How much orientation do new grads need? - page 2

I work with an RN who got her licence in December. She started working at the hospital in June of last year as a CNA. In August, they started letting her take her own patients, doing everything... Read More

    cotjockey...some folks aren't cut-out to be charge nurse...period. my question is why should they have to? why can't a novice nurse come-out & work for a solid year order to get those prioritizing, organizing, skills down first?

    have you read from novice to expert: excellence and power in clinical nursing practice, 1984 by: patricia e. benner (& it's still in print!!!)? well in her book she describes studies using the dreyfus model of skill acquisition which proves that everyone starts out being a novice at whatever they do...& it does take awhile before they're considered an expert...may be you should read it. here's a written editorial about this book:
    editorial reviews
    from book news, inc.
    presents a model of nursing practice describing five levels of competency. each level is described in the words of nurses who were interviewed and observed individually and in small groups, in patient care situations where the nurse made a positive difference in patient outcome. asserts that perceptual awareness is central to good nursing judgment and that this begins with intuition followed by critical analysis. discussion encompasses the helping role, the phenomenon of caring, management of rapidly changing situations, and collaborative relationships. benner teaches in the department of physiological nursing at the university of california school of news, inc., portland, or

    you know the trend is for novice nurses to be set-up in extended orientation programs....more like an nurse internship where the novice nurse is coupled with one or two expert or veteran nurses throughout their orientation. these nurses precept/mentor the new nurse while they go through generalized hospital orientation &/or specialized orientation requiring more classroom/clinical learning such as ed, l&d, critical care units, peri-operative, etc.

    these areas didn't use to hire novice nurses until they were able to master med surg (which was at least a year) first. now with the nursing shortage upon us...hospitals are doing whatever it takes to hire & keep novice nurses & utilize them everywhere. so if that means orienting them further than the original or common deadline (which is anywhere from 12 wks to a full year...based on the area of practice/speciality) be it. i rather work along side of comfortable, secure, & competent nurses than working with nervous, unsure, incompetent ones just for the sake of making them get-off of orientation & starting *their* respective shifts sooner or *on time*.

    one to three more months of orientation just might make the difference for this person...why not extend them the chance? your employer/don is willing to give your friend (if in fact she's a friend...i know you've said that you know this person since the 2nd grade) that courtesy...why not you? if upon that time they still aren't comfortable...then may be they should think about other areas to work within the nursing field. you never know though...those last few weeks just might be the key for her...providing she's coupled with a good expert nurse that is....not all experts are able to teach either & that may be a problem your friend is having as well. for example...if her preceptor criticizes her continually without any sort of encouragement...that would certainly make a person feel inadequate & they won't build any confidence as a result.

    i just don't understand your gripe unless it has more to do with your friend still being on days as oppose to going on nights?

    i really have to agree with sbe on this one.

    originally posted by smilingblueyes
    ya know some people are not cut out for charge or ever....

    and it takes time to be a real charge nurse! i think we ask a lot of people to suddenly charge when they become rn's. i know, i had to do it at the rural hospital where i used to work. it was tough, to say the very least, especially as we were 2 hours from the nearest level -3 facility and had to deal with level-3 stuff anyhow. i saw some who could not handle it and quit. they were not bad nurses, but not charge nurses. she may not be a charge nurse material. for me, it was 3 months' orientation on our ldrp floor and poof, you are an rn, you automatically charge. it is not for everyone and some cannot ever do it. she may be one of them....
  2. by   flashpoint
    We're a small 22 bed hospital...LPNs are cheaper than RNs and they're not going to pay an RN to just do patient care. RNs are either charge, ER, OR, ICU, or OB...point blank. Not right, but it's how it's done here...
  3. by   traumarn1
    I think to expect a nurse of 6 months to be able to fully participate as a charge nurse in an awfully high expectation. It'll take a full year before this person is even comfortable with being a nurse, let alone a responsible for the decision making on a unit. However, if the individual is "messing with your mind" in relation to workload, a subtle approach stating such is in order
  4. by   glascow
    It really bothers me that as an LPN, I am expected to say things to her, like, "You really need to go assess this new patient," or "Yes, you need to call about this patient being in SVT, NOW!" I would love it if our hospital would let the new RNs work the floor for a year or two before expecting them to charge, however, that is not how administration sees things. It's a lot of little things too, like taking three hours to assess a new patient because she is calling her son on the phone or just chatting with a patient who live across the road from her...going to lunch before starting a new IV on a patient on an insulin drip or taking an hour to call a doctor for pain meds because she wants to clean out the syringe drawer...taking 45 minutes to to a new admit assessment becasue she gets to chatting about the weather. I would help her out if I could but a lot of the things she is missing are things I cannot do as an LPN, but I still know needs to be done. I'm also not very comfortable saying things like, "You really need to do this IV before you go to lunch," and I don't feel like that is something I should have to point out to her.

