How much orientation do new grads need? - page 3
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
Jul 13, '03Originally posted by cotjockey
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...
I was a new grad eighteen years ago. I went through orientation with my preceptors (including one who'd been a nurse all of a year, and pushed me to go faster, faster) and at the end of the eighth week, I saw that I was no longer assigned to the preceptor. That was how I knew orientation was over. No review of skills, no evaluation, nothing.
Shortly thereafter, I saw my name on the schedule as being in charge. I asked about charge nurse orientation (which they had offered to experienced nurses new to the unit), and was told, "Well, you've seen the charge nurses, so just do what they do." I might have had three months' experience at that point.
I burned out really, really quickly in that place...to the point where I've never voluntarily worked on a med-surg floor again.
Jul 13, '03Good point to what Catlady said. My first thought was that maybe she ought to find another position elsewhere that could offer her the type of training that would be best for her.
Jul 14, '03What does that say about our facility? Well...I admit we can be a tough crowd. When I first started (almost seven years ago), I struggled. I was often belittled and put down by the more seasoned staff, but, they forced me to figure out where I needed to be and I worked my butt off to get there. I had to learn in a big hurry to manage my time effectively and how to prioritize what needed to be done. I also spent a lot of time reading about disease processes, drugs, and procedures. I don't agree that it is a fair situation to put anyone in. I see the same problem in a lot of the small rural facilities. We are constantly short of nurses so everyone has to pull their full load or things start to fall apart. I've never liked the way they treat the new grads...RNs, LPNs, CNAs...when they're fresh out of the chute, they need to be treated differently...given lighter patient loads, have a mentor who can help them through the rough spots, but unfortunatly, that's not how they choose to do things here. We're the only hospital for almost 75 miles, so there aren't a lot of other options. Nursing is such a dog eat dog world...it's too bad that more managers and administrators aren't able to see that and do what they can to help out...no one cares about the caregivers.
Jul 14, '03We're all advocates for our ptients, but so often we don't advocate for our fellow nurses when we perhaps should. I see genuine concern for this nurse in your posting, but at the same time, I'm also seeing a bit of "Well, if I had to learn quick and without much help from those nurses with high and often unrealistic expectations, so should she" in there as well.
You said that you've been knowing this girl for years- are you trying to give her support and nurturing? Are you vocal in expressing your opinions as you have here (she's smart, she's capable, she's new and still learning)? I hope so. This girl needs a friend, and hopefully you can be that for her. We all know what it's like to be a new nurse- we've all had to do it, very single one of us started out new. There's no getting around that.
I think that the hospital making her charge is doing a dangerous and thoughtless thing, but unfortunately, I understand that it is necessary. I was charge 6 months after graduation, and I continue to work charge on my unit even though my classification is still below that. It was unsafe, but I had no choice, and despite being ASSIGNED charge nurse, I was not prepared to do it and am still learning.
I know that you may be tired of guiding her, but even though she's only been a nurse for 7 months it seems as if you're lumping the CNA time in there as well. She's still a baby, and she's still doubting her assessment of the situation (should I call the doctor NOW? Or NOW? Or should I wait? What does this all mean in the big picture? Is this transient or is it a sign of something larger that I don't have the experience to recognize?). I have been a nurse for a year and a half and I still ask questions of those more experienced than me every single day that I work. I still need guidance, and so does this nurse.
It is completely unrealistic to expect, however, that every orientation program is going to be ideal for every type of learner. It's possible that she's not getting what she needs from her preceptors (been there) and the learning program that has been set up (and depending on where you are, this can be extremely poor). It's possible that all she needs is time. No one can say which is accurate in this case, not even her. She needs experience and distance from this time in her life to be able to dissect it and understand exactly what wasn't working for her.
I just hope that you are a good friend and co-worker to her (and I'm not doubting that you are). I hope that someone is there to hold her and and help her to recognize her strengths. If she ends up getting fired from this position (you did say they were considering terminating her in another month or so?) she will probably doubt herself and her career choices for the rest of her life, which is a shame and a great loss for all of us.
Jul 18, '03I totally agree with the nurse who wrote in about Patricia Benner's book From Novice to Expert. This is a wonderful classic, research-based, that explains the process that nurses use to move from primarily cognitive to primarily intuitive practice. It's a completely different way of learning and of functioning and it CAN'T be rushed or forced. Excellence in school doesn't guarantee a quick adaptation to practice; sometimes it makes that adaptation harder because scholars become dependent on their intellectual processing abilities, which are too slow for usual nursing practice.
Nurses need at least a year before they are ready to charge. I know I did. Give this new nurse a break and read Benner's book, and some of the excellent articles she has written on the same subject, to help the slower colleagues. I almost quit nursing because I had so much trouble getting in the groove. But I finally did and can handle charge nursing fine now. And I also got my MSN last year, using this very subject as the basis of my thesis.
