Adequacy of orientation

[Photofosterrn]

I have concerns that the orientation period I am currently in is missing something vital to my success as an RN once off orientation.

I am a new graduate nurse and I started my first job as an RN (no prior experience other than my senior preceptorship at another hospital) 6 weeks ago on a medical/surgical unit. The first week and a half, of my 12 week orientation, was spent in a classroom environment that did not include simulation. I spent one shift observing a preceptor's shift during a hectic night, and the next shift I passed medication. From then on, I was given a full patient load (5-6 patients) and told to ask my preceptor if I have any question. My preceptor has since spent her nights with me checking that my documentation in computer is complete and fielding any questions I may have.

I anticipated a more gradual transition from student to novice nurse.

If you could share with me how your institution handles the orientation process of RNs to the unit, tips on how to navigate this period, share your perspective what an adequate orientation should include, I would be extremely grateful! Thank you!

[Nurse SMS, MSN, RN]

When I am assigned to precept a new grad, they have the classroom stuff for a couple of weeks, then six weeks of orientation on the floor. I start by them assisting me, then gradually begin giving them patients to handle on their own. We start with one. I check everything they do at first with a fine tooth comb and after shift change is over we "debrief" privately to give them a chance to name what they feel they are struggling with and what they feel good about. Then I provide a little coaching. By the end of their time with me, they are handling the full patient load and generally speaking I am starting to get quite bored, acting as their assistant, much like they were mine at the very beginning of that six weeks. I am proud to say I have turned out some very well adjusted new grads who have done very well. We are a "no empty beds pretty much ever" step down unit. I am proud of and passionate about the way we orient our new grads.

I recognize it isn't this way everywhere, which is unfortunate. The Commuter's situation for new grads is unfortunate for many, since those who aren't as well prepared or strong in personality and fortitude are going to have a hard time surviving. Your own situation sounds less than optimal as well, though you do have resources around you, it sounds like. You just will be pretty miserable for a while and probably work a lot of overtime until you get things down. Make sure you are using a good brain sheet, getting optimal rest and taking care of yourself. By one year in you will be feeling much better. Hang in there. It isn't the orientation that most new grads hope for, but it IS the acute care, new grad RN position that most hope for and it definitely isn't the worst I have ever heard of.

[mmc51264, BSN, MSN, RN]

We have a gradual start: observe and assist for a **** or two and then start with supervised 2 pt, then 3, then 4 over a now, 8 week period. When they get a full load, there is a veteran nurse on the same team to be there for resource.

I was SO spoiled!!! I was in a program (that became to expansive) where I got 6 months (yes-6 months) of one on one preceptoring. I felt good when I was done. I spent the last 3 months of my first year learning our sister floor (uro/gyn-plastics-ENT), I am on an ortho floor.

I am very grateful for the experience. I don't know how anyone would expect a brand new grad to handle 4-5 (or more!) pts "by fire" that is asking for burned out nurses that are being set up to fail. Even our medical students and residents don't have that kind experience (well, maybe the residents a little-reminds me that July is coming-eek)

One thing I don't understand is the argument that it is cheaper to do less orientation, but if the new grad is going to have to have large amounts of overtime to chart, catch up, etc-where is the savings?

[B52, ADN, BSN, MSN, RN]

My colleagues and I were hired on a new unit. We had 2 weeks of classroom orientation, then we were all thrown on the floor with no preceptor. Also, the newly hired nurse manager quit right before the first patient arrived. We were all experienced, so we just did what needed to be done. There may have been one or two new grads on the night shift, but they were always accompanied by an experienced nurse.

[Pangea Reunited, ASN, RN]

My first job was a "sink or swim" situation. Unfortunately, I learned a lot by doing things wrong and/or making people angry. As for time management, you've got to experiment and figure out what works for you.

[mmc51264, BSN, MSN, RN]

for a **** or two

I must have made a big boo-boo typo LOL Sorry!!!!

[Mr. Murse]

I agree that it sounds a little rough, although not unheard of. When I used to precept I would usually give them one more person each week until they were carrying the full load of 6 to 7 patients, then I would still be with them for a couple of weeks after they were carrying the load unless they were really struggling and needed more time training.

