This is my first time posting to allnurses, I've been using this site since I started nursing school and has definitely helped me during times I felt I had no one to turn to, but I am now in need of advice! Here is my story...
I graduated from the University of Kansas with my BSN in May!
I graduated in May '14, passed boards in June '14, accepted a medsurg job in July '14...For the most part the good stuff just kept coming one after another! Fast forward 2 months, I was terminated from my first nursing job during orientation due to problems with time management, not seeming to be a "good fit" on the unit, struggling with a 6 patient assignment load, after 6 weeks of orientation.
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 was of course flustered and confused, and I replied in hesitancy but within good reason, and she replied by saying I couldn't answer her scenario questions appropriately, which were "classic NCLEX style questions" and that really concerned her and wouldn't think extending orientation could change that. In my mind I was thinking "First of all you asked me theses questions the morning after my 4th shift in a row, I have 2 months of nursing experience, have you ever been a new grad? Do you really expect me to know exactly what to do with what experience I have, knowing that new grads don't truly start to feel comfortable until 6 months into their first job? If so I don't want to work at this type of facility, and your expectations are unrealistic"
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.
Specializes in Critical Care; Cardiac; Professional Development.
Six weeks is really not adequate for a new nurse, even in med-surg, in my opinion. It would be if the schools focused more on time management and clinical skills but we all know that isn't happening and new nurses are not being turned out ready to hit the floor running, which is not the new nurse's fault.
That being said, 12 weeks is beyond excessive for a med-surg orientation. That's almost a full semester of schooling for pay without any payoff for the hospital! Ha! I literally do not know one hospital in my area that would not laugh you out of the line for a job if you stated you refused to accept less than 12 weeks of orientation. There's a glut of new nurses folks. You are no position to make demands. Try insisting on 12 weeks and don't let the door hit you on your way out while another new grad comes in to take your place. Pray for eight weeks. If you only are given six, then be seeking all the feedback you can along with specific benchmarks in writing to shoot for so that everyone involved is on the same page as you progress.
OP, you sound very intelligent and willing to learn. I wish you all the best and I think you are going to be just fine. This will be nothing but a blip on the radar of your past and a story you tell when you are the preceptor one day. Keep your chin up.
I'm a little surprised at how many RNs have posted about an expectation that new RNs don't need real, on the job training. I'm in my late 30s and this was a career change for me. I graduated in May. I got hired to a general peds floor. 4-5 pts. I had 12 weeks orientation. I struggled. I wasn't confident. Instead of pointing out my flaws (of which I'm sure there were many) my preceptor(s), ANM, NM, STAT nurses, CNS ALL supported me. To be the best I could be. There was never an expectation that I "knew" how to be a nurse. Who knows how to be a nurse right out of school? I never had more than 2 pts in school. No capstone, no internship, nada. 4 hrs of clinical 2x a week in Nursing 4. 4 hrs of clinical 1x a week for Nursing 1-3. When I was a teacher I spent a FULL YEAR in a classroom as a student teacher. And that wasn't a job about *literally* saving lives.
To those posters who made it sink or swim when they first started... is that the nurse you want coming in to work with your child? mom? spouse? Not me. I'd want the nurse who was given the support he/she needed when he was new to the profession. Who was given time to develop his skills because 2 years of classroom time and 75 stupid NCLEX questions didn't truly make him a nurse.
Specializes in NICU, PICU, PCVICU and peds oncology.
I'm a little surprised at how many RNs have posted about an expectation that new RNs don't need real, on the job training. I'm in my late 30s and this was a career change for me. I graduated in May. I got hired to a general peds floor. 4-5 pts. I had 12 weeks orientation. I struggled. I wasn't confident. Instead of pointing out my flaws (of which I'm sure there were many) my preceptor(s), ANM, NM, STAT nurses, CNS ALL supported me. To be the best I could be. There was never an expectation that I "knew" how to be a nurse. Who knows how to be a nurse right out of school? I never had more than 2 pts in school. No capstone, no internship, nada. 4 hrs of clinical 2x a week in Nursing 4. 4 hrs of clinical 1x a week for Nursing 1-3. When I was a teacher I spent a FULL YEAR in a classroom as a student teacher. And that wasn't a job about *literally* saving lives.
To those posters who made it sink or swim when they first started... is that the nurse you want coming in to work with your child? mom? spouse? Not me. I'd want the nurse who was given the support he/she needed when he was new to the profession. Who was given time to develop his skills because 2 years of classroom time and 75 stupid NCLEX questions didn't truly make him a nurse.
