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!

[HouTx, BSN, MSN, EdD]

Not being snide or disparaging.... really want to know.

What (specifically) is it that you feel that you need to 'learn' from your preceptor that you are not getting now. Hospital orientation has 2 purposes: 1) let the new employee know the 'rules' (P&P, HR rules, etc) and 2) validate competency. That's what orientation is for. It is not intended to fill any basic nursing education gaps.

New grad transition programs are a bit different - the objective is to have the new grad able to independently care for 'normal' patients -- keeping them safe -- with minimal supervision. One of the biggest problems for most new grads is time management. The only way to get better with time mgt is practice, practice, practice, etc. So, gradually increasing the patient load will only prolong the process - not producing any better results.

And - nursing orientation is one of the most well-researched topics since nursing research began - right up there with job satisfaction - LOL. There is a ton of evidence on what works..the problem is the cost. Organizations simply cannot afford to replicate those magical programs. Academia currently advocates a 12-month long process!!!! srsly.

[caliotter3]

I had an entire week of what was called "orientation" on my first nursing job. All that I can tell you after all these years was that I got one week's worth of a good look at a group of dissatisfied workers who spent as much time as possible complaining about everything. There was nothing organized about my training. Nothing was offered in the way of an orientation 'curriculum'. I kept my eyes and ears open and asked questions when they occurred to me. At the end of the week I had to evaluate whether I wanted to stay employed there since I knew that there were not likely to be any other job offers in that area.

[maxthecat]

I have to wonder what the patients thought of being guinea pigs in the programs that took a "sink or swim" approach?

[Libby1987]

Are you writing a paper?

[dishes, BSN, RN]

When I was a nursing student (in the 80's), our clinical instructors warned us that when we started working as RNs, we would be responsible for full patient assignments. They designed the nursing program to gradually build our skills, so that we were given full patient assignments during our final clinical placements. When I was hired as a new nurse, I expected to start with a full assignment, to ask questions and to learn from the answers. I expected that experience combined with my base nursing knowledge, would be a good teacher.

[Nonyvole, BSN, RN]

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.

Personally, yes. Because in the ER, we don't know what we're getting into at any point in time. The abdominal pain that EMS is bringing in could be a STEMI that codes as they're walking through the door...or it could be a drug seeker with no pathology. There is no way to gently ease somebody into emergency nursing where I work.

We do support teamwork, too, which is another reason that the sink or swim method works. No matter what, there's always somebody saying "hey, how are you doing? Need any help?" New grad, ER nurse of decades...doesn't matter. It also forces people to learn to ask for help. Can't get an IV? Well, let somebody else try. We cannot let our ego and pride get in the way of caring for our patients.

Now, I will say that I think new grads should be watched very carefully during orientation, because it is a bit of a culture shock.

And for me, I would have not liked somebody holding my hand every step of the way. As a second career nurse, I would have been very frustrated with an orientation where somebody was holding my hand every step of the way.