Need advice re: new nurses not getting good orientation

FLArn · Feb 28, 2011

If there are enough nurses on nights to do it and management support for it;; could a strong nurse from nights switch to days for a while to "re" orient these new nurses. It would suck for a while but may be worth it in the long run. Just an idea!

canesdukegirl, BSN, RN · Feb 28, 2011

Bottom line is that the responsibilities of the day shift should be completed during the DAY SHIFT. I can't believe they are getting away with not passing 1800 meds.

Can you talk to your NM about this? At this point, you need to have management intervene, because the duties that you are describing that are "left" for night shift borders on unsafe patient practices. I doubt the newbies will get into trouble with management, but your NM may be able to help them with time management skills...AND let them know in no uncertain terms that their duties MUST be completed.

mama_d, BSN, RN · Feb 28, 2011

If there was a way to train them on nights for even just a month, many of our problems wouldn't exist. Unfortunately I don't think there's any way it's going to happen.

Part of the issue is also that we're on our third set of managers in a year. So they're still trying to figure out the unit dynamics.

And I really don't want the new nurses to get bad vibes from myself and the other night shifters who are trying to hold them accountable.

I already have one new grad who won't make eye contact with me or speak to me...when I came over and helped her on the computer the other night when I saw she was struggling, she thanked another nurse instead of me. All over the fact that we got into it one night when I asked her why she was giving me a pt with positive troponins on a heparin drip that hadn't had any follow up PTT's done since the drip was started 20 hours earlier. (It was a transfer from another facility that also neglected to draw them.)

I don't want to totally alienate anyone else, but I have high standards for myself and my co-workers. I don't expect newbies to be as competent as someone who's been there for a while, but I also expect a certain level of care to be delivered regardless of how new you are. Or that there's at least a steady level of improvement.

Sorry I'm whining so much...I really just want my floor to be as stellar as it once was instead of continuing this trend.

netglow, ASN, RN · Feb 28, 2011

Clearly someone in your admin. has made a decision to take the low road and fall in line with a lot of other facilities. Ride rough and just see how much more cash can be made, really live on the edge of patient safety.

I have NG friends in this kind of situation. The NGs you work with probably are trying to decide if they even want to stay in nursing at this point. They know full well that they shouldn't really even be taking any responsibility with the poor orientation they've had. They look around and see mostly NGs and that is very worrisome to them. An NG I know working at a L1 trauma center er, says that you look around and it's a sea of NGs. Hard to find a mentor for questions as they do the heavy cases, and are unavailable. Thing is this place keeps advertising for NG/part time. They never get enough consistent hours to learn, and months go by without gaining knowledge... heck have you ever thought about this... so many NGs in these past few years getting crappy orientation if any... months go by... a year... so many not at the level an RN should be at. It's not their fault either.

classicdame, MSN, EdD · Feb 28, 2011

actually, nursing is 24 hours and I don't think night nurses need to "clean up". It is ok to leave stuff for them too if you cannot get to it. Prioritize. I would bump this up to the CNO

HouTx, BSN, MSN, EdD · Feb 28, 2011

We all know that new grads need experience and a supportive environment to become productive and self sufficient. The situation described by the OP is pretty much a guaranteed result whenever a work group is diluted with too many newbies. It is not their fault. However, the resulting stress frequently causes the experienced staff to "cut and run" also - which makes the situation worse. It then becomes a descending spiral, as more newbies are hired to replace those nurses... and so on.

I strongly believe that each department's "average staff tenure" and "average years of experience" are vitally important work indices that should be monitored and tracked by senior leaders. They should take notice whenever negative trends are identified in a department. Loss of experienced staff & decreasing avg experience have a HUGE impact on patient safety and overall productivity as well as job satisfaction for everyone involved. IMHO, an exodus of experienced staff, particularly those with more than 5 years of job tenure -- should be considered a sentinal event.