Okay, you've just made the case for all of us who have said that orientation isn't meant to replace clinical experience received as a student - to teach the nurse how to "be" a nurse in the way your year of student teaching taught you to "be" a teacher. Your school didn't prepare you to be a nurse, they gave you a bunch of courses that most general science degrees might include but don't end up with the grad being responsible for the welfare of others. Of course nurses need theoretical, intellectual and scientific education, but they also need to learn time management, prioritization, organization and psychometric skills in the real world. The clinical hours you received were severely lacking. You should have been doing 3x8 hour shifts a week in year 4, and you should have had at least an 8 week, full time capstone/clinical practicum. The nursing education industry is failing its clients and as long as no one holds their feet to the fire, that isn't going to change. It's THEIR responsibility to prepare their students for practicing as nurses, not the employers. Why do you suppose so many employers won't take on new grads? They know they'll be getting someone who isn't going to be able to pull their weight for a long time and they'd rather hire people who, with a little familiarization to the environment, are able to do the job - to hit the floor running.
I was very fortunate, as a student in a hospital program, to not only receive a lot of clinical hours as a student with lots of hands-on practice, but also a solid 8 week 320 hour practicum where I took a full assignment from the second week on. I was even given two nights of charge exposure. When I was done that, I was ready to get out there and work. I really believe that by eliminating the hospital programs they threw the baby out with the bath water. There were a lot of positives to that method of training, and had those aspects been kept and enhanced by all those liberal arts courses and theory classes, we wouldn't have so many new nurses feeling like they've been thrown to the wolves.
I agree - nursing school for me was a bit of a joke. If I had to do it again at least I'd know what to look for in a program! I didn't go through a hospital affiliated program - in case you couldn't tell
Thank you for sharing this- I'm taking note of it all :) Hugs to you, you know what to work on now. I'm not a nurse yet, but I've been a CNA... My first CNA job, I STRUGGLED with time management (I had 18 residents to care for alone, and one month of class training- I was having a lot if trouble trying to get everyone to the dining room, feed the few on the floor still, and totally lost as to how to get the beds and showers all done before noon)... I actually asked my supervisor before they brought it to me "how can I manage my time better?" They said- figure it out on your own. I asked other CNAs, they said the same thing... Then one day on a new hall, I met a resident LOL who had been a nurse! She liked to talk, and have me a lot of tips, starting with carry a little notebook with you in your pocket at all times- she called it her "brain", and that's what I call mine. Use that notebook for everything! Thad honestly was THE most important tool for learning time management- I wrote down everything in it like a diary, then analyzed it- I figured out how to organize my day so well that I even found that I had time to braid LOLs hair and visit with them and help them put on their makeup!!! At another job, I learned from another CNA how to be a part of a team, and I absolutely loved that job- now I know how to work on my own AND as a well-oiled team :) You will learn, too, but it will make it easier if you can find a mentor to actually show you how to schedule your day.
OP, sorry you're going through that. 6 week new grad orientation for a 6 patient ratio? Unacceptable.
Please do not judge yourself too harshly given that training and ratio. I refuse to work 1:6 and I am an experienced nurse. agree with previous poster that we always need to be prepared and can't be "too tired for a code" (or however she worded it) but still, staffing is key. I cannot imagine orienting and teaching some of my students/new grads under those conditions. How much meaningful teaching and bedside skill can be taught with 6 patients, two of whom are always confused/impulsive, two are circling the drain, and all need their medications and assessments done in a timely fashion? Best of luck to you. Hopefully you can land at a different hospital system in which cultivation of great nursing care is the priority over $.
I have had similar experiences and it is hard. I also took it very personally. Just remember, if they were in your shoes with your experience they would be doing the same thing you were doing!!!
I took a look at myself after I was done with that job. There were warning signs that I didn't pay attention too. I am an extrovert and a lot of the nurses I worked with were gossips and very clicky. I wasn't set up for success and it doesn't sound like you were either. 12 weeks of orientation is pretty standard for a nurse.
It took a few weeks but I was able to get my confidence back by talking about it and getting additional training on things I knew I needed to improve on. I also read my old text books and talked with my old instructors for support.
When I was in nursing school we had 3x 12 hour shifts for four months in the last semester. The previous semester I was in the OR full time with a preceptor. At the start of each experience, we were informed that if we could not handle the patient load adequately, we would not graduate. I think more schools need to approach their practicum in this manner so that students enter their first position more prepared.
Med surg is grueling and perhaps not the fit for you OP. There's nothing wrong with that. Eventually you will find your way.
Specializes in Tele/Interventional/Non-Invasive Cardiology.
