Jump to content

How do I go about asking for an extension of my orientation in the NICU?

Hi everyone, I am in week 10 out of the scheduled 12 weeks of orientation in the NICU as a new grad.

When I first interviewed for this position, I asked my manager, how open she was with extending my orientation if I did not feel ready to be on my own, and she said yes. So I took the job thinking everything would be fine.

Fast forward, a couple weeks into the job, and I am finding out many things about management, I wish I had knew prior to taking the job. Such as scheduling issues, writing you up for small things, and pulling out new nurses from their orientation to take their own assignments (stable) when they are understaffed. When nurses get pulled to help with the staffing, they are not compensated with extra days with the more acute assignments. Does anyone's NICU do this to new grads or is it just my NICU? Another thing is, that apparently management is unapproachable to extending orientations and they have fired a nurse in their probation period for expressing they felt unready to practice as a solo nurse and wanted an extension!!! I was appalled they would do that to a nurse after the time they invested training and to just them go like that, instead of giving the more time, so they can be a good nICU nurse? Unfair.

Anyway, my issue is that I have not really had any critically unstable assignments, and I feel there is so much more to see and I don't think I will see it in time before the end of orientation and I am panicking. My assignments have been pretty un-eventful, couple of ostomies, UAC/UVC's, intubated babies, CPAP, and a baby on ONE DRIP :( I had one admission only, but that was a stable assignment. My babies have desaturated a couple of times, to the point they required blow by o2, but other than that, nothing major....I've been asking for harder assignments and I've been getting what is available at the moment, so it's not like I can cherry pick what I want to learn.

However, I do feel that 12 weeks is not enough orientation, especially in ICU setting, and I am concerned about how I will do off orientation. Since my first meeting with my educator, i expressed that 12 weeks was not enough, and she blew me off instantly, by saying that it was, and that I was meeting expectations and would not need extra time. But i feel the only reason I've been meeting expectations is bc my assignments haven't really been challenging and we haven't had much variety to choose from lately.

So how do I go talking to my manager to ask for more time, guys? How would you guys phrase yourself in a way that doesn't make you look bad, like that poor nurse that got fired? 2 weeks max is what I need. 4 extra weeks would have been wonderful, but i would be satisfied with even just 2 weeks extra, to get a unstable admission, ECMO, oscillator, or a baby on tons of drips.

Sorry guys for the blabbing, just thought maybe someone would help out a little nurse in need. Hope you have a wonderful Friday.

NICU Guy, BSN, RN

Specializes in NICU.

I got 12 weeks orientation when I started as a new grad. I felt like I was ready to be on my own by the end of the 12 weeks. I knew that they were going to assign me the very stable babies and not unstable with a lot of drips. I also had experienced nurses around me if I had questions.

Do you think 12 weeks is not enough or not enough for you? I understand your desire to get exposure to very unstable babies, but it will be a long time until you will be handling those types of babies on your own. Getting exposure to the more critical patients does not have to be while you are in orientation. You will have assignments near another nurse that has a critical baby. I have been off orientation for a year and I have yet to have a very unstable patient. They should slowly give you more complex patients as time goes on after orientation.

You were asking about extending your orientation a few weeks into your orientation. Do you not have confidence in management to determine when you are ready to be on your own and the types of patients that they will give you post-orientation? It is natural to be anxious about being on your own without a preceptor or instructor to "watch over you", but you need to have confidence in your training and realize that there will be other nurses around you that you can use as resource people. Do not be afraid to ask questions?

This is your second (maybe third) job as a new grad. I think the problem revolves around your lack of self-confidence and trusting your skills more than blaming the NICU for not providing you with exposure to patients that you will not be caring for in the next 1-2 yrs. Is an extra 2-4 weeks of ECMO babies (which you need to be specially trained 5 yrs down the road) or very critical babies going to help you as new nurse right out of orientation?

Their job is to get you trained to handle the types of patients that you are expected to be able to handle in the next 6 months to 1 yr., the boring feeder/growers, stable vents, NAS, preemies. During that time, you will gain confidence and skills to be able to handle more and more complex babies.

