Is No Orientation the New Orientation?

[Inquisitive2]

Hi, thank you for your time.

I am trying to put nursing orientation expectations into perspective and make some important life decisions. I have been a registered nurse since 1982. I successfully consistently worked in Level 3 NICU through 1995 (12+ years) and enjoyed doing charge, transport, ECMO, etc., then I completed my BSN in 1999. For the next few years (during the new millenium) I simply volunteered as the elementary school nurse on a regular basis for approximately 650 students and staff.

Now that my four kids are grown and I am divorced, I am returning to the workforce. To make myself more marketable, I successfully completed an state approved RN Refresher Course and numerous nursing certifications.

Three weeks ago I began working in a Level 3 NICU and was told that I'd be on orientation for an unspecified number of weeks. The first week I completed general hospital orientation. Then once I arrived in NICU, from Day One I was required to actively scrub in for high risk deliveries, and since that time I average scrubbing in for approximately 2 high-risk deliveries per shift. Additionally, I'm already expected to take a full Level 3 NICU assignment at the same time.

When I initially interviewed I made it clear that I had not worked in NICU for a number of years. My employment dates were clearly stated on my resume. I let my interviewers know that I would need computer charting training, current equipment training, and time to complete policies and procedures, etc.

Here is my dilemma. Every single shift I have mentioned to whatever preceptor I happen to have for the day that, in addition to patient care (with which I feel comfortable), I need some time to address these other aspects of care so that I can become more proficient. The only response I get is that I need to take yet more patients (I already take 3 at a time) for effective time management.

My response is that if you want me to become more proficient then give me computer training so I don't hunt and peck, let me train on the equipment so I'm not attempting to figure it out on a patient while working at the speed of a full assignment, and let me familiarize myself with policies so that I know I'm functioning within my scope of practice. Furthermore, give me time to learn where things are kept so I don't randomly scan the supplies hoping to stumble across the necessary items.

I'm so busy that I don't even have time to ask questions. Besides my regular preceptor leaves me to flounder on my own while she goes to the back office to work on protocols. So, there's no one to ask anyhow. I spend much time away from work boning up on policies, etc. because I want to do a good job!

I hesitated to go up the chain of command, saying too much, and risk being the "squeaky wheel." However, when the manager asked me how orientation was going I remained objective and stated the facts. Today I went to the NICU educator, and let her know how I was spending my time and my concerns. To date the only interaction I have had with the NICU educator is that she handed me a DVD to watch relative to the NICU communication system. This same educator stated that for the first time, the NICU has decided not to offer NICU specific orientation to the two of us that hired into the unit. Instead we are essentially their guinea pigs seeing if we can simply learn as we go while taking assignments.

So, my question is, "What defines orientation?" Is No Orientation the New Orientation?

When I think back to my early days when I first started in NICU, I was successful because I got great training. Since I was a rookie, they could have blown me out of the water from Day One. However, I succeeded, thrived, and LOVED my job in a fast-paced environment because they took the time to train me.

Now I wonder, has general nursing orientation fundamentally changed and this is the new norm generally speaking, or should I be rethinking my situation?

I would be extremely appreciative of your thoughts. Thank you!

[Altra, BSN, RN]

What you describe is a recipe for failure/burn out of the newly hired nurse, and a potential disaster in terms of patient safety/outcomes.

I hope that you can have an objective conversation, ideally with your preceptor, the unit educator AND the unit manager or at least a supervisor, and lay out some groundwork/expectations.

[RhinoRocketRN]

hand in your resignation

[netglow, ASN, RN]

Sorry to say, more often than not in many places, you can get thrown to the wolves. Just about every nurse that has many years under his/her belt tells me things have very much changed since they began nursing.

You still hear of some places giving a great orientation. But just reading this board and spending a lot of time listening to people I know and have networked with, many in my area don't get much of an orientation/training, even as NGs. This even in specialties like a level one trauma er.

I'll add that I often hear from experienced nurses changing specialties, that they are thrown on their own after a shift or two of someone checking charting, etc. and then told just ask if you have questions, LOL.

[brandy1017, ASN, RN]

Apparently they are short staffed and want warm bodies up and running as quick as possible, but don't want to actually spend the time and money to properly train staff. Bet the place has high turnover. Good Luck! Let them know you need more training and be ready to find a new job if they are unwilling to invest the time and money needed to give you adequate training.

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[SummerGarden, BSN, MSN, RN]

op: was there a time when experienced nurses received real training/orientation? if so, that sounds great. today, everything you have written of your recent experience is typical of what i have experienced and what i have seen by the bedside. my guess is, while employers are not desperate for nurses, this will continue to happen. good luck with finding another facility where your preceptors and administration act differently.

[whereslilly]

I so feel for you. These are wicked times indeed. All I can say, if you were fortuitous enough to stay employed from the "Golden Age" of Nursing when there was a shortage then you are Blessed. Those of us who had to reenter the market has found slammed doors, and when an opening is found either its because its a revolving door position that no one can tolerate, or its what you have described. So sad. Do your best; that is all you can. My best wishes truly.

[N.U.R.S.E.]

Sad to say orientation is lacking in a lot of wo4k settings if you can on off days start looking for another job maybe slower paced than your present one.

[TheCommuter, BSN, RN]

I interviewed for a med-surg/oncology position at a regional acute care hospital last year. Keep in mind that I have no acute care experience and have never worked at a hospital. The interviewer, who also happened to be the assistant CNO, stated that I would have a week of classroom training and perhaps a week of floor training before being cut loose.

Med-surg requires training if you have never worked it before. Oncology is a specialty that requires training a nurse who has never worked it before. They offered me the job, but the lack of training is one of the main reasons why I declined the offer to work at this particular hospital.

[Good Morning, Gil]

Yeah, that sounds crappy. They hired you because you had previous experience and hoped they could just toss you in there. Don't really understand the whole "we're trialing this to see how it goes." Well, it's just to save money and help with staffing; they save a lot of money not training you. I hope it works out for you, and that they give you what you need. Hopefully your years of experience just come back to you, although this hospital is still very different than where you came from, I'm sure, and it's been years since you've worked the floor. They should be giving you 5 weeks minimum, I would think, since you have previous ICU experience or 6 if you need it. Sorry your place is so poorly organized. Hopefully you have good co-workers that can help you muddle through at first.

[DixieRedHead, ASN, RN]

All I can say is "Wow!" I would think that NICU would be the last place they would want to try this. So complicated, turns so fast with such dire consequences. Sadly I have nothing to offer you in the way of advice. Hopefully you can get some support from your coworkers.