Anyone ever ask for more orientation?

[beatrice1]

I know in LTC everyone says that you're lucky if you get orientation at all, or more than a week or two if you're lucky. I am a brand new Grad, started in LTC, had 3 weeks, (total of 10 shifts of orientation) I was with 4 different people, one of which totally ignored me the whole time I was with her. About 3-4 shifts.

I have been off orientation for 2 weeks. Everyone tells me I'm doing fine, but I feel so incompetant. I feel like I have to ask a question about everything i do. I'm still afraid to talk to the doctors. Not too confident in my assesment skills... anyway, I had a med error the other night. I think cause I am so damn nervous everytime I go to work. Talked to the DON about the error and told her my feelings about not being too sure of myself. She told me she thought I was doing fine for such a short time and being a new grad, but if I would feel more comfortable with more orientation, she was okay with that. so she put me back on 4 more days next week.

I went into my already sceduled shift (on my own) and I felt like everyone was looking at me weird. I don't know if they think I was put back on orientation cause of the mistake or that I'm stupid and need it. Most of the nurses say, you just have to learn as you go... Now I kind of wish I didn't even say anything... I think everyone now thinks I am incompetant not just myself??

Has this happened to anyone?

[TheCommuter, BSN, RN]

I've worked at multiple LTC facilities over the past five years. In the metro area where I live, new grads with no nursing experience will typically receive 3 to 4 days of orientation before being expected to work on their own. Trainees have asked for additional days of orientation, and management has granted the requests in the past. However, they are usually reluctant to extend orientations because time is money, since LTC facilities do not have large budgets that can be allocated toward education and training.

Unfortunately, this is a job that you will need to learn along the way. You are going to feel incompetent during your first year or two of nursing, and more days of orientation will not change this. Orientation is a time to learn the facility, the residents, coworkers, departments, policies, procedures, and paperwork while developing a routine that will work for you. Orientation is not paid practicum.

All nurses are continual works in progress, which basically means that we learn something new every day. Once you are cut loose to work on your own, you are always going to have questions. If you are unsure or need clarification, hunt down another staff member that you feel is helpful. If another nurse is going to perform a skill on one of her residents that you'd like to work on (Foley catheter insertion, IV therapy, trach care, wound care, tube feedings, etc.), ask him/her if you can do it for them.

In addition, many new nurses fear 'losing their licenses.' However, the vast majority of actions taken against peoples' licensure is the result of substance abuse or narcotic diversion, not due to medication errors or mistakes made while caring for patients. Good luck to you!

[AKav8trix]

Asking for more orientation is perfectly fine, especially as a new grad! I wound up asking for 2 more weeks, because I soon realized after a few weeks on my own (and some scary patient situations where I didn't have someone available to answer those questions when they were urgent) that I still had some things to figure out as a new nurse. I wouldn't have been able to learn as well, if I'd just done it on my own, because I didn't know enough yet to know what I was missing.

Getting a few more chances to have someone available to look over my shoulder when things got crazy, helped me to build my confidence and refine my routine to better care for my patients.

I'm sure in the end you'll be glad you did say something, and try to take advantage of every moment you have with your preceptor to learn as much as you can before you wind up on your own again. :) Kudos to you for having the courage to ask for more time!

[TheCommuter, BSN, RN]

I'm sure in the end you'll be glad you did say something, and try to take advantage of every moment you have with your preceptor to learn as much as you can before you wind up on your own again. :) Kudos to you for having the courage to ask for more time!

I see that you work in acute care and are employed by a hospital. This is the LTC forum. In general, formal preceptorship does not exist in the nursing home setting due to budgetary constraints. The OP is employed at a LTC facility.

[Orange Tree]

I asked to start orientation all over, with a new preceptor, after about four weeks (half way) into it. And even after my orientation and a half, I was still shaky....but eventually I was able to get a routine down and keep up (most of the time). You'll get it, just focus on safety above all else. Give your non-critical meds a little late if you have to. Don't rush yourself so much that you get frazzled and make avoidable mistakes.

