expectations of new grad ICU orientation

Ivanna_Nurse, BSN, RN · Oct 29, 2007

Hey there, my orientation was 16 weeks long, with me becoming more independent as time goes by. I had several checklists, with skills which I had to be checked off on, verifying that I am able to safely and independently practice those skills.

I always take the most critical pts and try to care for those who have vasoactive drips or other "not seen too often things. I would say that if you feel as though you have been shorted on Orientation, then maybe it would be a good idea to talk with your NM, and discuss your concerns. Perhaps you can extend orientation, or if you are still orientating, ask as many questions as possible. I know that I used to feel silly asking things, but if I don't ask questions or let on that I need help; I will never get the information or direction I need.

I would expect orientation to all shifts, consistent preceptors, weekly follow-up on performance and the ability to extend my training if needed. Good luck and hang in there. Keep asking until you get the information you need. ~Cheers, Ivanna

RainDreamer, BSN, RN · Oct 29, 2007

In any kind of ICU you should have an extensive orientation (at least 12 weeks, give or take some). It should include both on the floor and classroom time.

At first your preceptor should be showing you everything, there with you at all times, talking you through everything. After a while you'll do things while the preceptor watches. Towards the end of your orientation you should be taking the assignment on your own, with your preceptor there, like you said, in the background to be used as a reference when you need them. Only do things on your own if you feel totally comfortable doing so. If you need your preceptor there with you while doing something, then make sure they are. Never do something you don't feel you're capable of doing.

The ICU, or any nursing for that matter, is no place to mess around ..... if you don't feel like you're being adequately oriented, then you need to bring this to the attention of the unit educator and/or nurse manager.

poppy07 · Oct 29, 2007

I was told I would have 12 wks orientation. My charge RN and NM both tried (together...like a gang bang) to get me off orientation at 8 wks (and then put a guilt trip on me..."hit to the budget", etc.). I have 1 wk left, and the charge RN is still trying to act like I am on my own and count me as one of the nurses for the day. Meanwhile, my preceptor is never around...off talking to other people...so essentially, I am on my own, and have to seek help from who IS around. I just wonder where I should be at this point in my orientation, what skills I should have down pat by now, etc. Thanks!!

RainDreamer, BSN, RN · Oct 29, 2007

Do you feel comfortable taking an assignment on your own?

Do you feel like you can safely take care of these patients without constant supervision?

Do you feel like you've had enough orientation with a preceptor to gain the skills you need to safely take an assignment?

If you answer "no" to any of those, then please go talk with your educator and/or manager.

At the end of orientation you should feel somewhat comfortable in taking a somewhat stable assignment on your own. But even after you get off orienation it's imperative that you have a great support system and that you have experienced nurses that are willing to be there when you need help with anything and need your questions answered.

The fact that these people have been trying to get you off orientation at 8 weeks and have been putting you into the count is unsafe .... for you and the patients. This isn't acceptable and unless you stand up and tell them NO, you will not stand for this, you're putting not only your license at risk, but you're putting your patients' lives at risk.

Zookeeper3 · Oct 29, 2007

-i would only seek out my preceptor, if you can' locate them, ask the charge where they are, they should be more available;).

-you should be able to assess and pass meds (looking up unfamiliar ones) with in the time frame.

-new proceedures (or unpracticed skills like sterile tech) should be directed to your preceptor or charge rn, especially advisory statements that you lack the 3 check offs, or comfort with (will you just stand here and watch me?)

-titrating meds that are new and there are a few choices, first have an answer and rationale, then bounce it off the preceptor (don't staff hop)

-changes in patient status that require a second pair of hands, call now, not after you've worried for a few minutes and anytime you've an emergency, call for help loudly but at least start with the abc's, bls, this is all you need initially (not to run the code).

-when to call the doc, for your first few months should be discussed with a preceptor or charge. have a specific reason why and what you want from him "just wanted you to know", isnot critcally thinking. have all your pertinant data ready (you should be able to gather the important stuff and not give a 15 minute speech to the md- short and sweet.

-you should be able to make the calls when warrented to the most obnoxious doc and try to hold your own, with the preceptor next to you, not calling for you.

-you should know the difference of what you do and don't know, as well as your responsibility to research your meds before giving them, and a quick net search for a disease process (micromedex or what not). to be ready to get off orientation, you'll know that you'll spend the rest of your icu career reading, researching and learning. we ask our peers for opinions, not for all the facts.