[MunoRN, RN]

Unfortunately nursing students come out of school with widely varying levels of direct care experience and proficiency. It's not unheard of for a nursing student to take a full load with their preceptor doing close observation during their final preceptorship prior to graduation. So starting new grads at that point, after an initial orientation to the hospital, isn't unreasonable. What kind of load were you taking during your preceptorship?

[hppygr8ful, ASN, RN, EMT-I]

I have requested meetings with my clinical coordinator to gain a better understanding of their timeline for training to determine what particular milestones I am expected to hit and by what point in the orientation I am expected to achieve those milestones, something my preceptor was unable to answer for me.

I have asked my clinical preceptor to provide feedback on my time management and asked for ways to improve.

I have researched different methodologies of this orientation process to gain a better understanding of this tumultuous period and to gain a fuller understanding of some of the best and worst aspects of the new graduate transition.

One thing I have not been able to find is a research based article discussing evidence based practices for the orientation process and transitioning from student nurse to staff nurse.

If someone knows of any research out there, could you point me in the right direction as to where I could find it? Searching on the web has not provided quality researched based articles stating some of the best practice principles that provide a supportive work environment and a quality workplace orientation, two critical aspects that facilitate smooth transition. I believe that by gaining a better understanding this process, I would be able to understand what I should be and should not be expecting of the organization during this process.

Thank you all again for your feedback!

When I started psych nursing my preceptor handed me the keys to the locked unit and said "I'ts like getting into a cold pool. It's easier if you just jump in and start swimming" .

That being said I actually really like to work with new grads because after all we were all new once. Still I expect as another poster said that you come in ready to work and willing to get your hands dirty . I have one I'm working with now who has no willingness to do anything, passing routine tasks off to CNA's Like changing a diaper which is the best way to get a good look at a sacral wound.

Critical thinking, prioritizing tasks, and time management is key. Try to let go of your frustration and let the force flow through you. It will all come together in time. Instead of spending so much time doing research on Orientation processes focus your energy on learning the ropes - dive in a start swimming.

Hppy

[K+MgSO4, BSN]

We were on the register as students, therefore had a license, combine that with the GFC as 4th years I was told that I was replacing a RN on nights. There was myself and a new qualified nurse who was an absolute ditz. I ended up throwing her out of a code blue because she was creating havoc. The after hours coordinator took me aside afterwards and I thought I was done for. She complemented me on my ability to keep a cool head, 6 months later she offered me a job as she had taken on a new role.

[calivianya, BSN, RN]

My current job orients new grads for six months and experienced nurses for 12 weeks. 12 weeks was about the length of orientation I got at my first job, so you bet I was amused as a nurse with a year of experience in the same specialty to get the same length of orientation I got as a new grad. Not complaining, though, my floor is busy! It was nice having that extra set of hands for 12 weeks. I was doing a full assignment the first night, so my preceptor certainly enjoyed the 12 weeks also.

Just landed a PRN job that offers a six-week orientation, too... that shocked me. I got two days at my last PRN job. Six weeks is just ridiculous, in a good way of course. :) Obviously, hospitals in these parts choose to err on the side of over-orienting instead of under-orienting.

[Photofosterrn]

I am wonder, for all the RNs who posted that your orientation was a "baptism by fire", looking back do you feel that was the optimal way to train?

I'm reading a lot of posts and nurses have shared their stories but none of them have written anything relating that form of training to a positive outcome or even favorable over other more structured training period.

[MPKH, BSN, RN]

Orientation on my unit is generally about 4 weeks in length. You don't always get the same preceptor each shift, but the charge nurse do try to pair you with nurses that are unit staff and not new grad/new hire. You are expected to know basic nursing skills and tasks; we are not here to teach you how to take vitals or insert Foleys. Orientation is you learning the unit's routine, where things are kept, paperwork and the software for processing orders.

When I started nursing, I worked at a rural hospital. I had maybe 3 or 4 weeks of learning the ropes, but rural being what it is, I ended up replacing a nurse for a few of my buddy shift. I learned by being thrown to the floor...and it's worked for me. Learned what not to do by making mistakes and how to time manage.