate for safety too.

I don't believe in letting anyone run roughshod over an employee simply because staffing is short. What were you told your responsibilities would be when you interviewed? Has that changed? If so, you have legitimate concerns. If not, you still have legitimate concerns.

Never let anyone intimidate you into unsafe practice. It is not your only option. Finding a better employer is an option.

I wish you the best and I hope you get more advice . . . bumping this thread up . .

steph

Fiona59 · Oct 6, 2008

Hi Jaggy - I work in a rural hospital in far Northern California. I don't know much about the ways of nursing in Canada so can't help you there but I do think you are being woefully shortchanged in the orientation department and should stand your ground for more orientation.... Finding a better employer is an option.
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OK, Canadian healthcare is very different from American. Here we have only one employer -- the government of the province you live in. Alberta and the other provinces are then divided into health authorities. You are an employee of the authority that hired you as are the nurses in the hospital 5 km or 50 km down the road.
Orientation to general units are short here. Usually it's only units like ICU, NICU, Dialysis and the OR that are extensive.
Hires be it new grads or experienced nurses get on average five shifts to a general floor like surgery, medicine or LTC. The general opinion is that nursing school trained you to become a nurse and between your preceptorship and any experience you have from previous jobs is that your orientation is a time to learn the unit and the facilities routine and paperwork.
It's only under the last contract for my union that SEVEN shifts became the norm.
Most unit managers will try and accomodate requests for extra shifts but they have their hands tied due to budgets and staffing needs.
I may sound harsh and unsympathetic but that is the reality of nursing in this province.

allnurses Guide · Oct 6, 2008

Hi Fiona - thanks so much for that info. And no, you don't sound harsh or unsympathetic. Just telling it like it is, right?

In nursing school in Canada, do you get training in specifics of different areas in order to assure the employer you know what you are doing (not counting ICU, NICU, dialysis, etc)? Is a preceptorship different from orientation? How long is preceptorship? Maybe your preceptorship is more like our orientation.

In America - our training is pretty generalized - nothing specific. And many of us think we actually learn to be a nurse on the job, not in school. It sets a foundation of course, but really, the job is the key.

Regardless of the system, I still favor patient safety over "this is the way it is". Maybe it is time for a change?

I appreciate this thread - and your input. :bow:

steph

Pediatric Critical Care Columnist · Oct 6, 2008

Further to Fiona59's post... The collective agreement between the province of Alberta and the United Nurses of Alberta (at this time only RNs are represented by UNA) reads:

"11.03 The Employer shall provide a paid orientation period for all new Employees. The Employee's first seven shifts of patient/resident/client care shall be under guidance or supervision. Orientation to the site shall be provided prior to the conclusion of the aforementioned seven shifts. Where the Employee will be on rotating shifts, the first four shifts shall be day shifts and the the Employee's first two shifts on evenings and nights shall be under guidance or supervision. The broader orientation to the organization may be provided beyond the aforementioned seven shifts as determined by the Employer. "

There is no modifying clause under the Memorandum of Understanding regarding temporary foreign workers.

As Fiona59 said, the expectation when a person is hired as a nurse, LPN or RN, is that they already know how to do the work, but need some time to learn the particular idiosyncracies of the workplace. I work in a quaternary care pediatric ICU and got seven orientation shifts. In Alberta the temporary foreign workers have been given a course covering the provision of health care in Canada. If Saskatchewan isn't providing that, AND are hiring people that Alberta wouldn't without additional education, I see the conditions for a perfect storm developing.

allnurses Guide · Oct 6, 2008

Hi janfrn Just a couple of questions from someone new to Canadian nursing. Bear with me . .

"11.03 The Employer shall provide a paid orientation period for all new Employees. The Employee's first seven shifts of patient/resident/client care shall be under guidance or supervision. Orientation to the site shall be provided prior to the conclusion of the aforementioned seven shifts.

This is experienced nurses - not new grads, right?

Thanks.

steph

Fiona59 · Oct 6, 2008

Spidey'sMum:

My training include rotations through LTC, surgery, medicine, maternity, psych, and care in the community. The final placement in nursing school lasts about five weeks (there is a required number of hours to be worked so it depends on 12 or 8 hour shifts). The student was required to be able to care for a full patient load to obtain credit for the course. So, when I did my surgical rotation, I had to be able to medicate and perform all care for five patients (fresh post-op through to those being discharged). In maternity, I was required to be able to care for five Mums and their babes. Basically, you had to be able to do the job to get the course credit.

You are able to request two areas of interest and the college you attend tries their best to place you in Surgery if that is what you want (can be anything from gynie to neuro). It's very rare to get stuck with something that you don't have any interest in.

Most students wind up employed by the facility that did their preceptorship. Back in the stone ages when I went to school, we were offered a casual position on the units. Nowadays, grads are often hired before they write the national exams into full time slots.

Just to answer your question, no that applies to new grads as well. Long term orientations are in the specialties that we don't get in nursing school.

allnurses Guide · Oct 6, 2008

Spidey'sMum:
My training include rotations through LTC, surgery, medicine, maternity, psych, and care in the community. The final placement in nursing school lasts about five weeks (there is a required number of hours to be worked so it depends on 12 or 8 hour shifts). You are able to request two areas of interest and the college you attend tries their best to place you in Surgery if that is what you want (can be anything from gynie to neuro). It's very rare to get stuck with something that you don't have any interest in.
Most students wind up employed by the facility that did their preceptorship. Back in the stone ages when I went to school, we were offered a casual position on the units. Nowadays, grads are often hired before they write the national exams into full time slots.

Thanks - that is interesting. I think you may get more clinical time. We rotated through those areas as well but not much time in each. It is hit and miss whether you get to practice nursing skills like putting an NG down or starting an IV. Almost everyone gets to put in foley caths. :rolleyes:

I started out doing med/surg in acute - we had 15 beds. After a year I had a preceptor for OB and started doing L&D. I had to have 20 deliveries with my preceptor before I could be alone. About a year later I started in the ER. So, I did all three my last few years there. Sometimes I was the ER nurse (which also meant you were the house supervisor and had to deal with employees and staffing needs and doctors complaints). If a laboring mom came in and we had no OB nurse available, I had to leave the ER and go help deliver a baby. Usually I could get someone to cover the ER . .. .a few times, not. Scary.

I'm very sensitive after that experience (9 years) to making sure everything about our patient care system is safe. Staffing appropriately is #1.

steph

linzz · Oct 6, 2008

For experienced nurses here in Ontario, I am pretty sure that in the hospitals, it is similar to Alberta but not likely better as Ontario is not the powerhouse that Alberta is. We have a new grad program where the new grad gets full time hours for six months but I don't know how much of that is acutal orientation. After the six months you go on the list for a position that you will get when one comes available.

In LTC, the orientation is usually 3 - 5 shifts as the understanding is that you have 12 weeks of preceptorship and you should be ready. I guess in a perfect world this would be true but it is still a real learning curve.