-almost last, don't ask every dang nurse on the unit the same question, ask the seasoned nurses their rationale for their answer. based upon their response, decide how you'll proceed.

-finally, know that if you can do all of the above, well much of it anyway, you're ready. know that you can say let's shoot for 8 weeks, i'll do the next four with the same mentor (preceptor) and try a basic assignment. you need the person who knows you, your skill level to keep a close distance those first weeks.

-if you allow them to cut the cord early, you need to be self assured enough to refuse the "sick" assignments and not care what staff thinks of you. (it helps to get in 10 minutes early and check it out so it doesn't look like you're showing your butt or picking an assignm.) ((the previous shift may think initiation by fire or just not know you're off orientation early;))).

only you know what will work, everyone is rightfully fearful of getting off orientation, let alone early.

all those options aside. after 10 plus years of precepting, i've yet to see a new grad transition after 8 weeks well. you'll be overwhelmed and stressed for the next 12-`18 months as you grow to be independent... why make it worse?

personally i'd say "i'm flattered that you find me ready so soon. but it takes 12-18 months to grow a competent icu nurse, i'm hoping you'll commit to that last 4 weeks to best prepare me for my career here". (gag gag)

don't ever start caving in to that "take one for the team" mentality, it is a huge component of what is wrong with our profession, because it puts our patients last in the equasion.

tough one, might as well start learning how to hold your line now... how to leave 'em smiling thinking they won... takes a bit of practice;)

poppy07 · Oct 29, 2007

I responded to their way of trying to get me off orientation at 8 weeks "oh, no you only get 8 weeks..." they told me 12 wks, my preceptor told me 12 wks (and actually warned me they might try to get me off early).... I told them if I don't get 12 weeks, then I will need to be on orientation longer so that I can feel more comfortable with my skills and time management. They okay'd it, but after the fact, have been trying to put me on my own or with the charge RN who had an assignment...instead of with a preceptor. They tried to count me in the schedule the other day as a regular RN, and I still have another week of orientation left! When I told them I was going to be there different days, they tried to say "we will be short such and such a day."

I'm very irritated with this. I feel like I'm stuck working in a cheap hospital that doesn't care too much about adequately training new grads.

nyapa, RN · Oct 29, 2007

I don't blame you. Where is your educator in all of this?

cardiacRN2006, ADN, RN · Oct 29, 2007

12 Weeks isn't even enough.

marilynmom, LPN, NP · Oct 29, 2007

What do ya'll think of this?

I work as a nurse tech in an ICU (and I really love my job and the unit), I work at a teaching hospital. I get direct hands on patient care and can do things like central line dressings, central line blood draws, suctioning, caths, ABGs, I do my own assessment along with the RN (this is for my experience), vitals, etc. No meds of course and I don't mess with the IVs. I will have worked there for a year as a nurse tech before I graduate. Summer I work full time, during the school year I work one shift a week. I am one on one with an RN and basically get paid to learn and help.

They have already told me my orientation will be 8 weeks long (classroom and on the floor). I have talked to some of the newer grads and most seem to be doing well but they do get stressed out at times and everyone has told me it will take me at *least* 6 months to begin to feel comfortable.

Does that sound like a good orientation for me?

cardiacRN2006, ADN, RN · Oct 29, 2007

I worked in a similar environment as a tech. Except I had great nurses who let me do a lot more than that.

I came out of nursing school very confident of my skills.

I still needed more than 8, 12, etc weeks of orientation.ICU nursing isn't just about skills.

THe orientation is to allow you to think, assess, problem solve, anticipate, like a nurse.

8 weeks is being set up for failure.

nyapa, RN · Oct 30, 2007

I work as a nurse tech in an ICU (and I really love my job and the unit), I work at Does that sound like a good orientation for me?

Once upon a time, I would have said yes, on the basis that you have had extensive experience. As an EN I had my own patients. But, unlike any other hospitals in Australia, ENs can't give drugs at our facility. Very insulting, because they are trained for it. Nevertheless I thought I'd be fine. My role still included liaising with medical and allied health staff, and we were totally responsible for everything except the drugs - admission, assessment, problem identification, care, evaluation, and discharge. They were our patients

But being an RN is a different role. Suddenly you are responsible for the whole care of the person - including the drugs. You'd be surprised how much time administration of medications takes to prepare and calculate. It threw me.

So I would think that the very least you should expect from your employer is the same amount of orientation time as everyone else. Of course, you have skills that they don't and you may be miles ahead, but the more support you get the better.

Keep the safety net, because that is what orientation is, for as long as you can...