My termination story, any new grad success advice appreciated!

cat1235 · Feb 6, 2015

And most orientations are at least 3 months ....12 weeks.

cat1235 · Feb 6, 2015

Also in response to those who said it was fair quizzing you on the spot after 4 night shifts because what if it was a real situation .... uh huh no. That's not fair to say. In a real situation you act better than you think you would even if tired. Your adrenaline kicks in. You act as needed. That's the reality of it. Having a manager quiz you under those conditions, especially when you were nervous because she was questioning your capability as a new nurse, is a totally different situation. I'm on your side girl.

GirlOnPfizer, BSN, RN · Feb 6, 2015

I don't think this is a normal situation at all. You need to find another hospital with better working conditions. A hospital that wants you to succeed and to be safe. When I was a new grad, I had at least 12 weeks for orientation and that was after I had already interned on this particular unit about once a week for a year while in my last year of nursing school. A 6 patient assignment is probably never appropriate. I'm not sure what type of unit this is but at my hospital tele unit, I have never had more than 4 patients. When I was a new grad, we did 'primary care' nursing where we only had 3 patients but no CNA. Did they ever try to switch preceptors? Did they offer to transfer you to a different unit in the hospital? These are a couple things that my hospital would do for new grads that didn't seem like they were progressing like they should.

My advice to you is to take this as a learning experience. You don't even need to tell your future preceptors that you had this situation, you want your next orientation to be fresh, new start. Try looking for a hospital with better nurse to patient rations or one that boasts a great new grad program with classes and education to help you succeed. Good luck. Keep your head up.

GirlOnPfizer, BSN, RN · Feb 6, 2015

6 weeks of orientation should be enough, since the purpose of orientation is to provide familiarity with the physical space and typical patient population, charting expectations, availability of supplies and equipment, policies and procedures and culture on the unit. It's not intended to teach a person HOW to do the job - the expectation is that a new hire knows how to be a nurse,

I think this statement is absolutely absurd. I don't think any nursing student graduates from school knowing how to actually do the job of RN. I have NEVER had a job where I have been given an orientation for only 4 weeks. A hospital that wants to ensure their nurses are safe is a hospital I would want to be a part of. Maybe it's a state-to-state difference. Either way, 4 weeks orientation for a new grad or even an experienced RN is NOT the norm everywhere, and if it is at the hospital you are applying for the the state you live in, then RUN. If this is the case, your hospital obviously has budget and staffing issues. Not somewhere I would want to work.

dirtyhippiegirl, BSN, RN · Feb 7, 2015

I graduated from the same nursing program back in 2011. Do they not do a comprehensive capstone anymore? Our capstone hours actually amounted to more time than the new grad floor orientation did at KUMed (where I did capstone), lol. I was lucky to have a preceptor that treated me as an orientee...

NewYorkerGirl · Feb 7, 2015

Your comment about thinking orientation would be like an extension of your school clinicals is an important one.

It's interesting to read of all the different orientation experiences here. My orientation was 3 months, and I'm in a residency program which included weekly classes and sims during the orientation. The residency will continue for my first year, but now with monthly classes. This set-up felt very much like nursing school, and my NM even told me in the interview that I will feel like I'm still in nursing school. I felt very prepared to take on my own pt load after this.

I also attended a good nursing school and had 4 patients for the last half of my preceptorship. Even so, I still needed the boost my residency has given me.

OP, don't blame yourself. Patients are so needy these days that I don't think any new grad should be without a long orientation and residency program.

Graduatenurse14 · Feb 8, 2015

My orientation was "6 weeks" but the first week was all administrative stuff then within the next 5 weeks there were 36 (3 twelves) additional administrative hours that we had to do. I didn't get nearly enough time but my boss and preceptor know this. The higher ups are considering changing it since the RN turnover is so high!

LadyFree28, BSN, LPN, RN · Feb 8, 2015

I'll share my "success" story.

I was deemed "not a good fit" at my first RN job; I had been a LPN for 7 years, so I had some experience; I was on a Pedi Critical Care floor; in hindsight, this position was a personal goal 2-5 years down the road, but because I live in an area with a nursing glut, I took he opportunity.

The position and learning curve was very high; I have PTSD, so I was being triggered in all sorts of ways.

The situation was very sobering; I was a little depressed about it; but knowing that I needed help in gaining better experience by going back to basics, so I found a job within two months and became a supervisor in LTC-I learned how to sharpen my assessment skills to identify acute situations to send people out to the hospital, perform focused and full assessments, deal with challenging families and doctors; and making decisions helped me create a better nursing practice; within the next year I moved to a post-acute pedi position where my nursing skills excelled; I started precepting new nurses and was a supervisor.

