How does your unit orient new nurses?

[Schuur451]

Hello everyone,

I'm working on a new mentoring/orientation model for our ICU/CCU. We are still in the assessment period; defining mentor, assessing what the role will entail, assembling resources...I'm hoping to begin a formal mentoring program where core staff are assigned to new nurses based on personality/clinical interest. The core nurse would be responsible for making sure that clinical competencies/skills were adequately addressed, and also be a general resource person for that new nurse. In my thinking, the mentor would also be a social support for the new nurse, and help them to "fit in" to our unit.

What I'm wondering is how other critical care units orient and mentor their new staff.

Do you assign one preceptor/mentor that guides the person through their first months?

Is there a formal mentoring program in place?

What has worked for your unit in terms of achieving rapid clinical competency and also helping new nurses (especially new grads) feel like part of the team?

Mostly I'm just interested in what the practice is in different hospitals. We have had several of our new people express frustration that they didn't always have a "go-to" person who could answer their questions and provide guidance.

Any information would be greatly appreciated!

[General E. Speaking, RN, RN]

Our new nurses all go thru the usual general hospital orientation. The nurse is then assigned a mentor in ICU who precepts then throughout their orientation. They have a check off list of things to see/preform. The amount of time needed for orientation depends on the experience of the nurse. The new nurse usually gets the same schedule of their preceptor so there is consistency.

Everyone on our unit remembers that there are newbies in the unit and will pull them into the room when there is potential to learn/see something new. I believe there is some online education that they are required to do also.

[meandragonbrett]

Unfortunately my hospital has a cluster $@ approach of throwing everybody to the wolves. I had 36 hours of orientation to Surgical ICU with previous critical care experience.

[oldiebutgoodie, RN]

You might want to check out this article by Linda Morris and others:

"Designing a Comprehensive Model for Critical Care Orientation".

http://ccn.aacnjournals.org/content/27/6/37.full

Here is their evaluation of the program:

http://ajcc.aacnjournals.org/content/18/3/252.full

Oldiebutgoodie

[ICUenthusiast]

Our hospital gives preceptees a bunch of core competency check off lists, almost like a "care map" for the orientation period, etc. They are told they will have lots of small evals to help bite problems in the butt or identify preceptor/preceptee clashes. They have a lot of classes, but nothing very ICU oriented. Supposedly, they choose a mentor.

The preceptor takes one 6 hour class if they wish to precept and can then precept.

In theory, it sounds like a good model.. but only if individual units enforce it. With the exception of choosing preceptors... they kind of let anyone and everyone do it regardless.. even if they have shown to be bad preceptors in the past.

The model you're saying sounds good, honestly.

Some things people can't really seem to decide upon in my hospital: 1 vs more than 1 preceptor. Some people thrive by learning things from different people, as a different preceptor can offer different insight and different ways of thinking. Then there's some that think there should only be one preceptor for a preceptee, and some preceptees really can't adapt to a change in preceptors well (although this may reflect upon their ability in general to adapt..?).

As for preceptees feeling part of the team, luckily there's this quiet safety net amongst the individuals in my unit. They don't really stand out at first glance because they don't socialize at the nurse's station, talk loudly, etc. But they also tend to reach out to preceptees and help make them feel competent and wanted by the unit more than others. Otherwise, there's very little done to help preceptees feel part of the unit. The hospital overall gives preceptees a lot of "pep talks" in various classes about how they think every person there is special etc and how much of a difference each one can make. Unfortunately, it's kinda cheesy and I don't know how many people take it w/o lots of salt.

For rapid clinical competency, you need the unit as a whole aware of the preceptee. Offering up skills for them to practice is helpful. Another helpful thing is having preceptors that have a good balance between letting the preceptee take over all the work yet enough oversight to make sure it is safe (maybe not the first week, but after x many weeks). Telling preceptees what to do at x time every day will not make them competent nurses, only a nurse that only does what they're told to! Of course this can be solved by frequent meetings with both together, and separate, so issues can be identified and solved.

Unfortunately, learn from my unit's mistakes... preceptees are basically left to the wolves. If the preceptor doesn't like them, the preceptee tends to get a very negative eval only at the end of precepting, and often with no constructive criticism. All the paperwork is a good idea, but only when it's enforced .. and in our unit, the preceptees are motivated to do the paperwork... it's the preceptors that aren't doing it. Tends to fall on the preceptee's head though.

[wiltfongm]

Much of what I'm reading here sounds very familiar. In my CVICU, we routinely hire a large group of new grads at once, usually at least 8 at a time. So, the experienced preceptors get burned out quick because they are continually precepting. There is a formal caremap that the preceptees are supposed to bring with them every day during their orientation. However, there is usually a mad dash at the end of orientation for the preceptors to check off everything. Some preceptors are better about giving constructive and timely feedback then others. Some view the whole process as a unique responsibility and really try to guide the new hire into how the unit works while others think, "Oh cool, I don't have to work tonight!" I can't tell you how many preceptors I have seen take off after they get report on their patients and leave the preceptees to fend for themselves.

However, having a formal precpting process in place takes time to establish, and there has to be buy in from everyone participating. Knowing which skills or types of patients that the preceptees needs during orieintation is critical. If they don't get the experience during orientation, they won't likely be as prepared as they should be when off orientation.

[BrandonB779]

In the Medical/Cardiac ICU I am currently orienting to, we go through general orientation on top of the then specialty training. We get a telemetry re-run class w/ specialty information for 2 weeks before the actual ICU training that takes places w/ 2 noted mentors (incase the schedules dont line up, 3-12 hour shifts) and we follow them around. We have our checklists that we are required to do, but we also have 2 educators from the Critical Care department that go around the hospital looking for cases that could really use our experience like open hearts, brain surgery, etc. We also get a day to follow around respiratory therapy to learn the vents and see what they do, and then also our REV team (Rapid Evaluation Team) like a 911 inside the hospital incase a patient starts circling or something is just feared wrong, its really fun and cool. Then in addition to that there is the AACN / ECCO critical care modules on the computer (boring, much more prefer classroom settings) for systems, treatments, etc. The usual course of orientation is about 4-6 months.

[Residentmaid, MSN]

I am a new RN~ from 16 years as an LPN. I started in a CCU at a small hospital in March. The orientation is 6 months, with more time given if needed. We generally follow one preceptor, unless there is a scheduling difference. I was originally assigned to an older preceptor that would not even let me press the "weigh" button on the beds (NOT kidding, and I have 16years experience!) The preceptors do not have a training program, and are pretty much precept as they see fit. This works if you get the right one. I was fortunate enough to get a preceptor who Kicked my butt every day for 4 weeks. I am pretty sure I will be thankful for her for the rest of my career. I have found that their are some nurses out there that really love to teach, those are my favorite to work with.