How Long Should New Grads Be Oriented/Precepted Before Working On Their Own?

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Long story short:

- Made it to an ok suburban hospital as my last resort but grateful outside the Houston metro area [since Houston has the biggest medical center in the nation & I'm not there. I know, I know]

- I'm on a surgical ortho/ICU stepdown unit

- My New grad orientation is 3 months and after that they expect me to be able to handle 5 patients on my own.

I have seen many other hospitals who train their new grads from 6mo up to 1 year.

So far I'm 5 weeks into this and do not feel comfortable at all of handling 5 patients on my own.

At the moment I'm up to 4 patients and my preceptor is making me do everything but I have no problem with that as long as I know what I'm doing and Im not shy to tell her that I don't know what I'm doing on certain skills/procedures.

My manager is trying hard to get me to say that I'm ready to take on patients on my own so I can get on the December schedule but all that's on my mind is protecting the patient and my license. & I can tell her patience is wearing thin with me because I keep telling her that I'm not comfortable at all, and I'm not afraid of what she thinks.

What do you guys think about this?

Should I seek employment elsewhere after my 3 months are up?

OR

Just do the best I can to learn and get involved [which i am] and then reassess at the of the orientation/preceptorship?

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Specializes in ICU.

I think if you are handling four just fine that you are almost there. Start taking all five, and if you feel too overwhelmed by the time your orientation is up, request more time. It takes a lot more money to find someone totally new and train them than it does to extend your orientation a bit longer, so your manager should hopefully be receptive to that. However, if you're doing okay with four, it sounds to me like you are probably progressing just fine. I don't think any of us feel 100% ready at the end of orientation to be taking patients alone, but they've got to let us go eventually. Just keep a great relationship with your preceptor and other nurses on the unit. You are not going to be thrown to the wolves and left entirely alone once you have patients by yourself. These people will still be around, and you can always ask them for help. :)

My orientation was 3 months. About three weeks of that was purely classroom time, so the actual amount of time I spent on the floor with a preceptor was about 8-9 weeks before they turned me loose. I'm in a MICU - but the acuity of patients at my hospital is so low that I felt ready. I bet you probably have more complicated patients than I do for the most part, and I only have two of them at a time, so take my advice with a grain of salt.

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Thank you I needed that. Everything is going well for me, the only thing im working on is my time management but hey I dont mind staying after charting as long as my patients are alive and unharmed.

My goal is the ICU in the future and maybe im just somewhat upset because I really wanted to be in the med center but Im here for the moment and i might as well put in my 1 years worth of work and then look around. But I work nights and it's not as stressful as days but there's still alot of work to do [mostly pain management and dressing changes] Recently I just found out that I can get anywhere from 3-5 patients depending on the acuity of the unit.

Thank you for the advice!

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Specializes in hospice, HH, LTC, ER,OR.

I would have killed for a 5 month orientation at any job. My first couple of jobs the orientations were from 1-4 days. My current job in the ER they attempted to kick me off orientation after 2 weeks. I made sure I received all 9 weeks.

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

If you're doing OK with four patients, go for the five. A new grad shouldn't feel comfortable -- you're still learning and growing, and that's not a comfortable experience. In about two years, you'll know enough to be comfortable.

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Even with experience, 5 patients can feel like too many! I just want to reassure you that it is a very common feeling that you just can't get everything done or do everything as well as you would like. Skills like time management and prioritizing will come with time, safety is the one thing you don't want to compromise on.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you I needed that. Everything is going well for me, the only thing im working on is my time management but hey I dont mind staying after charting as long as my patients are alive and unharmed.

My goal is the ICU in the future and maybe im just somewhat upset because I really wanted to be in the med center but Im here for the moment and i might as well put in my 1 years worth of work and then look around. But I work nights and it's not as stressful as days but there's still alot of work to do [mostly pain management and dressing changes] Recently I just found out that I can get anywhere from 3-5 patients depending on the acuity of the unit.

Thank you for the advice!

Medical centers aren't always what they are cracked up to be.....the best experience I have received has been at community hospitals. At large medical facilities there are many procedures that nurses don't do because of med students. 3 months is a good orientation....having them 6 months to a year is a LONG orientation. 5 patient in med surg is a good patient load....you sound like you are doing fine.

you need a good brain sheet.......here are a few.

doc.gif mtpmedsurg.doc

doc.gif 1 patient float.doc‎

doc.gif 5 pt. shift.doc‎

doc.gif finalgraduateshiftreport.doc‎

doc.gif horshiftsheet.doc‎

doc.gif report sheet.doc‎

doc.gif day sheet 2 doc.doc

doc.gif Two pt worksheet.doc (45.0 KB, 348 views)

doc.gif Pt Assessment Tool.doc (51.0 KB, 451 views)

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Thank you all for the responses & the brain sheet!

So far I got bumped up to five and it's pretty hectic! Mind you I work nights and it's never calm! And some of the day shift think we have it so easy! We're supposed to be working as a team but it doesnt feel that way.

My preceptor seems to not be that much of any help she somewhat talks down to me in a condescending way and here's the kicker! She's been there for 9 months [As a New nurse]. Basically I've told my manager and she apologized and tried to pair me up with someone else but couldn't find anyone that would take me. So my plan is to learn as much as I can, and do everything to the best of my ability and look for something else by 6 months in because I've been there since the beginning october but was not on the floor until the last week of Oct. And most of the positions I was applying for in the med center were for RN graduates with 6 months of practicing.

But I wont let them force me out on the floor alone until i feel somewhat ready, since every time they try to give me 5 patients we always have one that gets discharged. In reality last night was my 2nd night with 5 patients.

Any advice in my situation? Thank you all for being my sounding board...I just had to get that out...

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Specializes in Critical Care, Education.

As a veteran Houston TMC ICU nurse, I can assure you that Esme is absolutely correct - those facilities are chockablock with med students, interns & residents - and THEY do all of the stuff that RNs normally do in non-teaching hospitals. You'll also have to deal with the hassle of remote parking (& pay for the privilege) that adds to your commute time.

The only way to get better at time management is to practice it.. and you will never be able to master handling a 'full load' if you are working with fewer patients. This time next year, you will be the one that new grads look up to because you can do it without a second thought. None of us were born as expert nurses... we all got there the same way.

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Thank you for the advice HouTx. Is there a way I can message you privately? I have a question about ICU & an opportunity that just came up.

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Specializes in public health.

At least 6 months, preferably 1 year if on specialty unit

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