Can not make it out of orientation???

Flatlander · May 12, 2014

I'm glad they're alerting you to this possibility. I have first-hand experience: it happened to me. I was let go at end of orientation as not ready to take on a full load independently. I took it personally and felt extremely let down. Hospitals in urban areas are dealing with patients with high acuity and nurses are expected to work at a very fast pace. It is not an easy transition for a new grad with little actual floor experience. There is so much to learn in so little time once you arrive on the unit.

The best advice I can give is to keep reviewing your knowledge and skills. Before you set foot on the unit, know your meds and procedures backwards and forwards. I cannot stress this enough. Then be prepared to keep learning every day on the job, reviewing each days' learning after your shift is done. (Passing the NCLEX on the first try is great, but doesn't mean you have the knowledge and skills at the ready -- I don't know why this is true, but it was true in my case.)

Having your basic nursing knowledge and skills down pat will help prevent feeling overwhelmed by all the new things you've not yet encountered, such as unit protocols, new emr's, new faces, where to find things, new forms, etc, etc.

It is also essential to ask for regular weekly or scheduled written reviews of your progress with detailed areas where you need to improve. Without this you might find out you are not in good standing when it is too late to be corrected; or you just might never know exactly why you were terminated.

You will also encounter coworkers and managers who are supportive and some who could care less -- they've seen the newbies come and go. This is the reality shock that people warn new nurses about.. and it can end badly.

The good news is, we can learn even from painful experiences. What I learned is what I've shared with you above. You can share it with your classmates, too.

applesxoranges, BSN, RN · May 12, 2014

Some of the issues is that people have not had enough time on the floor during school. That is one biggy that nurses always talk about how diploma nurses were prepared to take on a full load whereas new grads now a days have to have a period of time where they are trained to the floor.

Sometimes it's also not a good fit.

I guess I will be one of the ones not "making it out of orientation" because I hate my job already and cannot stand to see myself doing it for five or even ten years so I am looking to return to the ER. I've interviewed at two ERs so far. If it goes well, I will have a new job by the end of the month.

My experience has been in an ER and the stuff down there makes more sense for me I guess. I know what will need to be done for x, y, z that walks in the door. I've triaged as a paramedic in a busy hospital before. It's a different level of thinking. I am glad that I left for the short period of time and decided to get my feet wet, but I am also glad at the opportunity to return.

There is also apparently a new grad shock that new grads find out about when they start their new job. A few people directed me to those resources about the new grad shock because I did indicate that I was unhappy although I think it's the general consensus of the hospital floor nursing staff. Four new grads quit out of med-surg and another one was let go in the ICU because she was "assessing" her patients without turning them. A bunch of other staff want to leave due to the ridiculous patient loads they give them.

allnurses Guide · May 12, 2014

The top reasons I have seen new grad nurses fail to hold onto their jobs comes down to one of two camps. In the first, the new grad is unable to manage time well, tends to be very anxious and tends to over think things. In the second, the new grad is unable to manage time well, is anxious about appearing "competent" and tends to not ask questions and to make many mistakes, some of which are dangerous.

The first and foremost issue for almost all new grads is learning good time management. The second is reconciling the "nursing school" way of doing things with the "real life" way of doing things. The third is managing anxiety well and not letting it either make you too paranoid (over thinking) OR make you too fearful of asking questions. In both of these scenarios, the new nurse is cut loose but for very different reasons.

The first type is let go because the anxiety actually gets in the way of good nursing care. The time spent quadruple checking, reading up on things, the time spent charting all make for late medication administration, unhappy patients, slow patient care and incremental overtime. This is a person who not only makes his/her shift hard on themselves, they make it hard on those around them as well.

The second type gets let go because they are dangerous. Inability to accept that one is going to be new and barely competent for a while is absolutely necessary. Giving the impression that you think you know everything and fearing looking "stupid" are both the kiss of death. Patients and coworkers both are unable to count on this person as a member of the team and both have a difficult time bonding with this person due to this person's driving need to look like they have it all together. It is absolutely necessary to accept that you are going to be the lowest man on the totem pole for a while and that not only do your coworkers expect you to have questions, they see it as a bad sign when you don't.

