advice for orientation

Hi everyone. I was hoping I could get some advice on how to make the best of what little time I have for orientation. I got my license 8/2012 and worked LTC/SNF from 9/12 to 11/12. Yep only 2 months. That's for an entire different post. Anyway, I got 6 days of training, which was pretty sufficient. I'm aware there are places that give you only 2. Anyway, 6 days is still pretty short when you take into consideration learning how and where to chart, where to enter new orders, incident reporting... I know much of it you learn as you go along after orientation. I was lucky in the last facility I worked at that all the nurses gathered at the computers at a single center nurse's station to finish charting, so there was always someone right there for me to ask. But not all places are set up like this. Plus I want to chart throughout the day, not save it all til the end, and the other nurses will be off doing their work, not immediately available to answer questions. In the past I was "trained" by nurses giving me the keys to the cart to pass the meds for the shift while they did the treatments and documentation. But what I need out of orientation is to see how THEY pass meds, do accuchecks, give insulin, assess, do wound care and breathing treatments, trach care, g-tubes AND document all in 1 shift. I do understand it takes time. I really do. I'm not expecting to be super nurse right away. I know you get your own routine down after a while. I was just starting to before I left the last nursing home. The charting was what was the death of me. I felt like every day I was coming in, my ADON would tell me "you owe me charting" (luckily she was nice about it) on Something I had not known about. What I mean by that is charting an incident or occurance somewhere other than the progress notes that I had never learned about or even knew of to have asked someone. During my orientation, a resident suddenly passed away. It was a perfect opportunity for me to learn what all needs to be done in that situation. Instead, however, the nurse training me had me pass meds instead of showing me what all needed to be done. I kind of get it in this case, but I should have asked her at the end of the shift what all she had done and to show me the charting she did. My first day off orientation, I ended up sending someone to the ER. I didn't know where to go in the EMR to print whatever needed to be printed for the paramedics to take with. I got help from another nurse, but she printed everything on her own while I was with the resident giving her oxygen, so I didnt get to see what to do. The next time I had to send someone out, the nurse with me didn't know what to do either so I winged it by photo copying the med list and face sheet from the chart. So when I start my first few days, what is a good way to come off assertive, asking for specifics and not allowing myself to just be used to pass the nurse's meds for him/her (because many do like to take advantage of that.) I'll pass all the meds, but also please grab me when you do a tx and chart. I need to learn. Thanks for reading.[/quote']

That all sounds identical to what's happening at my new job. I love the residents and my coworkers are nice...but OMG the PAPER!!! It's forbidden to practically hand a resident a tissue without a physician order which needs to be noted and copied and filed in fifty different binders and my first shift on my own I had two resident falls smack in the middle of the Big Bad Morning Med Pass AND constant comfort care for a sweet gentleman I was praying would not die on my shift. I know that sounds bad but I would have had zero clue what to do...all I know is there's like 500 forms to fill out. And the resident fall paperwork. Why can't it all be in one place? Noooo... One form is here, another in the social workers office, another down the hall. WHY???

I've just resigned myself to knowing that I'll just have to learn it all as I go.

That all sounds identical to what's happening at my new job. I love the residents and my coworkers are nice...but OMG the PAPER!!! It's forbidden to practically hand a resident a tissue without a physician order which needs to be noted and copied and filed in fifty different binders and my first shift on my own I had two resident falls smack in the middle of the Big Bad Morning Med Pass AND constant comfort care for a sweet gentleman I was praying would not die on my shift. I know that sounds bad but I would have had zero clue what to do...all I know is there's like 500 forms to fill out. And the resident fall paperwork. Why can't it all be in one place? Noooo... One form is here, another in the social workers office, another down the hall. WHY???

I've just resigned myself to knowing that I'll just have to learn it all as I go.

Sigh....Exactly. At least I'm not in it alone. I have an interview for a SNF tomorrow, and I'm thinking positively, hoping I'll get the job. And if I do, I need advice on how to make the most of training. I just don't want to be used by nurses to pass their meds for them, as some of them DO take advantage of their orientees in this way. Don't get me wrong, I'll gladly work my butt off. But for goodness sakes, someone please teach me this time. I really want this job to work out. I genuinely want to learn and be the best I can be.

Sigh....Exactly. At least I'm not in it alone. I have an interview for a SNF tomorrow and I'm thinking positively, hoping I'll get the job. And if I do, I need advice on how to make the most of training. I just don't want to be used by nurses to pass their meds for them, as some of them DO take advantage of their orientees in this way. Don't get me wrong, I'll gladly work my butt off. But for goodness sakes, someone please teach me this time. I really want this job to work out. I genuinely want to learn and be the best I can be.[/quote']

I would say, don't let your preceptor walk away from you to tend to something else. Meaning...ask her to watch you pass meds. Don't let her run off to do other stuff. If, in the middle of passing meds, she needs to answer a doctors phone call or sign for meds from the pharmacy or send a fax, make sure she knows you want to watch her so you can jot down notes, or hear what to say to the doc, or see exactly where the fax forms are. Anything she does, you watch, even if med pass gets interrupted. If she tells you to just go ahead and pass meds while she does this or that, you can politely say "I know med pass needs finished, but I really need to learn how to put a physicians order in the mar so can you please walk me through that and then I'll be happy to keep passing meds?"

While I don't feel completely unprepared...I am doing okay...I did fall victim to being used as a med passer and (insert widget here) fetcher, so in retrospect I feel like I should have been more proactive about saying hey- I really need to observe everything you do!

what pinkiepink said is what i expect from an orientee

I'll teach you everything i know, but you need to stick

with me like glue

all too often the temptation for long introductions

and friendly chit chat gets my orientee left three

rooms behind

if i hear,"at xyz place, we did it a different way" too

many times, i will believe you really want to go back

to xyz place instead of being here and you're wasting

my time

sometimes it may not be practical to answer a question

right then, please do carry a notepad

Thank you very much for the responses. And that was great advice on how to politely say that I need to watch how s/he handles things. And as far as having my preceptor standing next to me while I prepare and pass meds...

YES! That is exactly what I want. S/he could teach me how to do it faster while standing next to me.

Thank you very much for the responses. And that was great advice on how to politely say that I need to watch how s/he handles things. And as far as having my preceptor standing next to me while I prepare and pass meds... YES! That is exactly what I want. S/he could teach me how to do it faster while standing next to me.

It can be nerve wracking but it's necessary! Also, when you do, ask her to be sure to tell you when a resident requires anything "special" for meds...like one has to take them in pudding, that one needs them crushed, tho one insists on taking them one at a time, etc. make a hall cheat sheet you can keep in a locker or mailbox there, since you can't take anything with patient names out of the facility...it really helps to have it to refer to when you're on your own so you don't have to run back to your cart for a straw or applesauce for someone.

It can be nerve wracking but it's necessary! Also, when you do, ask her to be sure to tell you when a resident requires anything "special" for meds...like one has to take them in pudding, that one needs them crushed, tho one insists on taking them one at a time, etc. make a hall cheat sheet you can keep in a locker or mailbox there, since you can't take anything with patient names out of the facility...it really helps to have it to refer to when you're on your own so you don't have to run back to your cart for a straw or applesauce for someone.

Definitely! What I did in my first job was during report, I ran down the list of residents asking if they are crush and if they will only take meds with a specific choice like applesauce or pudding. I marked it on my list. As you suggested, I kept that for reference for the next shift.