[beast master RN]

i had 3 day to orientate , not alot of time , plus i was a new rn, i worked for a couple months 2-3 and the don asked if i would being willing to do a couple extra days orientating with a day nurse who had been there for a very long time and was familiar with all the paper work,, rds monthly assessments/ skin . it was very good she showed me how to be more of a charge nurse delegate to my cnas , fax doctors , also when to fax when not to , when to call, when i came i just owned im here to train with X i need help in a few areas and shes the best so here i am, people get it

[Thedreamer]

Orientation should be you following the same nurse for a few weeks. Thats my solid opinion on the case. Being tossed around from nurse to nurse only confuses you since you arent seeing a consistent work flow. It also has the issue of comfort. A new face every time you come to learn something brings a lot of challenges, the worst being uncomfortable asking questions.

I got 3 months orientation for PCU after being an LPN for years when I first got my RN. Thankfully I was given an amazing preceptor and paired with her schedule. I worked with her every day I was being oriented. I built a relationship professionally that let me ask any question without fear and because of that I was able to learn a great deal more than other newer employees to the unit who got shuffled around nurse to nurse.

Those same nurses are still struggling and needed an additional 2 weeks/1month MORE orientation than I received. Yes it depends on the facility and all that jazz but I guess what I am trying to say is, never be scared to ask for help or more orientation. LTC has a large population of patients and acuity is just going up and up as the years progress.

Hospitals are tossing patients out a lot sooner then they did years back and thats bringing the acuity up a lot in rehabs and LTC facilities.

[Hospice Nurse LPN, BSN, RN]

Hospitals and LTCs are different. A hospital will give a much longer orientation. LTC it's 2 or 3 days (even for new grads). I've never heard of more than one week in LTC.

[LoveMyBugs, BSN, CNA, RN]

When I started out in LTC/SNF/LTAC I guess I got lucky as I got almost a month where I was in the LTC hall with the sweet little laddies.

I started working for a month or two on my own on the LTC hall and as I became more confident they wanted to move me to the skilled hall, I told them I would have to have more orientation on the skilled (SNF) hall and if they wanted me to work the vent (LTAC)hallway then I would need more orientation.

They gave it to me, because the vent hallway was a scary hallway to almost all the nurses in the building and the skilled hallway was such a busy hallway with some major dressing changes nobody wanted to work the hallway, they gave me the orientation that I wanted, but I had to advocate for myself. One shift I came in and they had me scheduled to work on the vent hallway and I told the RCM that I could not work that hallway, the skilled hallway maybe, but not the vent as I had not had any orientation to that hallway, and I got the orientation that I wanted.

I have recently started a new on-call pediatric LTC job and as my month long orientation was ending I asked for 3 more days and was given 2, because I was nervous because the paitents were kids and the meds were different.

I have never regretted asking for more orientation.

[turnforthenurse, MSN, NP]

I was given 6 weeks to orient on a progressive care floor...but really it was 5 weeks, because I spent my last week of orientation cross-training in ICU. 6 weeks kind of scared me because a lot of places do 12+ weeks (I don't know about LTC). I was with multiple RN's during my orientation period. I felt pretty incompetent coming off and I felt pretty incompetent for awhile. I have been a working RN for 4 months (almost 5!) and I'm just now starting to feel comfortable, but I still ask a lot of questions and in no way do I feel like I know everything! Talking to some doctors still make me nervous (mainly the ones that I have had issues in the past). I feel like with any nursing job, you learn as you go. I learn something new every day. And please remember that no question is a stupid question!

[AZMOMO2]

I had 3 days and it consisted of here take the cart on day 1. LTC is pretty much like that. I think they all looked at you funny because the med cart is pretty basic so they don't see a reason for an extended orientation. The biggest thing is all the paperwork, being confident with calling doctors comes with practice. Orientation can't teach you that. As your skill set improves and you become confident it will get better, you will NOT be perfect. Med errors in LTC are so common because there are so many residents with so many meds and so many distractions along the way. Try your best, ask questions, find someone who you can use as a mentor, and keep plugging along. Don't psych yourself out about needing more orientation time if it consists of you doing it and someone is there as back up... there is always someone there for backup if you need it even when you are on your own!

[cpl_dvldog]

I think most new grads feel incompetent when finishing orientation. Just remember to ask question when in doubt. It is better to be thought an idiot than to prove it. I hired straight into trauma ICU. My only saving grace was I precepted there my last semester and a few of the nurses didn't realize I had already graduated when I hired on. They didn't think twice about my asking questions. At times I am still a little anxious, but not as much as before.

Just don't sweat it and when in doubt ask someone.