I'm a little surprised at how many RNs have posted about an expectation that new RNs don't need real, on the job training. I'm in my late 30s and this was a career change for me. I graduated in May. I got hired to a general peds floor. 4-5 pts. I had 12 weeks orientation. I struggled. I wasn't confident. Instead of pointing out my flaws (of which I'm sure there were many) my preceptor(s), ANM, NM, STAT nurses, CNS ALL supported me. To be the best I could be. There was never an expectation that I "knew" how to be a nurse. Who knows how to be a nurse right out of school? I never had more than 2 pts in school. No capstone, no internship, nada. 4 hrs of clinical 2x a week in Nursing 4. 4 hrs of clinical 1x a week for Nursing 1-3. When I was a teacher I spent a FULL YEAR in a classroom as a student teacher. And that wasn't a job about *literally* saving lives.
To those posters who made it sink or swim when they first started... is that the nurse you want coming in to work with your child? mom? spouse? Not me. I'd want the nurse who was given the support he/she needed when he was new to the profession. Who was given time to develop his skills because 2 years of classroom time and 75 stupid NCLEX questions didn't truly make him a nurse.
Thank you! That mentality is getting old. And like another poster said, the patients today are SICKER than in previous times because care is being shifted away from the hospital. On one hand, I agree, that this is the fault of nursing schools. I was in a hospital based program and it STILL doesn't make you feel prepared to be a nurse. It's not until the responsibility is YOURS. Also, at my hospital and my state where I trained, it was a union state that utilized CNAs and nurses had better staffing. At this hospital, the RN does EVERYTHING: blood glucose, toileting, ambulating, phlebotomy, turning and positioning, linen changes. Getting numerous snacks, expected to come in every hour. Two patients going off the floor at the same time that are on tele? Make it work. There's only one charge nurse. There was NO way I could've been prepared for that. Our instructors actually told us to delegate this in schools but now in my real life job I delegate NOTHING.
All this to say, yes, let's blame the RN schools. But that's not going to change anytime soon. These hospitals that have residencies and new grad programs SHOULD know that not all nursing programs are created equal. They SHOULD know that some nurses will struggle. While it shouldn't necessarily be the fault of the employer to prepare, if you advertise new grad or residency programs know what you are getting. MDs get a 4 year residency and have to run things by their attending, even in a clinic setting. Why should new nurses be thrown to the wolves? Because that's how it's always done?
The same thing happened to me. Let's start with your original conversation with the NM. She was willing to give you another week, then changed her mind. It may not seem obvious yet, but they did you a favor. If things were "that bad", after 8 weeks of "good things", then you should have been told that you were close to being fired. A good preceptor would not let that happen. A NM gave me the (BS) same speech, and couldn't even provide any examples after stating she observed "unsafe practices". A new grad after 8 weeks on the floor does not know everything.
I'm in my second orientation at a new hospital and can't believe the difference. My preceptor is supportive (as well as the other nurses on the unit) and has the time and patience to answer questions. I did learn a lot from the first experience, most of which are on youtube. I'll mention that working on a unit, there's a social element to it. Try to foster a good working relationship, because you will need to depend on your colleagues after orientation. But keep your mouth closed about your personal life unless asked, then be discrete.
10 weeks is average for orientation. Yeah, 8 is a little short. But time management is a huge deal, and oddly enough difficult to find any references since it is unit specific. Just look around you and learn from the nurses doing the job. How are they keeping up with charting, meds and assessments?
I felt devastated as well. Take a couple weeks and try to separate the BS from what is valuable to take away from this experience. Leave it off of the resume and practice interviewing with other nurses. Lots of good info on this site.
Nurse SMS, MSN, RN
6,843 Posts
Six weeks is really not adequate for a new nurse, even in med-surg, in my opinion. It would be if the schools focused more on time management and clinical skills but we all know that isn't happening and new nurses are not being turned out ready to hit the floor running, which is not the new nurse's fault.
That being said, 12 weeks is beyond excessive for a med-surg orientation. That's almost a full semester of schooling for pay without any payoff for the hospital! Ha! I literally do not know one hospital in my area that would not laugh you out of the line for a job if you stated you refused to accept less than 12 weeks of orientation. There's a glut of new nurses folks. You are no position to make demands. Try insisting on 12 weeks and don't let the door hit you on your way out while another new grad comes in to take your place. Pray for eight weeks. If you only are given six, then be seeking all the feedback you can along with specific benchmarks in writing to shoot for so that everyone involved is on the same page as you progress.
OP, you sound very intelligent and willing to learn. I wish you all the best and I think you are going to be just fine. This will be nothing but a blip on the radar of your past and a story you tell when you are the preceptor one day. Keep your chin up.