Fast forward two years after starting my first nursing position I secured a position at a Level I Pediatric ER. I have utilized all my experiences to help give me a base for this position; I still have a lot to learn, and they understand that I am a work in progress. I just started, I am very proactive and vocal in advocating what I need and my rationales when working and my orientation has been amazing as far as adhering to focus in goal setting and learning how to navigate through things; a lot of support is being required, and I am taking advantage of that.

I've realized that I have changed in the way to approach my orientation; I learned to self study before I started my position-I self studied after work at the previous position; I modified and found some great resources here on AN, and found some great resources I have been able to put to great use, and study on my days off.

You will find your niche and find ways to build your own practice; I believe in the 3 C's: Competent, Consistent, Confident: If you focus on being competent and consistently be competent, then you will build confidence; that confidence will help you know what you know, and understand what you don't know-helping you with finding ways to gather information, and help you build a better nursing practice.

You WILL find a job; find out what you want to do; and go out there and find another one.

Best wishes.

Ruby Vee, BSN · Feb 10, 2015

First of all, I was not aware of how serious my situation was until my manager met with me after my shift (at the end of my 6 week orientation, I work nights btw) to ask me how I felt I was doing on orientation (I did meet with the educator once a week), she then proceeded to discuss a situation that I had with a pt that ended up going to ICU 2 days ago.
My preceptor was concerned that I had some issues handling the situation on my own, it was the first time I had a pt have a sudden decline in pt status, of course I needed her help, but apparently she told my NM that she was very very concerned after that incident. My NM then proceeded to quiz me on clinical scenarios to see how I would hypothetically react in those situations. Of course I gave my best answer but I didn't have the perfect answer that she was looking for, keep in mind I work nights and this was the morning of my 4th 12 hr shift in a row, I was not in the right mind, I was too exhausted and tired to be answering these questions to the best of my ability.
If I was given the opportunity to meet with my manager at a more appropriate time that was not after my shift, I know I could have given a better answer. In conclusion she said she would extend orientation another week to see how I did, discreetly adding that the unit does have a budget so she would not extend my orientation on light terms. The following day on my day off, I get a call from her saying that she doesn't think that the unit is a good fit, that extending my orientation another week wouldn't make a difference, and that she would have to terminate my position.
I know it may sound like I am spiteful and complaining, this is of course all from my side of the story, but I don't think I was treated fairly at all. But in the end what happened happened, and I am ready to move on keeping in mind what they said I did struggle with. I do agree with all the things they said, I did have trouble with time management and managing a large patient load, but the terms of my termination was not done fairly I feel.
At this point, I just ask for any advice on how to succeed as a new grad, your orientation stories, how you succeeded, what you wish you knew when you started, or anything else, or any comments you have. All I can say is I did not expect this coming out of school, I am still coping with it, I was absolutely devastated and depressed the following weeks after. I felt I had been thrown away, that it was all business and their decision was based on whether I was worth spending more money on...But I have had a good support system and I know I WILL GET THROUGH THIS. I still have my license and passion for nursing, all good things happen to those with patience and willingness to be better.

Six weeks of orientation to a Med/Surg unit seems more than adequate. I've worked Med/Surg before, but I didn't get six whole weeks of orientation. More like two weeks, including three days of HR paperwork. I understand that patients are sicker these days than they were when I first started -- but I got 7-14 patients on day shift, 14-28 on night shift. I've worked ICUs where I did't get six weeks of orientation.

We don't know the circumstances of your patient's decline and transfer to ICU; we don't know how you handled things. But if your preceptor has serious concerns about the way you handled things, you should have been listening to those concerns with an attitude of learning as much as possible so that you can do better next time. Your comment that you did't understand the seriousness of your situation makes me wonder if you've been really hearing what your preceptor had to say.

I've been in the situation of trying to discuss my serious concerns about an orientee with the orientee only to be met with defensiveness and justifications. In almost every case, the orientee didn't understand the seriousness of the situation or of my concerns until they were terminated. Then they were shocked and defensive. "I've only had a few weeks of orientation," or "I'm a new grad! If they wanted an experienced nurse they should have hired an experienced nurse!" My only hope is that the experience taught them to pay attention the next time someone takes a chance on hiring them. Hopefully, you've learned your lesson and will learn.

