how much orientation

Trauma Columnist · Jul 11, 2010

I took a nephrology job right out of school and had 5 months total orientation which included shadowing time with the other mid-levels, MDs as well as lectures by the MDs.

To this day - 4 years later - we still have monthly education by our MDs.

marty6001, EdD, EMT-P, APRN · Jul 11, 2010

When I was a new grad APRN, I took a job in an inner city ER. They gave me 2 months orientation and asked at the end if I needed more. I still took patients, but had another APRN that I ran the case by before presenting to the attending.

pedspnp · Jul 12, 2010

thanks ideally I would like to be in the office she is at, alot of times I have a question, and seeing the pt is so much better than giving a description of it over the phone, but there is no room at the site she is at and none of the other providers are willing to move to a different office..in my contract it states that my md would be at my site once a month for direction and consultation so far that has not happened I am having a meeting on tuesday and am going to bring this up. I feel like some how I have failed in my first job as an NP by them deciding to have me spend days on site with her almost as if it is remedial training

pedspnp · Jul 22, 2010

So i had a phone meeting and it was decided by the supervising md and admin that my orientation had gone badly that I was only given 8 days and then left on my own in a differrent town with only telephone consulting, i only did this because I was assured that the other 2 providers would be available for consult, well that did not happen, so starting tomorrow I spend 2 days a week with my supervising dr ( this after 6 months on my own) i feel like i am being retrained and feel like a failure,that i have not met my goals, but on the othe hand if they were not confident about my abilitys, would they continue to leave me alone 3 days a week, Ihave been there 6 months have not had a formal review only comment made was my confidince level that came from pt satisfaction surveys. What I was told was they want me with her for 2 days a week to see more dx and build up confidence in myself I was feeling confident, so I dont know what to expect or think advice please

Trauma Columnist · Jul 22, 2010

I agree that this job started off badly. I hate to say it but it may be in your best interest just to do what they ask, take it as additional time to get MORE comfortable and then go on.

I had 5 months of orientation and then within another 5 months, made an error which had SERIOUS repercussions. I truly felt I knew what I was doing but in reality, I didn't know what I didn't know.

Take all the extra training you can get.

Conversely, if you really feel this isn't going in the direction you want, then maybe its time to start looking?

pedspnp · Jul 23, 2010

I agree that this job started off badly. I hate to say it but it may be in your best interest just to do what they ask, take it as additional time to get MORE comfortable and then go on.
I had 5 months of orientation and then within another 5 months, made an error which had SERIOUS repercussions. I truly felt I knew what I was doing but in reality, I didn't know what I didn't know.
Take all the extra training you can get.
Conversely, if you really feel this isn't going in the direction you want, then maybe its time to start looking?

thanks i spent the afternoon with my md, and what if boiled down to was admin is worried about the numbers, they felt that i was not getting enough patients, I came in after the md left 6 months beforeand put a new grad in place of an md, did little marketing to let parents know i was in town, so of course children need to be seen, so they went to someone else, so today I was in my md's office seeing her pt's and they were surprised that there was another provider at another location and it was more convient for them to come to my office, by the end of the day my supervising md commented I lost two patients to you today good for you. so all the stress and worry for not. so it is agreed that for the next 3 months i spend tuesdays and thursday with her and build up my practice, and get to ask questions with her there to see the whole picture

caliotter3 · Jul 23, 2010

Be careful. When employers do retraining, firing the employee is often the desired end result. Put your guard up if it is not already there. This is not necessarily a genuine move to help you improve, more than likely a period to prepare to show you the door.

Trauma Columnist · Jul 23, 2010

Agree that as APNs we have to be billing in order to continue in the practice. However, from this latest post, it does sound like they are trying to build your practice and it sounds like you think they are sincere. As an APN, its a little different playing field than as a staff nurse - they have a lot invested in you.

pedspnp · Jul 23, 2010

Be careful. When employers do retraining, firing the employee is often the desired end result. Put your guard up if it is not already there. This is not necessarily a genuine move to help you improve, more than likely a period to prepare to show you the door.

actually it is not retraining, she never once went back into a pt's room. we had a chat about building my practice up since the area is very rural and people dont know i am there, i had a few of her pt's comment well since you are there where I live I can just come to your offfice. I am not worried about my job security more worried about getting the word out

VivaRN · Jul 23, 2010

It sounds like more time for learning and, as you said, they are not approaching this as that you were deficient or incompetent in some way. What a great opportunity.

What I was wondering about was the patient surveys saying you lacked confidence, but you say you felt confident? I would wonder what the behavior was that patients may be picking up on as lack of confidence... because that is not likely to change after spending time with the MD if you already felt confident.

To traumaRUS - I made an error as well that had serious repercussions and it was (thus far) one of the worst/personal growth experiences of my life. Truly a unique experience I felt not many could understand or share. Thanks for sharing.

pedspnp · Jul 23, 2010

It sounds like more time for learning and, as you said, they are not approaching this as that you were deficient or incompetent in some way. What a great opportunity.
What I was wondering about was the patient surveys saying you lacked confidence, but you say you felt confident? I would wonder what the behavior was that patients may be picking up on as lack of confidence... because that is not likely to change after spending time with the MD if you already felt confident.
To traumaRUS - I made an error as well that had serious repercussions and it was (thus far) one of the worst/personal growth experiences of my life. Truly a unique experience I felt not many could understand or share. Thanks for sharing.

what happened in the beginning i had changed my treatment plan after telling the parent I was going to do one thing then did something else. Now I don't talk about the treatment plan untill I have the prescription or lab order in hand. I have parents thanking me for not putting the child on abx untill after the lab tests are back.