If after the 12 weeks are up and you still feel that you cannot handle the feeder/growers or stable vents, then tell management and ask for more time. Do not ask for more time to get exposure to babies that you will not be caring for in the next 1-2 yrs.

I wonder if you are concerned about an acuity that your unit simply doesn't have? If you've been there 10 weeks and have been, as you said, asking for harder assignments but those assignments aren't available, maybe you are worried for nothing? Not every hospital has the world's sickest babies at every moment. Try and listen to your supervisor - NOT all the gossip - and believe her when she says you're ready!

Firing the nurse who wasn't ready after the orientation period wasn't about fairness, they would have kept her if a couple of more weeks would have assured she would be ready. After 12 weeks of being able to observe her teachability, progress and everything else, they made a business decision.

I disagree with the above poster. Only you know if you're ready and if you are not ready please speak up now. This Is your life and your license.

ThePrincessBride, BSN

Specializes in Med-Surg, NICU.

I am almost done with a twelve week nicu orientation and like guy in babyland (cute screen name!), I feel like twelve weeks in more than enough time.

You won't be getting the sickest babies on the unit out of orientation (or at least you shouldn't).

Hollybobs

Specializes in ICU.

Personally? I wouldn't say anything. I'd accept I hadn't had the world's most ideal orientation. I'd desperately try to fit in the most acute assignments possible in my last week or so. When I started having my own patients I would make sure that all my clinical decisions were safe (there is always someone to ask) and I would start learning through experience plus asking others plus reading up in my spare time.

It sounds like they can't provide the preceptorship you'd like and there is no guarantee you'd get the cases you wanted even if you got an extra 4 weeks. The message is clear where you are that asking for extra time is frowned upon. They obviously can't offer a comprehensive preceptorship anyway, as evidenced by being pulled away.

You could always suck it and see. If you feel unsafe, you could always ask to be put back on for a couple of weeks, at least you'll stand out for negative reasons (in their view) after you have given it a go. Who knows, you might learn faster by trying it. As above posters have said, you won't get the super-sick ECMO type patients in your first few months anyway, you will build up. And if you are given an assignment that is far too challenging as a result of a poor preceptorship you can always say "I had little/no experience of this, I can take the assignment with support/it is too complex for me at this point".

You may never feel "ready", maybe they can see that you are?

Hi everyone, I am in week 10 out of the scheduled 12 weeks of orientation in the NICU as a new grad.

When I first interviewed for this position, I asked my manager, how open she was with extending my orientation if I did not feel ready to be on my own, and she said yes. So I took the job thinking everything would be fine.

Fast forward, a couple weeks into the job, and I am finding out many things about management, I wish I had knew prior to taking the job. Such as scheduling issues, writing you up for small things, and pulling out new nurses from their orientation to take their own assignments (stable) when they are understaffed. When nurses get pulled to help with the staffing, they are not compensated with extra days with the more acute assignments. Does anyone's NICU do this to new grads or is it just my NICU? Another thing is, that apparently management is unapproachable to extending orientations and they have fired a nurse in their probation period for expressing they felt unready to practice as a solo nurse and wanted an extension!!! I was appalled they would do that to a nurse after the time they invested training and to just them go like that, instead of giving the more time, so they can be a good nICU nurse? Unfair.

Anyway, my issue is that I have not really had any critically unstable assignments, and I feel there is so much more to see and I don't think I will see it in time before the end of orientation and I am panicking. My assignments have been pretty un-eventful, couple of ostomies, UAC/UVC's, intubated babies, CPAP, and a baby on ONE DRIP :( I had one admission only, but that was a stable assignment. My babies have desaturated a couple of times, to the point they required blow by o2, but other than that, nothing major....I've been asking for harder assignments and I've been getting what is available at the moment, so it's not like I can cherry pick what I want to learn.

However, I do feel that 12 weeks is not enough orientation, especially in ICU setting, and I am concerned about how I will do off orientation. Since my first meeting with my educator, i expressed that 12 weeks was not enough, and she blew me off instantly, by saying that it was, and that I was meeting expectations and would not need extra time. But i feel the only reason I've been meeting expectations is bc my assignments haven't really been challenging and we haven't had much variety to choose from lately.

