New Grad to Fully Functioning RN - How long?

ericuRN · Aug 27, 2006

Wow! Only 11 days? Most employers allow at least 4-6 weeks after completing classroom part of orientation. I don't know what kind of facillity you work for, but you shouldn't be going three shifts without a break when you are in orientation. I work for a large teaching facility and most floors take care of the orientees till they at least make it through orientation. After that, who cares if they get a break, lunch, bathroom break, etc. No nurse should ever feel comfortable going out of orientation, so talk to your preceptors. A good preceptor should be able to pick up on whether or not you are ready to go. Good luck!

I'm a new grad RN on a med-surg floor in orientation. It's a smaller hospital so we get a variety of cases from shift to shift on the one unit. Mental health, oncology, general surgery, ortho, medical cases, etc...
What do you think is a reasonable amount of time before a new grad should be expected to be ready to go with a full load on their own? I've had 11 days with a preceptor and was just granted 4 more. I get the impression they're hoping I'm going to indicate I'm ready after that point. I'm beginning to wonder if I'm ever going to feel "ready" or if it's just a 'jump out of the nest' kind of thing.
I'm overly cautious and ask my share of questions. My assessment skills are fine, but I still struggle with some of the subtleties (fine crackles). I'm fairly organized (though not perfect), but also take longer to do some things because I'm having to think about the task a little more. I still need SBA with several skills that I don't get an opportunity to do very often (central lines, chest tubes, starting IVs, etc...)
The thing I struggle with the most is finding the time to go over all the patient's transcriptions and imaging and lab results, etc... I always hit the highlights and most important values, but I'm not able to get a completely clear idea of everything that's going on like some of the other nurses seem to do. I do work hard and try hard (no breaks in the last 3 shifts, it's crazy) and I know things will get better with time, I'm just wondering how long it should take me before I'm good to be on my own w/ only the charge RN for back up.
Thoughts? What do you see in your facilities with new grads?

truern · Aug 27, 2006

I agree with the previous poster. 11 days is outlandish!! I get about 3 weeks for classes and at LEAST 6 weeks with a preceptor. At the end of the 6 weeks I can ask for more time if I feel I need it.

TazziRN, RN · Aug 27, 2006

New grads and experienced nurses new to a specialty area should have no less than 3 months' orientation.

JB CC-RN · Aug 27, 2006

You need 10-12 weeks to give you the knowledge and experience to feel comfortable in your new surroundings. You need time with a preceptor to help you with policies and procedures, getting familar the equipment and routine on the unit. There are so many things to learn, 11 days are just not enough.

ericuRN · Aug 27, 2006

I work in a critical care area and had 16 weeks minimum which included classroom. I can't imagine being thrown out to the wolves after 11 days. If she is working 12 hour days, that is a little over three weeks. The other thing that concerns me, is the fact that she isn't getting a break for three days in a row. I have worked in smaller hospitals and know how short staffed they can be, BUT her preceptor should make sure that she at least gets at least a little break each shift while in orientation.

mariedoreen · Aug 27, 2006

They're 8 hour work days, we had 3 days of classroom orientation. I did get 4 weeks full time precepting as a nursing student back in May at the same facility... maybe they're counting that too, I'm not sure. The lack of breaks are my least concern as I'm the one choosing not to walk off the floor when I feel like I have so many things to do. I'm assuming when I pick up my pace I'll work that out, I just mentioned it to illustrate that I'm actively making the effort to learn and function independently. Regardless, the replies I've seen here have shown me that I'm not unreasonable in wanting/needing more orientation time with a preceptor.

Catys_With_Me · Aug 27, 2006

They're 8 hour work days, we had 3 days of classroom orientation. I did get 4 weeks full time precepting as a nursing student back in May at the same facility... maybe they're counting that too, I'm not sure. The lack of breaks are my least concern as I'm the one choosing not to walk off the floor when I feel like I have so many things to do. I'm assuming when I pick up my pace I'll work that out, I just mentioned it to illustrate that I'm actively making the effort to learn and function independently. Regardless, the replies I've seen here have shown me that I'm not unreasonable in wanting/needing more orientation time with a preceptor.

I personally don't think your time there as a student in MAY should really count. You do need more time, don't let yourself feel pressured into going on your own before you're ready.

Antikigirl, ASN, RN · Aug 27, 2006

WOW! Heck I am going through orientation for a new job, that actually I have been working already with agency for over 500 hours...and STILL get 4 weeks of orientation (even though I so don't need it!). Eleven days is insane for a new grad!

Okay first...take a deep breath because you are asking way to much of yourself to know without experience! What you need to do, and what I did, is create a list of things you wish to accomplish per week...say anywhere from 3-5 dependant on schedule. Make those your weekly goals...and try to do those. That really helps focus you on reasonable goal setting and obtaining instead of swimming around in the neverending swirl of what we all need to know!