So yes, it is possible to flunk out of orientation and to fail to keep your job. You have to find the balance of facing your fears, being humble, learning as you go and trusting what you have learned already. You have to be effective enough to take on your portion of the work load, efficient enough not to need much more time than anyone else to complete your work, confident enough to face your fears, humble enough to ask for help and organized enough to meld all these things into a successful shift, day after day. Those who can't do this don't get to keep their jobs.

ETA: This is speaking in generalities, of course. Please don't take this post as a cause to launch stories of "I did all those things and they still fired me". This is simply meant to be giving general information as to reasons why new grads lose their jobs on orientation.

2bAngilRN · May 12, 2014

I'm glad they're alerting you to this possibility. I have first-hand experience: it happened to me. I was let go at end of orientation as not ready to take on a full load independently. I took it personally and felt extremely let down. Hospitals in urban areas are dealing with patients with high acuity and nurses are expected to work at a very fast pace. It is not an easy transition for a new grad with little actual floor experience. There is so much to learn in so little time once you arrive on the unit.
The best advice I can give is to keep reviewing your knowledge and skills. Before you set foot on the unit, know your meds and procedures backwards and forwards. I cannot stress this enough. Then be prepared to keep learning every day on the job, reviewing each days' learning after your shift is done. (Passing the NCLEX on the first try is great, but doesn't mean you have the knowledge and skills at the ready -- I don't know why this is true, but it was true in my case.)
Having your basic nursing knowledge and skills down pat will help prevent feeling overwhelmed by all the new things you've not yet encountered, such as unit protocols, new emr's, new faces, where to find things, new forms, etc, etc.
It is also essential to ask for regular weekly or scheduled written reviews of your progress with detailed areas where you need to improve. Without this you might find out you are not in good standing when it is too late to be corrected; or you just might never know exactly why you were terminated.
You will also encounter coworkers and managers who are supportive and some who could care less -- they've seen the newbies come and go. This is the reality shock that people warn new nurses about.. and it can end badly.
The good news is, we can learn even from painful experiences. What I learned is what I've shared with you above. You can share it with your classmates, too.

I am sorry you were let go from orientation. I appreciate you sharing your personal story. I always feel that sometimes it is warranted so others who are naive can learn from your mistakes. I will definitely take your experience into consideration, as well as everyone else's input shared on this thread. Again, thanks!

Where are you now as far as orientation/job? Have you been able to apply what you have learned from this experience somewhere else?

Flatlander · May 12, 2014

Thanks. I've taken a non-RN job to have some income and maintain a job history. It is medical-related and keeps me in the health care environment. I've had time to re-think my career aspirations. Like so many, my goals during school were all focused on acute care nursing. Now I'm exploring opportunities in clinics and homecare as a possible better fit.

In response to the Guide's post above, I see myself in "camp one:" anxious, over-thinking, overanalyzing. Anxiety makes it hard to think clearly. To be organized requires a relaxed and confident state of mind, clear of mental clutter. Once you become aware that you are not measuring up and are possibly "under the gun," even though it's not communicated directly, you get the picture. Paranoia sets in. Getting past these internal hurdles requires internal work and is not accomplished in a day or a month. We do the best we can with what we've got.

Thanks for your interest in my outcome. Don't let this stuff spook you. Concentrate on learning all you can, including taking care of yourself (nutrition, exercise, stress management -- in ways that suit you best.)

allnurses Guide · May 14, 2014

Exactly! It becomes a double edged sword. Any new grad should really consider use of a brain sheet. It does the organizing for you and helps clear up some of that mental clutter. I used one and still do sometimes. In fact, I should have yesterday. Yesterday was a royal mess on my floor and I felt like I had no idea where I was in my day most of the time. So even those of us who have made it just around the block still can use some help from time to time.

Flatlander · May 14, 2014

My preceptor did not use brain sheets. She noted times that meds were due for each patient and that was the extent of her notes as far as I could tell. One of my problems was that as soon as we completed one task, she directed me to the next task immediately. There was no time for me to plan my next move. I would like to have had a little bit of leeway, even if I had to flail around a bit while finding my own rhythm and pattern. This is one of the things I would do differently: I would ask to have a few moments to plan my next moves without my perceptor's direction. She kept trying to speed me up, but it didn't allow me to think for myself. Toward the end of my orientation I began to feel almost abused by the constant ordering to do this, now do that. I wanted to shout "Leave me alone and let me do my job." Which of course would be inappropriate. It took me awhile to recognize these feelings and what they signified.

Swellz · May 17, 2014

My preceptor did not use brain sheets. She noted times that meds were due for each patient and that was the extent of her notes as far as I could tell. One of my problems was that as soon as we completed one task, she directed me to the next task immediately. There was no time for me to plan my next move. I would like to have had a little bit of leeway, even if I had to flail around a bit while finding my own rhythm and pattern. This is one of the things I would do differently: I would ask to have a few moments to plan my next moves without my perceptor's direction. She kept trying to speed me up, but it didn't allow me to think for myself. Toward the end of my orientation I began to feel almost abused by the constant ordering to do this, now do that. I wanted to shout "Leave me alone and let me do my job." Which of course would be inappropriate. It took me awhile to recognize these feelings and what they signified.

I had a preceptor like that, and got so rushed that I made a med error. I usually had a problem asking for help, but that day I did, and I warned her I couldn't think at the pace we were at and something would happen. She ignored me, I continued running and not thinking, and I screwed up. No harm to the patient thankfully. I had multiple preceptors, so I just requested to not train with her again. Apparently I wasn't the only one who had complained about her and she hasn't oriented a new grad since.

Flatlander · May 18, 2014

I had a preceptor like that, and got so rushed that I made a med error. I usually had a problem asking for help, but that day I did, and I warned her I couldn't think at the pace we were at and something would happen. She ignored me, I continued running and not thinking, and I screwed up. No harm to the patient thankfully. I had multiple preceptors, so I just requested to not train with her again. Apparently I wasn't the only one who had complained about her and she hasn't oriented a new grad since.

Good for you, that you spoke up. Glad it worked out for you. Love this site. I learn so much from others and the validation of some of these experiences sure helps. Thanks for the reply! I want to reiterate that I take full responsibility for my failures (I hope), because ultimately I am the one who has to recognize the problems and work towards solutions.

Hope I didn't hijack the OP's thread here. 2bAngilRN, I hope you find this site useful as your career progresses... I suspect you already have. I wish I had found it sooner, too.

CardiacKittyRN · May 23, 2014

It's not necessary a bad thing.. A nurse just might not be ready yet to be on her own. I'm a new grad and I will say the learning curve between student & RN is sharp. Had I not had previous experience.. I don't know how I could have done it. We just hired someone new & oriented for 3 days and decided she didn't want to do this job anymore... Another new RN who was orienting at the same time as me on a different unit was having a hard time managing the pt load by herself so they have her an additional 3 weeks orientation time. She now works on her own & is doing fine! It just takes some people longer than others..

sunmaidliz · May 29, 2014

This comment seems like it's describing me. I've been fire from three jobs in my new grad year after orientation at each one of them. I'm definitely the first type of nurse and in all honesty, I have a hard time managing time and mastering skills. I make a lot of mistakes that make me unsafe. It is a drain on my coworkers and creates a problem. And I have a hard time being in the position of being the ignorant newbie and I have a hard time asking questions and asking for help. That's just me and my personality. Perhaps I'm not suited to be a registered nurse. It's not so much that I'm not smart. Nursing isn't for everyone. Unfortunately, I didn't realize it wasn't for me until I was already invested. It's too bad I couldn't have faked it and shined it on, making some use out of it until I was able to move on.