    Why are you not comfortable with helping your friend learn to prioritorize? Are you expecting too much of her because she has RN after her name.

    As an LPN, you are correct, you should not have to point out seemingly obvious things to her, but as her friend, give her some guidance. Show her by example, while you may not beable to perform some tasks, if it is your pt that needs an IV started immediatley and she wants to go to lunch, point out the pt's condition and why the IV is needed ASAP. I was out of orientation for 2 years before being charge- that was the policy. (back in '92) Then I had to go to a charge nurse class and had a charge orientation. I knew nothing about being a nurse when I graduated, the real lessons started when I got out of school.
    Last edit by glascow on Jul 7, '03
  5. by   nimbex
    more than a hospital is willing to pay, sorry to add, it takes a floor nurse one year to be able to do charge, an ICU nurse 18 months, been nursing for 8 years, seen all the short cuts and the results.

    makes more sense t invest at the begining if you're asking me.
  6. by   ceecel.dee
    We have the same expectation on new RN's at our hospital, for both new grads and those with experience from elsewhere. Very often, the new grads adapt better than those who come from institutions where you aren't doing "in-the-trench's-like" nursing. We (orientators) are very carefully supportive of the new RN's needed leadership skill development. Some just don't "have it", and don't seem able to "get it". Most do, though. It is an extremely stressful place for them to be. They initially are ultra focused on tasks, and when they finally begin to turn their attention to the leadership and responsibility aspects, they typically hit the wall labeled "overwhelmed". Support is essential at this stage (unfortunately, this is also the stage where the orientators are becoming weary).
    I agree that a new employee should not be placed in the charge role for a minimum of a year, preferably two years. This would allow them to ease through the "overwhelmed" phase and beyond, to guarded confidence.
    But, we don't always get what we want.
    Just give your friend as much support as you can. Tell her what she does well. Offer suggestions gently, as her friend (instead of as an LPN advising an RN if that makes you uncomfortable). When you hear the others evaluating (judging) her negatively, remind them conversationally what a big job it is to learn, how scary it must be to be responsible for anything that may walk in the door, that you-all have been around longer and need to be willing to share your knowledge and experience. The added stress of nonacceptance could seal her fate.
  7. by   purplemania
    what is really sad is that she is going to feel like she can't nurse at all because she "failed" this charge nurse test. In reality, she has not been prepared or supported by management. Not allowing her time on the floor means the mgmt is being penny wise and pound foolish, IMHO. I hope she quits and goes elsewhere for the support she needs.
  8. by   peaceful2100
    Well, I am probably headed into a real serious mess. I am a new grad. I am on my 4th week of orientation. My orientation is SUPPOSE to last 9 weeks however they are pushing me more and more because they are extremely short staff on nights. One of the traveling nurses contract is about to expire in two weeks and it is not being renewed, one girl who was precepting me this week and last night was the last night for her full-time and she is going PRN, another nurse is about to retire, another nurse is quitting. So that hardly leaves any full-time regular Registered nurses. By the time I take boards and become a R.N. then they will probably be pushing me even more. One girl who is going PRN told me don't be surprised if they have me charging soon after orientation. I am so scared because of the potential problems and no one don't want to work med-surg at this hospital. The units are considered taboo because of the bad reputations of some of the doctors on those floors. The good nurses have already left and are leaving because of these doctors. It is out right scary.