Complaining that you couldn't give your best answers to your nurse manager's hypothetical questions because you were at the end of your fourth twelve hour night shift holds no water. Patients don't always choose to go bad when you're at your best, and you still have to be able to manage the situation safely. Yes, when patients really go bad, you get a surge of adrenalin which hopefully helps you focus your thinking. But I would think that having my manager accost me with hypothetical questions because there were concerns about how I handled a patient situation would also give me a burst of adrenalin.

As long as you were still on probationary status -- and I'm assuming you were as most probations last 3-6 months -- there was nothing unfair in terminating you. If they don't think you were a good fit, then you weren't. Sorry, but it sounds as if you were dealt with fairly. You blew it. I hope you do better next time.

Lâ™¡vER · Feb 10, 2015

I got 6 weeks orientation as a new grad in a ridiculously overwhelming PCU. Nursing is hard everywhere, but not being set up for success doesn't much help either :/

Sorry this happened to you. Think of it positively, you walked away with 6 weeks real world experience, and you have honest expectations for the next job.

dinah77, ADN · Feb 10, 2015

Six weeks of orientation to a Med/Surg unit seems more than adequate. I've worked Med/Surg before, but I didn't get six whole weeks of orientation. More like two weeks, including three days of HR paperwork. I understand that patients are sicker these days than they were when I first started -- but I got 7-14 patients on day shift, 14-28 on night shift. I've worked ICUs where I did't get six weeks of orientation.
We don't know the circumstances of your patient's decline and transfer to ICU; we don't know how you handled things. But if your preceptor has serious concerns about the way you handled things, you should have been listening to those concerns with an attitude of learning as much as possible so that you can do better next time. Your comment that you did't understand the seriousness of your situation makes me wonder if you've been really hearing what your preceptor had to say.
I've been in the situation of trying to discuss my serious concerns about an orientee with the orientee only to be met with defensiveness and justifications. In almost every case, the orientee didn't understand the seriousness of the situation or of my concerns until they were terminated. Then they were shocked and defensive. "I've only had a few weeks of orientation," or "I'm a new grad! If they wanted an experienced nurse they should have hired an experienced nurse!" My only hope is that the experience taught them to pay attention the next time someone takes a chance on hiring them. Hopefully, you've learned your lesson and will learn.
Complaining that you couldn't give your best answers to your nurse manager's hypothetical questions because you were at the end of your fourth twelve hour night shift holds no water. Patients don't always choose to go bad when you're at your best, and you still have to be able to manage the situation safely. Yes, when patients really go bad, you get a surge of adrenalin which hopefully helps you focus your thinking. But I would think that having my manager accost me with hypothetical questions because there were concerns about how I handled a patient situation would also give me a burst of adrenalin.
As long as you were still on probationary status -- and I'm assuming you were as most probations last 3-6 months -- there was nothing unfair in terminating you. If they don't think you were a good fit, then you weren't. Sorry, but it sounds as if you were dealt with fairly. You blew it. I hope you do better next time.

I take issue with several of your comments

Nothing irks me more than the attitude of "This is all I got, so no one else deserves better!"

12 weeks is standard on most med-surg or tele floors these days- at least is is at the facilities worth working at

By your own admission, you realize that pts are MUCH sicker these days, with many more complex co-morbidities to manage.

My Mother-in-law, who has 35 yrs experience, 25 of which was in burn/shock and trauma, has the exact opposite view or you- she always said when she started out a new grad 35 yrs ago, she had ratios similar to yours on NOC- but she also said that back then the average pt was only in for, say an appendectomy, and otherwise healthy

Nowadays, it seems most pts have many dx. with many complex meds and needs to manage

When I worked tele ( only left 7 months ago) my average pt has type 2 DM, AND HTN, AND hypothyroidism, AND CHF, and they were in for Pneumonia which often sent them in downward spiral of sepsis...

Can't even remember how many times I called a rapid response for someone who went septic and was sent to ICU

I never missed it, because my ratio was never more than five, which meant I had the time to watch those pts that were really sick like a hawk

and because I had 12 weeks with a preceptor ( and yes, a couple of those weeks were classroom and HR stuff)

So by the time I was on my own, I was truly confident

I was also not a new RN, but was new to tele

Why the heck anyone would advocate for LESS training, which leads to failure and unsafe conditions truly boggles my mind

Nick2you · Feb 23, 2015

Don't feel bad. I was terminated from my first nursing job because I had trouble with my preceptor, and I didn't pass boards. You will get through this. Orientation should be a time for learning and having a good preceptor and unit that will aid in facilitating your learning is important. If you had anxiety there was no way you could learn or be successful in those conditions. Continue to be positive and think of the great nurse you will become.