How did first job/orientation work for you?

Ruby Vee, BSN · Sep 26, 2016

Feeling as though you don't know anything is an excellent start because you really don't know anything. Graduating from nursing school and passing the NCLEX is just a start -- your license gives you a license to learn. I am frankly frightened of any student or new grad who DOESN'T feel as though she knows nothing! They're the ones who are going to go off and kill someone because they don't know what they don't know and won't ask because they think they know all they need to.

Orientation can be different in different settings. In my ICU, you're partnered with an experienced nurse for up to seven months. As you progress in your orientation, you take over more and more of the care and become more and more independent. I may start your orientation at your elbow for 12 hours, but by the end of it, I may be off helping someone else and you can come find me with questions. I wouldn't ever leave you alone with a patient until I was sure that I could trust you. The nervous new grad is the one I trust. I know you'll come and get me before you do something stupid.

As far as equipment: you'll want your own pen (because in some hospitals they disappear with alarming alacrity) and your own stethoscope. Start with that, and see what the other nurses on your unit are doing, where folks store their work bags, what equipment is available on the unit.

Good luck! There are some threads here about what to expect from your preceptor. I am on my phone and haven't figured out how to link the relevant threads, but I'm sure you can find them using the search feature.

Nursebface · Sep 26, 2016

I have 3 weeks of orientation left. I made a post recently about it. It's scary. Taking a patient load is scary. But I'll tell you about how it works for me at least.

I am paired with another nurse, nurse of the year actually.. yikes. I started with 1 patient and I'm now at 5, my max. I carry a bunch of pens, stethoscope, alcohol prep pads, highlighter, and tape. I advise all of the above. Take a clipboard and make yourself a flow sheet for each patient. On the clipboard have a loose leaf paper on there for you to write notes on that you'll ask some one or go home and look up. Not sure of what an EGD is? Write it down and look it up later. I wish you good luck for this adventure you're starting. Take the advice that I haven't accepted: don't get discouraged. Don't panic. Take your time. You won't know a lot of things for a long time. It's all okay. You got this!

Nature_walker, ASN, BSN, RN · Sep 26, 2016

I just came off orientation and my experience is different. I'm on an emergency psych floor, so the only things I can carry with me are my pens, my keys and my gloves. No stethoscope for me when I'm out in the milieu, and no glove boxes out in the milieu as they pose a safety risk. That's why I have to carry my gloves in my pocket and when I'm done with them, carry them back into the nurse's station.

The biggest thing I learned is to ask questions. My preceptor would rather I asked him a million questions than just assuming I knew what I was doing. I was paired for 8 weeks and the first shift, I just watched how things go, then I was slowly given more responsibility as the shifts progressed. By the last two weeks, I was doing the job with him just supporting me when I needed help. Now I'm on my own, and the whole unit has been amazingly helpful when I have questions.

When in doubt, ask! Congrats and good luck!

AvaRose · Sep 27, 2016

I'm on week 3 of 4 at a Transitional Rehab (short-term patients). I started shadowing the nurse for one shift and then every day or 2 I picked up another patient (started with one...now I'm up to 4). Granted the biggest problem I have is timing 8 am med pass and trying to keep Patient A in her room long enough to get both of her IV antibiotics into her since she wants to go to the Dining Room for every activity they have. That and there are only 9 patients in the facility I work at so having nearly half of them is pretty good I think :)

barcode120x, RN, NP · Sep 27, 2016

My orientation for my telemetry position was 12 weeks long. I loved our orientation/hospital and actually enjoyed it. First 6ish weeks was lots of nursing program refresher classes on anything and everything nursing related. It also included paid skills day, paid certification course (EKG, ACLS, critical care classes, etc), and last but not least, how to work the computer. The last 6 weeks was precepting. We all started off at 1 patient and gradually moved up the ladder to 4 patients. They kept us at the same preceptor but you could request a change if needed and if you felt you needed more time precepting you could ask for it. I had a wonderful nurse educator and preceptor, awesome charge nurses and great nursing management. Based on hearing orientation here and my previous nursing classmates, I'm lucky to work for this hospital.

Tips/advice? Always ask questions no matter how dumb or bad they are. You are better off asking a dumb question and having it repeated multiple times than doing something unsafe for your patient or potentially causing them harm. If you don't know what you are doing or what to do, ask for help. If you FEEL uneasy about doing something or just this yucky gut feeling, speak up. Get a 2nd opinion. Last advice I have for you, get plenty of rest before each shift and find multiple coping mechanisms (praying, working out, etc).

Equipment? All you need is your stethoscope. But I guess it doesn't hurt to wear a watch, carry a pen or 2, carry some flushes and some alcohol swabs too. That's how I roll around.