    I will NEVER feel ready to be a charge nurse at just 7 months after graduation. That is ludicrious in my mind. I will refuse to charge and if they expect me to. I guess I will have to do it just once and then put in my two weeks notice at the end of my shift. There is a lot of responsibility in being a charge nurse and not much training comes a long with being charge nurse. I remember one nurse who was never charge nurse was told she was going to be charging and she was like I don't have any training on being a charge nurse, I have never charged before. That is scary.

    I have been expected to take care of 6 patients already. My preceptor is covering me and checking my work but basically I have been doing all the care on my own. I am on a surgical care floor. I have been doing everything like assessments, vital signs, meds including IV piggy back and IV Pushes, calling doctors, checking off orders, I have even been given responsibilty of narcotics and keep narcotic keys which I did not even know a graduate nurse was allowed to even do such a task.

    It is all so overwhelming for me. I just keep thinking next month I will be having to cover for LPN's by double checking their assessments, doing their IV push medications, double checking their paper work in addition to my own once I am licensed and I just feel that is too quick for me to have that kind of responsibilty ESPECIALLY on a busy surgical care floor where my patient load will more than likely increase to 10-11 with a LPN starting next month.

    No wonder so many more new grads leave within the first couple of years it has all become so overwhelming to many and a REALLY huge shock. I know I have talked to several of my classmates who are literally shocked about the REAL world of nursing.
  9. by   stella123 rn
    I agree, 7 months is too short. All of our charge nurses have at least 10 years experience and have been at the facility for at least 5. They would not even THINK of allowing a new grad to be charge. Our charge nurse's have a lot of responsibility and are very good. I can not imagine being charge. I have been a nurse for a year and a half. There is still so much to learn.
  10. by   Rapheal
    She needs more experience, more time. It is bad for her, her co-workers and the patients to put an inexperienced nurse in the role of charge nurse. But as we all know- it is all about money for the hospitals and LTC facilities.

    IMHO it is unfair to judge a new nurse as incompetent when she has had less than a year's experience. If she is overwhelmed then even the obvious things may slip by her. Kind of like when your kid is asking you for permission to go some where, while you are driving in the rain, the car next to you is weaving and the radio is playing a commercial real loud. You feel really stupid when your kid says 'But you said I could go the party" (of the teenage wild child whose parents are on vacation and who has been suspended from school for drinking). Not good.
  11. by   NurseJacqui
    Length of orientation depends on the nurse. Some catch on more quickly than others. I know new grads who have made great charge nurses and seasoned nurses who make terrible charge nurses. It all depends on the individual.
  12. by   woodcarver
    I think it's a shame that it's such a dog-eat-dog environment amongst nurses, so much competition, so much belittling of other's abilities. it's easy to get caught up in, i've been guilty of it too-- you're stressed, you're compensating for others, and the whole situation is unhealthy chaos created by those in charge who are probably not even nurses!!! So we take it out on each other, we bite in to gossip and never, God forbid, be direct with a co-worker, or compassionate! I agree with what everyone's saying-- she may need more time and shouldn't be expected to adopt this new role when she's not even sure what the role of an entry-level RN is yet!! I agree she should find some other place more supportive-- there are places out there, really! Some place that fosters growth and prides itself in the thoroughness of its orientation rather than priding itself in how quick people "suck it up" and "buckle down." Health care is cut throat but we have to try to not cut down those we work with! It sounds like your frustration (and rightly so) should be directed at management and at the extreme nursing shortage that creates a situation like this, and not at a woman who apparently is just trying to sink into a new life role.
  13. by   flashpoint
    I really don't feel like I am belittling her, more than anything I ma wondering if there is something I can do to help bail her out of this mess. I really don't think it's fair to expect a new grad to function as charge, but I also know that she knew waht she was getting herself into when she took the job. She is very book smart and she knows her stuff very weel. Right now, she is having extreme difficulty putting it into practice. Even when census is low and we only have four or five patients, she seems to struggle and for many of us, it gets really old telling her the smae things over and over and over. "Yes, Gina, you need to call the doctor about the respiratory distrss NOW." I didn't put her in this situation and I would help her out if I could. Unfortunatley for her, she is going to the night shift starting tomorrow...the night shift is made up of a bunch of great nurses, but they have very high and often unrealistic expectations. There are a few of them that are going to eat this nurse alive simply becasue they know she is continuing to struggle. Sigh...