How long should it take a nurse to be competent in a new area?

[heathIam, RN]

Looking for some suggestions and ideas of what is a reasonable expectation here...in the past the picu I work in had a fairly unforgiving attitude that if you didn't get it within a short period of time you were out. Now, we have made attempts to recognize that everyone adapts in different time frames and in different ways, but we are wondering how long is reasonable to give someone to develop the competence to care for a basic intubated picu patient. Our query is around a nurse who has been working in our unit for about a year. She is not a new grad but has worked for many years prior to this in a recovery room and newborn nursery. How do we determine whether she really gets it or whether she needs something else?

[guest2210]

She definitely should be competent at a year. Realistically, she should have been competent at 3 months, since she's not a new grad. Any longer than that and still not competent, there is definitely a problem.

[roser13, ASN, RN]

Are you her manager? Or co-worker?

[RN4all]

First of all patient safety should be your first priority. You hired this person (I am guessing that you are the manager, or supervisor) because you believed she was qualified for the job, therefore you are bound to give her the adequate time allowed to acclimate herself to a new environment. You do not want to expose yourself, nor the department to any legal ramifications. As a new grad she should get a good year to be comfortable to fly alone. If she is a seasoned nurse attempting a foreign department then six months of orientation should be sufficient for her. You should be meeting with her every week or to to see where she stands and how she feels. If you feel that after three months she hasn't grasped anything, and you have some legitimate concerns then you may not just have a problem with her, however the orientee perhaps they have different teaching/learnig styles and aren't bonding. You may need to find a different orientee for her. What ever the problem is she does deserve the opportunity to blossom within a new area, the opportunity that you entrusted in her. If staffing is an issue then you will be forcing herand yourself into a position that could be very liable and costly to a family. What would you expect if you were in her shoes?

[nurse2033, MSN, RN]

Your training program should have a mechanism to measure both progress and competency. If you don't, then you have a great new project! A new trainee should not be released for independent duty until a number of critical measures have been reached. If they can't reach these measures in a specified time, they should be fired. "Nursing" along someone who may ultimately cause chronic low level clinical harm, or worse a critical event, is not worth it. I once had a trainee whom I would not release for independent duty. Over my objections they were cleared and soon caused two critical events in the same day and was fired. I was not happy to be vindicated but we improved our documentation after that so it wouldn't happen again.

That said, I know you have a situation that still needs resolution. I agree with some others that in 3 months both management and the nurse should be comfortable. If you don't have a good QI program now is a good time to start. This nurse should not be singled out, looking for a way to fire them. But if you are looking at everyone's performance, you will have a way to gauge their ability. Please just make sure to tell the staff that you are doing this. Good luck.

[llg, PhD, RN]

I have lots of experience with NICU orientations (not PICU), but I think the educational situation is common to all areas.

I usually based my judgments on such matters on whether or not the orientee is progressing or staying the same. I am willing to give an orientee (or new employee) a little more time if I can see that they are stronger now than they were a week or two ago. As long as they are making noticable progress, then it is still possible that they will continue to improve. However, if they reach a plateau and are no longer improving, that's different. If they stop improving, I'd give them 2 or 3 weeks to "take a breath and solidify their previously learned skills) ... and then expect to see them learning again. If they don't keep learning and improving, then it is time to counsel them out of the area.

[elprup, BSN, RN]

Every new grad should be told this before they graduate. And why does every employer not acknowledge this fact? My first job let me go...told me "if you cannot learn everything you need to know in 3 months, then maybe you are not meant to be a nurse". Ya, on a med surg floor. I just got my BSN, had zero prior medical experience, which they knew, and then they tell me this. I told them they were wrong, nobody can learn it all in 3 months, hello, knowledge is based on experience!

So, now that I am not considered a new grad anymore I cannot apply to those programs. And because I do not have enough experience to get reg staff RN position, I am screwed until somebody gives me a break. IT SUCKS!

Thank you for letting me vent. And thank you for letting me know they were wrong.

[pharmgirl]

I am a new grad in ER (although I had a year medsrg as an LPN). I asked my manager one day after a rather difficult code how long until I feel comfortable. She said 6 months before I had a clue and 1 year til I was comfortable. She then proceeded to tell me if I still was uncomfortable she will work with me one on one and not to worry.

[heathIam, RN]

Thanks for your responses. We have already implemented actions along the lines of what has been suggested. The emerging concern is the apparent inability to transfer learning from one situation to another. As a previous RR nurse I would expect an understanding of the importance of having certain medications easily available for urgent intubations, yet this learning from previous work and from recent similar events within the picu does not seem to be translated. It is almost as if each day's learning must be analyzed with the nurse and key points identified.

As part of our education/orientation quality improvement I have asked for there to be an exit interview as well as several along the way check-in interviews with new staff. There is never just one way to prepare staff and we need to be continually learning from our staff to make it a better work environment, but I am also concerned about being too willing to accomodate. Co-workers must feel safe and able to depend on new staff at a certain level of competence.