Job Orientation

[NewNurseMidwest]

I am a new grad and began orientation at a hospital a few weeks ago. Orientation will be approximately 6 weeks and then I will be assigned 4 to 5 patients.

I have been assigned two patients since day two of my orientation. With being a new grad, I am nervous about hanging IV's, IV pushes, etc. Assessent is very important on this unit, but I have not been given much direction on how/when to assess. I know that my charting is slow and I need to figure out how to speed up, especially since I will need to handle a couple more patients in a few weeks.

Is 6 weeks a "normal" orientation for a new grad? When I ask questions, the experienced nurses comment such as "didn't you learn that in school, you paid $xxxx to go to that school and they didn't teach you that," etc. I have been assigned to 4 or 5 nurses during my orientation (I was told during the interview that I would have one preceptor) and they don't agree with each other so I am confused. Some will chart as they go, while others wait until the middle and end of the shift.

Looking for suggestions on the best way to complete this orientation and be ready for a full patient load. Thanks.

[dudette10, MSN, RN]

Contrary to what many people have told me, which is, "Forget everything you learned in school. This is the real world!", you do indeed use what you learned in school every day.

Maybe you are having a block of sorts thinking that nothing you learned in school is useful, just because you didn't get a lot of time with nursing tasks?

Let's start with your first question: "How/when to assess?"

Assessment techniques in school are exactly how they are in the real world. You assess every system formally at the start of shift, and you are re-assessing every time you walk in the room. Your re-assessment is called a "focused assessment," and it's based on what the patient tells you and what you see even if the patient is saying everything is ok. Relate what you see/hear to the reason for admission and with co-morbidities, patho-wise.

Everyone telling you different things...

Yes, it can be very frustrating to have different preceptors telling you different things when you're a newbie. I ran into the same problem, and, as time went on, I spent a lot of time with the policy and procedure manual. (That helps a LOT!)

I also learned to recognize between differences in nurses' technique (neither right nor wrong), and I was eventually able to choose the technique that worked for me. My organization right now is based on a little bit of this nurse's way of doing things and a little bit of that nurse's way of doing things, and I am still tweaking as I go along.

It is soooo overwhelming at first. Literally everything seems new. The simplest of nursing tasks can make you anxious, like hanging IVs and IV pushes, as you stated. You will be surprised how quickly you no long focus on the steps in the task per se, and you're focusing more on why you are pushing that med or hanging that IV and, by reassessing the patient, you are better able to evaluate whether or not it is working.

And the paperwork. Oh my! It seems like a new piece of paper is being thrown at you every minute, and you can't see how it all fits. Eventually, you will know not only how to complete the paperwork, but when a new procedure is scheduled or someone is moved/transferred/coding, you will know which ones need to be completed.

There is a LOT that experienced nurses don't come out and say because it's almost too natural for them to be able to break it down and explain it. A lot of it is on you to be able to put it all together. I know that sounds frustrating, but you have to do it that way.

Hang in there. Just give it time. I look back on the past four months, and I am amazed at how far I've come...and how far I still have to go.

[HouTx, BSN, MSN, EdD]

PP is absolutely correct - assessment is a continuous process. However, your employer should have a policy that specifies the minimum requirements - how often & who does it. Always make sure that you are familiar with organizational policies, because those outline how your job is supposed to be done (duty to employer). Failure to comply with policy can often result in termination.

In addition, as a nurse you also have a duty to the patient that trumps everything - so even though the policy says to assess at the beginning of each shift your professional judgement could indicate that it needs to be done more often. Failure to fulfill your duty to the patient can result in loss of your license, no matter what the policy says. For sure, always conduct a focused assessment to determine whether your interventions had the desired result... always after prn treatments or meds.......always in response to any changes in patient condition (prior to calling the doc).

Six weeks orientation should be fine if you're not in a specialty unit - having to learn new skills. As far as preceptors using different routines, that's always going to be the case. Each one has found what works for him/her. You will also. A word of advice - try to chart as you go rather than block charting at the end of the shift. This is especially true on a busy unit, where patients come and go pretty often. You may have to change patients mid-shift in order to acommodate changes in census or emergency conditions. What if your patient goes south and has to be transferred to a higher level of care? No one can wait for you to catch up on your charting. You could also run the risk of forgetting to chart an important detail. It's just better practice to chart concurrently.

Good luck. Keep us posted on your progress.