So how do I go talking to my manager to ask for more time, guys? How would you guys phrase yourself in a way that doesn't make you look bad, like that poor nurse that got fired? 2 weeks max is what I need. 4 extra weeks would have been wonderful, but i would be satisfied with even just 2 weeks extra, to get a unstable admission, ECMO, oscillator, or a baby on tons of drips.

Sorry guys for the blabbing, just thought maybe someone would help out a little nurse in need. Hope you have a wonderful Friday.

I don't know - perhaps I am wrong here but I think your expectation is wrong.

Orientation is just that - a start. Having said that - it is impossible to get the hardest cases in an ICU within orientation. At least in the adult ICU I started years back as a new graduate the basic orientation was just that - getting familiar with the basics. After you come off you still have support when you need it and when you take sicker patients. I did not start and had a IABP one month later or artificial heart of ECMO. That happens with time. So the usual is to come off orientation once you are able to manage the basics and the learning just continues on the job. My first patients in ICU did not have multiple pressors but perhaps one. Once I was more comfortable, I got sicker patients but was always able to ask questions or reach out.

It is normal to have somewhat a little bit of anxiety when you are new to ICU but the learning curve is steep and you will be learning for the first 2 years ongoing until you are comfortable.

If you ask to extent your orientation you might send the message that you are too insecure or anxious.

If ICU is not for you it is better to try to find something else. If you are generally speaking ok and just concerned you might be just ok coming off orientation. I have never met a newer nurse that was thrown into really sick pat or machines they did not know.

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Moved to the NICU forum for more responses.

Convince your manager, either by words or actions (or both!) about your competency level, demonstrate to the manager your willingness to learn and being open to new ideas, and say to the manager you feel like you may not have enough diverse exposure to use your skills in an efficient and effective way, and as discussed in your interview, request an extension of your orientation. If that does not work out too well, rake it to your HR union rep.

Maevish, ASN, RN

Specializes in ICU, Postpartum, Onc, PACU.

It's appalling (to me) that they would force a new grad off orientation and not make it an option to extend if you felt you needed to (let alone punish a newbie for even asking and being HONEST) not to mention lying about it from the beginning. I'm glad there are amazing people out there who feel like they can go from being fresh out of school to being a competent NICU/ICU/PICU nurse, but you're most certainly not alone in not feeling ready and I venture to say that most aren't. I wasn't sure I was ready after 3 months and I'd been a nurse for about a year-and-a-half at that point. That being said, I did go off orientation because the good nurses told me that I wouldn't feel 100% right off orientation. Their goal is to get you to the point where you CAN take the stable patients so that the more experienced nurses can focus on the sicker pts and then they should gradually give you sicker and sicker ones. Just because you don't have the sickest patients doesn't mean you can't help with them if need be.

There will never be a point where you know everything or have seen everything, but they want you to work towards the goal of being comfortable (for real, not just one of those people who thinks they are) with most problems that come through the doors. If you don't feel like you can handle a patient on one drip who's stable, critical care wise, then you should say something. If you feel like you can handle basic ICU pts then you're ready and you should have help when you get more critical pts.

You'll be fine and don't feel "less than" because you can admit you don't know everything yet. Most people don't. :D Besides, give yourself some credit! You're fresh out of school and not even a seasoned nurse in another specialty! xo

KRVRN, BSN, RN

Specializes in NICU.

Newer nurses usually aren't given the sickest babies. This is true, but a seemingly stable baby can go downhill. Assignments may be changed to pass off a deteriorating baby to an experienced nurse midshift but that might not be apparent right away and you might find yourself with a sick pt that you normally wouldn't have had for a few years. If this unit is busy and they are having to pull new hires off orientation to care for the easier babies, they are probably having to push the envelope of safe assignments. I say ask for more time.

I suspect the story about the new person being fired for asking for more time has more to it that you aren't privvy to.

×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK