Cardiac Step Down: 6 week orientation for new grad

Ruby Vee, BSN · Jun 8, 2018

A stepdown is not a stepdown is not a stepdown. In other words, in a busy big city teaching hospital, it may not be enough time. In a smaller, community hospital where all of their sick patients get shipped to the big city teaching hospital, it may be plenty. Our orientation (big city teaching hospital ICU) used to be six months, but the trend now is to only offer four months and extend it if necessary.

Serhilda, ADN, RN · Jun 11, 2018

I'll be working at a smaller, lower acuity hospital in cardiac IMU as a new grad. My orientation will be twice that, along with everyone else I know, so I'd be concerned as well. I would not hesitate to extend it at all if you feel uncomfortable. Hopefully you'll have a supportive unit to make a short orientation more manageable.

JKL33 · Jun 25, 2018

The problem with "can be extended if need be" is that they have already professed their ideal, so by the time they decide to extend someone's orientation (even if it was never adequate to begin with) they're already disappointed that some preferred ideal goal was not met, and the orientee is effectively labeled in their minds as someone who didn't come up to speed fast enough. If they were really okay with extending orientations, they would offer that extra time period to begin with.

Just not an ideal position to be in.

I would advocate for people to do whatever they can to advocate for a proper orientation and understand the risks of taking a first position where, right out of the gate, there is a demonstrated lack of concern about the new nurse.

Good luck with your decision ~

jbeaves, BSN, RN · Jul 7, 2018

I'm working on a cardiac step-down unit in a moderately large city. The orientation on our unit is typically 6 to 12 weeks with 8 being the average. Our unit's educator, who oversees the orientation process of all of our new-hires, decides when she believes you are ready to fly on your own.

It may sound intimidating but I think it really depends on the kind of support system available on your unit after you start on your own. Our hospital has charge nurses who don't take patients and who are made fully aware of who is newly off orientation. As a result they know to kind of hover over you for your first weeks on your own.

A majority of new nurses also begin on nights. This is good for a couple of reasons. First, there is typically less going on so the atmosphere is less overwhelming (no doctor's rounding, meals, physical therapists, case managers, etc.) so they can focus on improving their practice before moving to days. Second, less going on frees up more experienced nurses to be available to help a new nurse in need.

In any case, I wish you the best of luck and welcome to the profession! :)

MusicGuy · Oct 16, 2018

I would caution against nights unless you're seriously OK with being up all night. I started on nights and found that not too many happy people were around to answer questions, but your situation may be completely the opposite. Also ask yourself if you can learn while sleep deprived. Another thing to consider is that there is much less physician interaction on night shift. I learned the most on days when I was able to discuss plan of care and find out exactly what the physician wanted for a patient and why.

6 weeks is crazy if your patients post CABG or thoracic surgery. You'll have to learn about chest tubes, pacers, wire care ect. If you do take the job, I recommend to read as much as possible.

**PhyllisMSN, MSN, RN** · Jan 20, 2019

It is so interesting to see the different orientation processes around the country. As a new grad, I would expect no less than 4 months orientation on a specialty floor. I have only worked in large teaching hospitals, and sometimes they will go up to 6 months for new grad orientation.

NurseTrishBSN, CNA, RN · Mar 14, 2019

Cardiac unit educator here. Our new grads go through a nurse residency program of 16 weeks. It varies based on the size of the hospital and acuity of the patients. Our nurses take a max of 4 patients. This hospital is growing pretty quickly with a current capacity for 260 patients. Hope this helps!