The PP is absolutely correct - the manager needs to step up and take definitive action. It isn't popular, but one effective action is rotating experienced staff to another shift to provide adequate guidance & mentoring. However, in this case it seems that the managers are turning over nearly as fast as the staff - maybe they are too inexperienced also? At the very least, this department should not add any more inexperienced nurses until it has had time to 'heal'.

nursej22, MSN, RN · Feb 28, 2011

I am picking up an "us versus them" tone from the OP. Granted there is always a bit of rivalry between shifts. but I would urge you to think of your unit as a team, and let the past go.

Have you ever worked with a new hire that was always saying "that's not how we did it at my old job." Pretty annoying isn't it, and it creates friction.

I recommend creating some scripts and getting your coworkers to buy in. Labs not called: suggest the off going nurse page during report, he/she can take the call if it comes in, and if not, you follow up. They won't page? Grab the phone and do it while they're still there.

Meds not passed? Maybe this is a med error and you will start filing incident reports. I know my pharmacy would get real cranky it they got several of these.

And as I often say, kill 'em with kindness. Make a point to greet the hostile ones. Maybe bring a treat and share from time to time. You get more flies with honey, more cooperation from friends than enemies.

Katie5 · Feb 28, 2011

It's not a good situation- make the best of what you've got. Surely not all the nurses on days are fresh?

Medications can be passed- they are probably overwhelmed. The nurse manager needs to stop complaining/apologising and regroup. Take off orders if she has to and place calls to labs and whatever, while the rest play catchup.

canesdukegirl, BSN, RN · Mar 1, 2011

OP, if you can take each new nurse that you are trying to help and explain to them that you aren't angry at them...that you are only trying to help them manage a very busy shift and let them know what the expectations are, you will more than likely clear the air. If you take a "cheerleader" approach to it ("I am rooting for you and I want you to succeed, so here are some tips that I use to get me through a busy shift" sort of tone), then they will not see you as the bad guy, but rather as a resource person. New grads are trying hard to please everyone, and it gets overwhelming. If they hear from you that you are ON THEIR SIDE, then they won't feel quite as overwhelmed and are more apt to listen to your suggestions.

You may have to take the lead in getting them up to speed. I know it is difficult to do, because you have your own duties to attend to, but it will benefit you in the long run.

It is good that you are venting HERE instead of at work. I sense that you are feeling the loss of the stellar unit that you had...but it seems to me as if a challenge has been placed in your lap. Since you care enough about your unit to post the situation on this forum, you seem to me like the type of person who would mentor these NG's.

I hope that your NM is backing you and is listening to your suggestions.

Music in My Heart · Mar 1, 2011

When I walk into labs from hours ago still needing to be called to the doc, at least one bad IV every shift, 1800 meds not given, admits not completed that have been there for hours, etc ALL THE TIME

I'm not sure how this is a training issue. I'm only 15 months out and I got that stuff figured out pretty quickly... and it wasn't a matter of being told, it was a matter of making it my personal responsibility not to dump on my coworkers. Really, people have to be taught that? Really?

The day charge nurses know how bad it is, to the point that they apologize to night staff, and tell us "I did the best I could but I can only do so much to get four different nurses caught up."

Sounds like maybe you've got some folks who shouldn't have made it off of probation.

It doesn't help that the attitude from days now is that it's night shift's responsibility to cleanup whatever they didn't want to do. I worked a 16 hr shift not that long ago and almost every nurse on days made the comment "I'm not doing XYZ, nights can do it"...while they were sitting there bs'ing.

Again, it sounds like an issue of lousy workers and lousy management.

I'd much rather see the issue get resolved without management intervention, especially since so many of the newbies seem to have potential if they could just get the right kind of support.

Like what kind of support? How do you teach responsibility and work ethic?

Katie5 · Mar 1, 2011

I'm not sure how this is a training issue. I'm only 15 months out and I got that stuff figured out pretty quickly... and it wasn't a matter of being told, it was a matter of making it my personal responsibility not to dump on my coworkers. Really, people have to be taught that? Really?
Sounds like maybe you've got some folks who shouldn't have made it off of probation.
Again, it sounds like an issue of lousy workers and lousy management.
Like what kind of support? How do you teach responsibility and work ethic?

Perhaps so, perhaps not.You on the other hand need to chill with the toxic posts!