Inadequate ICU orientation? And, how to address it?

Zee_RN, BSN, RN · Jan 17, 2002

I went from Med-Surg to ICU. I had already taken the Critical Care Course so I didn't have to coordinate class time with clinical time. I got 12 WEEKS orientation.

A Telemetry RN would probably not need 12 weeks but would get at least 6 weeks at my facility. Our ICU manager is very open and willing to extend orientation if the employee requests more. The better prepared you feel, the safer the patients are and the more comfortable you are as a nurse.

I'm the Nurse Recruiter at my facility now and have been doing recruiting for a little more than 2 months. I am shocked at the stories I hear from nurses at other facilities about how little orientation time they get. My employer is not perfect, but I can tell you one thing, we emphasize orientation!

I cannot imagine a nurse manager denying a sincere request for more orientation. Do you think it's possible the Asst. Mgr can come with you to talk to the Manager?

dawngloves, BSN, RN · Jan 17, 2002

When I went from Tele to ICU, I had an 8 week orientation that included four weeks of classes twice a week. I guess it depends on the acuity of the patients in your facility.

Did you care for some real sickies in Tele? You know what a dumping ground it can be. I had vents (long term trach) all kinds of drains, a lines, whatever. The only difference I saw was balloon pumps.

hoolahan, ASN, RN · Jan 17, 2002

Why not try 8-hour shifts instead of twelves, just for orientation? It would give you slightly more exposure to different types of surgical pt's. What is on your skils check list? Is there a list of skills/types of pt's you have to get "checked off" on? If so, and you aren't done at the end of your time, then there is good documentation to extend your orientation.

Grouchy, take a deep breath! You are nervous, and that is GOOD! If you weren't nervous about doing something new, and concerned about how well you will do, I'd be way more worried about you. You will NOT learn everything in a week, four weeks, four months, or a year!! You can only possibly learn the basics in an orientation. Think of all you have going for you, you can read monitors!! Can I tell you how much harder it was for me when I started out in ICU w/ NO monitor experience. I was scared $hitless!! And I wasn't enrolled in the "ICU Course" for six months, it was only given every 6 months! So, when a vent went off, if it wasn't obvious, I just ambu'd and yelled for help! Once I ran with the defibrillator into a pt's room, only to find him brushing his teeth! I was NOT a new grad!!

I am not trying to make light of your concerns, only saying, give yourself a little slack, see how it's going midway through, set some goals, what do YOU think you need to learn MOST before orientation ends? What are you weaknesses; focus your orientation on getting answers to those questions. Buy a good ICU hanbook, and keep it with you at all times. Flip it open and skim the contents if you have to. Find out who the smartest people in the unit are. Which docs, crna's anesthesiologists, etc, like to teach? Pepper them with questions. When you get report, ask before sign-off, is there anything I should watch for particularly with this pt? Make cheater index cards, like steps in drawing labs off an a-line if you have to. Get a small spiral notebook that will fit in your pocket, if you have no pockets, get a new pair of scrubs with as many posckets as possible. Write all important ditty's you need to remember in the notebook, soon you won't need it, but you will feel secure knowing it's there. I typed out and shrunk up and pasted the instructions for CVVH into my little notebook, computer codes, everyone's little notebook should look different, whatever works for YOU!

You will be great, you can DO IT!!! Now go look in the mirror, and tell yourself that, and tell yourself that q morning of orientation.

Good luck.

babsRN · Jan 17, 2002

You've gotten some great advice already. I can't really top Hoolahan's pointers. Don't be afraid to ask questions. People love to teach, and it is flattering to them that you ask. All of my doctors when faced with staff competency issues say...just ask. I've never worked in a facility(28 years experience, 18-ish in ICU) that didn't offer 90 days orientation...of course if you can come off early great...if not, and it's a good match overall, goals are set and orientation may continue longer. You can do this...don't let anyone tell you otherwise.

Agnus · Jan 17, 2002

Your concerns are good ones.

Evidently they are looking at the bottom line and may also think you are doing fine. It just may be thier orientation is not well thought out in terms of specifics as to what you might need.

Let her know specific areas where you are uncomfortable. Try to be specific in stating what you feel you need to learn and or practice on. Ask for specific experience (example go to cath lab, or learn to assist with a broch) Also ask for feed back where she feels you are strong/weak and what she plans to do to help you gain these skills/knowledge, in a safe mannor. Voice any concerns you have about patient safety.

PhantomRN · Jan 17, 2002

i transfered from tele to icu and i recieved 12 weeks orientation. our tele carried many very sick people so the transition was actually pretty straight forward. they actually thought my orientation should end after 6 weeks, i kept adding things i wanted to it.

tripletmom · Jan 19, 2002

I understand completely your fears. I work on the M/S/P unit until ICU is short staffed. I get pulled because I have ACLS and PALS (since when does this alone make you an ICU nurse). Luckily most of the nurses I work with in ICU realize this and I get the "light" patients. I ask continuous questions, most are terrific teachers and I have learned a lot. But I was told that you should have at least a year experience in ICU before being considered an ICU nurse. I have a long way to go but the knowledge I've gained so far is priceless. Good luck to ya!