What I did on top of that was to journal during my orientation and first few weeks. That way I really took a good look at my day, and at the end of my journal notes I would put three things I wish to improve upon. That comes in handy for making up those weekly goals! It is best to make those weekly goals for things that acutually pop up frequently during a shift than things that happen once in a while and the journal can help focus you!

Yeah it sounds like a lot of work, but it really isn't, and well worth your time to become the best nurse you can be! You brought yourself this far...now welcome to the actual school of nursing...actually doing it on your own!

Oh yeah..and if you show those goals to your preceptor...total bonus time! Your manager will hear of it believe me and they will think you are on the ball! BONUS!

Good luck!

tridil2000, MSN, RN · Aug 27, 2006

The lack of breaks are my least concern as I'm the one choosing not to walk off the floor when I feel like I have so many things to do.

....you're on the the express lane to burnout.

nursingisworkRN · Aug 27, 2006

Take your breaks. This should not be your least concern. If you do not take proper care of yourself, you cannot take proper care of your pts. Twelve hours is too long for me without a break, and I am sure with 8 hours that you are legally required to be getting at least one break. This is probably off the clock, but I am sure you need to eat, get a drink, go to the restroom, and take a mental hiatus from the job. You will come back more focused and energized, which will make you a better nurse. It sounds like you may need to speak up about this. Ask how they determine meal periods on your unit. Do you need to sign up or cover each other's pts? Tell your charge nurse/preceptor that you need a break. Sometimes I have had to say that I will fall over if I don't eat something in the next 5 minutes. Best to give them proper notice before they are short a nurse :).

As far as your 15 days of orientation with your preceptor, that seems about right to me. I had 18 days (maybe the rest of the world says six weeks, but it was 2 12hrs and 1 8hr a week, so 18 days total) with my preceptor. Some other new grads got twice that amount. I think it is determined by your performance and abilities. I don't know about the full load. Most nurses seem to have trouble with that. Thank staffing ratios for that. You are licensed to do your job, and the state determines how many pts you can be assigned. Speak up if you need help, feel unsafe, or are behind in your assignment. Sometimes the work keeps getting piled on until you push back. Know your limits and find your voice.

To quote you "I've had 11 days with a preceptor and was just granted 4 more. I get the impression they're hoping I'm going to indicate I'm ready after that point." In nursing, it is best to be straight forward and proactive. If you are not ready, then tell your manager you are not ready. Set three goals with your preceptor each day, and review your progress with your preceptor before you leave. Then meet with your manager and preceptor to review your progress. Their feedback will guide your learning. At the end of my time, I did not feel ready. I met with my manager and preceptor to discuss this. They both gave me specific examples of my performance that indicated I was functioning as a competent nurse. It made me feel a little better, but I was still nervous as all get out!

Are you the only nurse who will be working the shift on your unit? If not, then identify who is available as a resource for you. Know your policies and procedures, and know who to call when you are unsure of what to do. I have asked doctors about things I don't know (can we say clogged nephrostomy tubes?) and was direct. "I am the nurse caring for pt x. This is the problem (state assessment). I have limited experience with (state nature of problem). None of the other nurses here have worked with this before. What would you advise?" Of course, only do this after you have done your research, utilized your other support systems, and have come up empty handed. I am sure many times the doctors must think I am an idiot, but I personally never feel bad for asking. Better safe than sorry when there is a life on the line. My pride is expendable, and it makes for good stories at the dinner table.

As far as feeling confident, I think that takes awhile. I am finally getting comfortable with the idea that I am a nurse. I have been on my own for 5 weeks (15 days if you prefer :wink2: ) and still have times where I feel that I don't know enough. But everybody started at ground level, so try to keep your chin up. It is a leap of faith, but you are never alone. Please keep us posted when you are on your own, as I would love to hear about it. Best wishes! And take your breaks! Robyn

ericuRN · Aug 28, 2006

I agree with whoever posted about taking breaks. The thing is, you NEED to take breaks. A new grad can only process so much information. You need a break to sit down, get a change of scenery, and go to the bathroom. I have been in nursing for a long time and I can tell you first hand that it is not good on your bladder/kidneys/stress levels to not take a break. Obviously you don't want to take inappropriate breaks, but your preceptor should be the proactive one and step up to the plate to make sure you get a break within an appropriate time frame. That is part of your preceptors' responsibility. It obviously already bothers you that you haven't had the opportunity to get breaks or you wouldn'tve mentioned it. Take it from someone who has been there, done that. You should make it a priority to take a break. Otherwise, once you are done with orientation, you will continue in that pattern and eventually become resentful that you are working x amount of hours without a break and become burnt out. You are new and are putting forth a valliant effort to be a team player, but you need to realize that you can be considered a "team player" :nurse: without running yourself ragged and not taking breaks.