AtLeastMyDogLovesMe · Sep 27, 2016

Hi everyone,
As a new grad RN about to go into orientation, may I please ask what advice you would have for someone like that? I am very nervous and still feel like I don't know anything!
So I would like to please ask... how was your orientation? Do you have your own patients but is partnered up with an experienced nurse? How did orientation work for you???
Also, for equipment.... lots of nurses don't carry much but some wear pouches for everything! What do you do>?
Thank you so much!

You should definitely feel that way. Everyone does. And at the end of your new grad orientation you will STILL feel like you don't know anything....and you will make mistakes. All that is okay. The important thing is not doing any harm to your patient. How do you do that? Don't do anything you're not comfortable with without your preceptor and don't be afraid to look dumb. Your preceptor wants to know you are thinking and the way they can tell you are thinking is by the kinds of questions you ask. He/she can also guide you down correct path if your line of thinking is off but again...that can't be done if you aren't asking questions. No preceptor wants a new grad that pretends to be a hot shot so don't do it.

Everything else will be just fine. :)

Summers3 · Sep 28, 2016

THANK YOU so much to everyone who have answered! I am glad to know that feeling scared/like I don't know anything is still normal!

Thank you for taking the time to advise me at my start of my journey. I sincerely appreciate your help and consideration for me! :)

FurBabyMom, MSN, RN · Sep 28, 2016

So, my disclaimer is that my first job orientation was not very well laid out, not was it well structured for a new grad. For many reasons, I left that employer relatively early, took another job and then left that job for my current institution.

Take a deep breath. While your preceptors should *ideally* be able to help you and be well suited (personality) to help you learn, they may not be. They may also have a particularly not fun or bad day. They may be someone it takes time to warm up to. They may be introverted. None of those are necessarily bad. Just remember that all of your coworkers started somewhere, nobody was born being a perfect nurse (and your coworkers haven't figured it out yet either - I can promise that - I had a day this week that proves that myself for me). If that doesn't help - remind yourself we all get dressed in a similar fashion. I am not saying they should be allowed to be outright rude or abusive. That's not it at all. Please don't misunderstand me.

When I was on the floor I started by doing clinical skills, and having my competency (at being safe for doing them) assessed by my precpetor. She was not checking off that I was great at it, but checking off that I knew how to do it, knew what could go wrong plus how/when to call for help. Gradually my share of tasks and the assignment grew, I think I started with two patients with a fair amount of guidance and built up (typically, we were 1:4 to 1:6 on days depended on census and acuity) while reducing my need for assistance. However, expectations were not clearly set, more was expected of me without necessarily communicating it to me, and that was frustrating. I also got less orientation than I was promised. Someone (not me) decided I was "ready" to be on my own, regardless of how I felt about the situation. I suppose nobody feels ready, but I was not involved in assessing my own abilities and skills.

I didn't carry much with me. I carried my "brain" sheet (fact sheet about my patients). Everywhere I've worked, in an inpatient setting, the nurses have some kind of tool for themselves generally patient info, code status, allergies, isolation, pertinent labs/diagnoses, admitting/attending physician, pending studies/tests etc, as well as things like activity level, and lines/tubes/drains. I had a few pens, a pen light (I started in neuro), and generally had a saline flush or two plus some alcohol pads.

Orientation has been different everywhere I've worked. It's really different now that I'm in the OR. I'm now precepting folks in my environment. I only have one patient at a time. But there are a series of steps that have to be done before different parts of a procedure. I generally work with my orientee to determine what my expectations should be. How far into orientation are they, what is their assessment of themselves / their needs, etc. I also look at the cases / procedures we're doing and who we're working with surgeon and anesthesiologist wise. They have their eccentricities too, and I definitely gauge their mood and assess how my plan is going to go based on those things too. Often, I let my orientee do as much as they can with as little assistance as possible. I do not stop someone unless what they are doing is going to cause harm, is truly unsafe or is really not appropriate for the situation (trying to worry about something minor when something major - ex difficult intubation is occurring). I try to talk through situations orientees may not see to help them learn how to process them / critically think through them. Sometimes I take over because of the patient's condition, things in the procedure, etc. I always explain what I did and why plus why I took over.

When I was on the floor / stepdown my orientation was several weeks (4-6 weeks) and in the OR I was on orientation for about 8 months. Depends on the situation, what you're expected to learn and how orientation goes.

vintagemother, BSN, CNA, LVN, RN · Oct 6, 2016

I'm on week 7 of orientation. I'm a new grad (former LV/PN)

I carry a ton of stuff in my scrubs: steth, pen light, highlighter, different colored pens, a sharpie, white board pen.

Alcohol wipes, blunt needles, NS flushes, IV tubing caps.

We have a ratio of 5:1. I've been taking care of 5 for several weeks. With help, from my trainer/preceptor.

Recently, I've started researching my pts dx, tx, meds, etc when I get home (the unclear aspects only)

I also re-read my haphazard notes and have created checklists for others I need to complete. These things have helped immensely with my time management and confidence.

gizahon · Oct 10, 2016

Good luck and congrats, you will be fine. God bless us nurses