How do you orientate the "new nurse?"

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I just finished up orientation at the LTC. Some of the nurses were helpful and showed me exactly how to do things. Other nurses were not helpful in any way. :angryfire Those nurses sat on their butts all night and said to me "The only way you will learn is if you do it all by yourself" Please tell me your "orientation" experiences and/or how you feel is the best way to orientate a new employee . Thanks

Hi Blackcat99-

I think the type of orientation depends on the needs of the orientee. Obviously, a seasoned nurse new to a unit will need a different orientation than a brand new grad with limited real life nursing experience. Any experienced RN can feel like a fish out of water anytime he/she changes specialties, so it is important to take that into account, too. Sometimes they might feel the need for more orientation based on individual needs.

The model of orienting that I like is where the preceptor & preceptee meet briefly and discuss goals and backgrounds. Some people need to start with the basics, while others know a few things and can tell you right off the areas that they would like teaching & orienting to. Everyone has different needs & goals where they need teaching/support. With new grads, I think it is good to have them shadow/team with the preceptor at first just to get oriented to the unit & routine, then take a few patients of their own with the preceptor nearby as a resource. Gradually, the new staff member can build up to a full assignment...but still having the preceptor there.

Forcing someone to do something immediately by themselves in the "sink or swim" model of teaching is cruel and just plain bad teaching. A good preceptor/teacher would assess your knowledge base & then guide you until you felt somewhat more confident to function on your own. There's no worse feeling than fumbling and bumbling a new procedure in front of a patient! That's very inconsiderate to both patient and new nurse.

I think you know in your heart what a good preceptor is. You know how you learned best & what was the most helpful. It wasn't the critical, distant and lazy nurse who made the best preceptor. A good preceptor will push you to fly solo, yes, but they will not throw you into the fray without a little practice and support first. You might consider discussing your precepting experience with your new LTC supervisor. Maybe some people on your unit WANT to precept, while others don't. If you sing high praises for those who helped you the most- they may be designated again next time and/or recognized for their professionalism and dedication.

Congrats on the new job in LTC! Hope you feel at home soon. :balloons:

I just finished up orientation at the LTC. Some of the nurses were helpful and showed me exactly how to do things. Other nurses were not helpful in any way. :angryfire Those nurses sat on their butts all night and said to me "The only way you will learn is if you do it all by yourself" Please tell me your "orientation" experiences and/or how you feel is the best way to orientate a new employee . Thanks

I suspect the 'sink or swim' approach is utilized by nurses who either had this done to them in the past, or if the facility is just so hard/short nobody has time to help the new nurse thus do not want to extend the courtesy of offering her extra help lest she become dependent. They may also be resentful as they feel put upon by this added job of mentoring a new nurse; not all nurses enjoy this. I've worked on many units like this in Texas, unfortunately. (altho we have some excellant larger hospitals with dedicated internship programs I would recommend highly)

New grads would help themselves by doing some research before they jump into that first job; to make sure there is a real committment to new grads, preferably through as dedicated education dept who offers new grad internships which is ideal.

Ideally one will have a preceptor invested in your success and be nurtured in a teaching atmosphere but we won't always encounter this. When I was a young nurse I quickly became very self sufficient when i moved to Texas away from my teaching hospital I trained in. I sensed I had to....and luckily I had my good diploma training to fall back on. I quickly identified the nurses who liked to mentor, and became a sponge to them (while staying away from the less supportive types who seemed to enjoy a new grad's discomfort. ) ;)

Good luck to our new grads out there and hoping you are having fairly good experiences! :)

:) Thanks all for your replies. I have been a nurse for many years. However, when I start a new job I always like to first observe the usual routine and the way they do things at that particular facility. I would never do the "sink or swim" orientation to anyone. I agree it is a cruel thing to do. I am definately going to tell the higher-ups about the 2 good helpful nurses. That's a good idea.Thanks. The last person I orientated got 6 pages of helpful hints in addition to the actual orientation process.

Specializes in HIV/AIDS, Dementia, Psych.

