I am a second-career nurse. I taught high school for 9 years, went back to school to get a BSN, and just started nursing in March of 2020. What a crazy time to get started! Lots of learning opportunities.
I took a position in a Progressive Care Unit with plans to eventually move into an ICU after gaining some experience. I was given a full 12 week orientation, with a couple weeks to float to the surgical and cardiovascular ICUs. When COVID hit the hospital, management decided to open up a new Step down unit and convert the current one into a Medical ICU. The plan was to begin the conversion in September. However, due to increasing number of COVID patients, this conversion happened literally overnight in July. Suddenly, we were receiving some of the sickest patients, with minimal ICU training. Nurses from other units were floated to help us out, but it was still rough. I am an independent learner, so I have been putting in the time and work to hone ICU skills as a new grad as quickly as possible. However, as a new grad I also feared being given assignments that I wasn't prepared for - this affects the safety of the patients and my nursing license. I'm not afraid to ask for help, and thankfully my charge nurses have been great resources.
A position opened up in the CVICU, and a charge nurse encouraged me to apply. I thought this would be a good move, since the nurses there are more experienced in the ICU. My long-term goal was to work in this unit, as well. I applied, and was offered the job. I told them I'd accept as long as I was guaranteed a full 12-week orientation in the new unit. My manager agreed, and stated she'd roll me off orientation early if I didn't need the full 12 weeks.
I started working CVICU in early December. After 2 shifts, management removed me from orientation due to staffing demands. Now I'm a full-time CVICU nurse. I don't have ZERO knowledge about heart patients, but not enough to feel safe caring for them independently. Currently I'm being given patients in the unit who are step down or General ICU acuity. While it is manageable, I'm having to pick up extra shifts if I want any orientation. My would-be preceptor and charge nurses are helpful to teach me when they can, but we are all busy. I have spoken up about this to my manager several times, and this person's hands are tied by the higher up boss, who thinks I don't need orientation. The charge nurse is also fighting for me to get an orientation, but I'm continually denied because of COVID beds and staffing. It's very frustrating. I am told that the situation in other local hospitals isn't any better. However, I signed a two-year contract to work at this hospital, and will be fined if I leave early. I'm not sure what else to do, other than report this to HR.
I understand things are tough all over right now. Needs are critical. Staffing and morale is low. But I'm frustrated because I'm hungry to learn and grow as a cardiac ICU nurse, and am denied this opportunity. Apart from seeking employment elsewhere, do you guys have any insight? Any similar stories? It could be that things are just rough right now all over.
You started out on PCU but this turned into ICU without adequate training. Then, you received 2 days of ICU orientation in the ICU. To me - this is a danger to your license. However, it is your decision on if you feel comfortable and safe in your environment.
What about unit based competencies? Every place I've had to work, I've had to demonstrate competency on procedures and using unit-specific equipment. Most units I had to repeat this every year. If you didn't do competencies or couldn't demonstrate them within 30 days of hire you were taken off the floor and possibly fired.
I'm a CVICU open heart manager, and there is no higher-up boss who makes decisions for me regarding orientation needs. I make those decisions on an individual basis. Report what to HR? If you start reporting your manager I suspect your tenure in that unit will be limited.
So anytime you have a concern ( and lack of education in your area of work is a huge safety issue ) the mantra is to "follow the chain of command "
But it sounds like you're being given patients within your capabilities?
Three things to know
1. You can ABSOLUTELY always refuse an unsafe assignment. And you should You are not just defending yourself but your patient as well. They need a nurse who is well equipped to perform her role .
2 . Every hospital I've ever worked at has a chain of command . If you have concerns such as being given a patient you aren't trained to care for - follow it.
3. Never be bullied by management. Let me say it again. If they are so toxic that you're threatened for standing up for safety then let karma come around when they have to be a patient of an inexperienced overwhelmed nurse someday and find a new job or fight them in court.
I have in fact taken an issue with staffing through the chain of command and the individual causing that issue was removed from their position
speedynurse, ADN, BSN, RN, EMT-P
544 Posts
You started out on PCU but this turned into ICU without adequate training. Then, you received 2 days of ICU orientation in the ICU. To me - this is a danger to your license. However, it is your decision on if you feel comfortable and safe in your environment.