Jul 18, '03I just have to reply to this thread. I graduated in Dec. 2002 with my ADN and started in January 2003 at a local hosp here. Just got my notice a few weeks ago from the trainer that I have to shadow the charge nurse for a couple of hours so on weekends I can rotate into the charge position. I guess once your six months are up you have to rotate into charge and code nurse. I still freak out when they assign me code and pray there is not one (have to provide code for whole hosp, one nurse from certain units have to do this). But now they want me to do charge too and I don't have a clue what charge does. I am afraid to ask because they will remember that I need to train and then they will rotate me in. Can some of you clue me in on what charge does so I don't look so dumb when I train? I don't think a few hours is going to cut it but I will give it my best shot.
So I can see why some just don't get it.
Thank you for listening.
Jul 18, '03Lilpoo_1:
Can you tell us what kind of floor you're going to be expected to charge on? What's the average census? And what are LPNs allowed to do in your state as opposed to RNs? It will help us to give you some advice.
Jul 19, '03Not everyone is cut out for a charge nurse position. Like some nurses can't hang in L&D but thrive in NICU. It is so easy for someone to point and say see? No one is perfect, gosh!!!!
Jul 19, '03I work on a med/surg/onc/ortho floor. We generally have about 35 patients with each nurse handling 5-6 patients (including the charge nurse on the weekends). Right now we don't use LPN's very often. We have one that floats now and again. So it's just the RN's and CNA's. I appreciate any and all advice that you can give me.
Jul 20, '03I don't know about any of you but I was not trained as a charge nurse in school. I was trained as a bedside nurse with the understanding that I would probably be charge at some later date. The skills of being charge are very different.
It is a tremendous responsibility to be charge. I started being charge after 9 months of getting my RN. I was charge a day shift were I had pleanty of back up where and when it was needed. I had been an LPN for a year prior to getting my RN and that year was on the same unit.
I was told when I first became charge I was horrible. I was a witch. Everyone said that they had understood it was because of the stress of the new resposibility.
The charge makes some heady decisions and is the resource for others on the unit. This is a lot even for experienced nurses. Here we have a new grad who has far from seen ever senerio and has only what she learned in school to rely on for decisions and to make judgements. It is a know fact that patients do not fit text book senerios.
When I first saw the name of the thread all I could think of was, "as long as it takes."
I have been nursing for a few years now. I just moved into a new area. I had supposedly a month of orientation. Let me tell you that month was waisted. Oh I didn't have any patients and I also did not have any training. It was a total waist of time and money. Now I am on my own and feel like an idiot. I can't get questions answered and either no one has the time or they feel it is my fault that I do not know. I tried to talk to my boss. She understands I have said I would quit. I am off all this week and I offered to come in at a time convenient for her just to discuss this. She doesn't have a single minute to talk to me. I said to give me a call when she figured out when would be best and basically she said there was no time. She has put a temoprary bandaide on the problem that precipitated my comments about quiting.
That problem and others still remain. I have been put off as every one was bussy, surveyors etc was giong on. Now that is all stopped but somehow there is stil not time.
I am flexible and resourceful. There are just some things that I don't know about this particular unit, hospital, this type of nursing etc.
My point is if they took the time in the beginning to do what needed to be done I would be flying high. All I need is some basic information, some guidance, and to have a resource that is actually there.
So now they are likely going to loose a good nurse and I am soured toward hospic. If I stay I feel at risk becuase my triaing and information base is missing.
Put your energies into traing her instead of complaining. Remember everyone does not get everthing the first or even the second time. Remember we nurse are suposted to be compasionate. I just think it is ironic that the "compasionate hospice nurses" I work with have less compasion for nurses.
Jul 20, '03As some one said not everyone is right for charge anymore than everyone is right for every kind of nursing
Jul 27, '03whether u r nurse- in-charge matter it does not matter, as the senior nurses believes that u were trained to do it so do it
Jul 30, '03As a Staff Dev. Educator and Coord. of Orientation for about 23 years, I can tell you that there is a HUGE problem with the way this new grad was treated.
1. I know rural hospitals need to have nurses who can be flexible enough to work in very different areas; my feeling is this is not the place for a new grad to start out. This is similar to asking a new grad to be a Travel nurse or AGency (although there are probaly some doing it).
2. She should have 12 weeks in ONE area, learning how to set priorities, organize her time, & develop critical thinking, and doing that on fewer patients, until she has mastered those things. If she never does master them, then maybe nursing is not for her.
3. She should certainly not be expected to work in critical care, OB, and most certainly Charge until she can handle the more basic things. How can she be in Charge of other staff, or any emergency that come sup, if she can't manage her own assignment?
4. This is classic case of "eating our young", even though people don't realize it, or they are not trying to make her fail.
The hospital needs to do her and themselves a favor, suggesting that she work at a larger hospital until she learns the basics.