I work in LTC and have given many a new employee their orientation. They don't really give us any ground rules at my facility, so I came up with my own way which follows:

On the first day I have them follow me around and not do much of anything. I tell them to carry a notebook and pen and jot down notes and questions they may have being that sometimes we don't have time to answer questions properly while we're working. Day 2 is pretty much the same with the orientee doing a little bit of the work for him/herself. Day 3 I usually follow them around while they do the work so I'm there for help when needed, then I let them go little by little until they're on their own. Sometimes it's different depending on the experience level of the nurse, but my way usually works out pretty well.

Specializes in Geri, psych, TCU, neuro--AKA LTC.

Day one: Follow me, observe me, and ask a ton of questions.

Day two: Follow me, help me, and ask a ton of questions.

Day three: I'll follow you, help you and ask you a ton of questions. I will be right with you every step of the day. I will never make you do something alone that you have asked for assistance with (a procedure, personal care, dressing change, etc.)

Depending on the nurse's background, new vs. seasoned nurse, the orientation is tailored to his/her needs, spoken and unspoken. I noticed a lot about the orientee's comfort level while I'm observing. If he/she needs more time to orient, I go to my DON and advocate for the orientee.

And good, bad, or indifferent, I will be honestwith the DON about how I see your progress.

I agree with shadowing for a couple of days..and adding pt load little by little..this has worked out well so far with the new grads I have oriented. :)

Where I work, nurses get four days orientation. Supposedly, all new hires have previous med/surg or hospital experience and are comfortable with hands-on patient care. This is not always the case, though, and so there are those who are very uncomfortable about dealing with simple issues that seasoned nurses don't think twice about. ( I work at an extended-care facility.)

I get asked to precept a lot and I don't like it. It's a paradox--I like to help people, yes, but most of the nurses I precept rarely stay--maybe 1 out of 10 will and it's so much extra work on me for just a dollar more an hour. So yeah, I get an attitude sometimes when I get stuck with somebody who seems dumb as a post and the thought of them being on the floor alone in a few days scares the bejesus out of me.

Other reasons? I can tell pretty quick who really has some experience under their belt after asking a few questions and watching them with the patients and four days is just not enough to teach someone not only basic nursing care issues, but the computer system, the floor routines, pharmacy needs, etc. It's too much.

More than once I have went down to the supervisor's office, thrown my hands up in the air and said,"I can't take this anymore! Don't make me do it again!"

I know that some of these poor nurses sense my frustration. :crying2:

i haven't even had the hospital orientation or the standard one week nursing orientation where new nurses are taught iv starts, paperwork, policies, etc. i started on the floor before my orientation, which is this coming week. i have been on the floor for 2 weeks now. my first day, i just followed my preceptor around and watch her do things and she explained what she was doing, the routine of taking meds out of the pyxis, checking if labs have been entered in to the computer, pre-op prepping the patient, admitting/discharging patients,giving medications, calling the dr, etc. the following day i was given 1 patient. now im at the end of my 2nd week and was given 4 patients today. i am able to do things on my own, but my preceptor is there to remind me of what needs to be done, answering my questions, and explaining to me various things that we havent covered yet. so far, the only thing i havent done yet is start iv's. i would like to think im doing alright so far, from my preceptor's point of view. i haven't asked her personally, but being that i had 4 patients today should mean something at least. :rolleyes:

What makes me crazy are the nurses who their 2nd day of oriantation tell me "I've got it". Some people really want to do it that way. Me personally I want to know every single one of the residents. If things aren't real busy some of my favorite activities are having nurses review the policy and procedure manual and then compare it to the pharmacy's manual. (they are actually different.) Then quiz them on how they interpret it and why?

I also like them to review the residents' charts and tell me what they find. Meds, dx, holes in history, care plan stuff, etc. I think it helps alot in LTC when you have 23 residents who may be perfectly stable but have multiple underlying conditions. If its the end of the month, we do POFs. Its amazing what you can learn about residents if you do POFs in detail.

I also try to give nurses a heads up about the different doctors. You know the "this one won't do anything unless you say 'I want thus and so' and this one never offer a suggestion unless you really don't want that because to him if a nurse suggests it he has to come up with something different."

It rarely happens that way though.

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