New grad needs your advice/thoughts please

[Florence NightinFAIL, BSN, RN]

i graduated from nursing school in december 2010. in february 2011 i was hired as a casual float on 5 floors (2 surgical and 3 medical).

the hospital had scrapped its grad orientation program (8 weeks on one floor) years ago and i got 2 weeks on floor and one week on another (both surgical). i've been floating between the two surgical floors since march.

my educator recently told me that i would be oriented to the 3 others in the next one or two months. i think i might be ok with two of the medical floors but the third one is where my question/post comes in....

it's a cardiac floor with tele monitoring. i was told that i would not have to deal with the tele but still it's a cardiac floor and i'm very uncomfortable in working there. i think i would need at least a year of med-surg experience and some courses before even thinking about heading there. i don't want to take a chance on cardiac.

so i'm asking:

1) how much orientation do you think a new grad needs on a medical cardiac floor with tele? and what courses should i be taking? i should also mention i have zero experience with cardiac nursing inclu. clinicals.

2) as a casual float can i refuse to be oriented there because i consider it unsafe at this point? [consider also that i have not refused to work on the other four floors which, when you look at the orientation i received, is i think pretty scary]

3) how should i approach my manager/educator about this situation without sounding like 'i don't wanna!" i want some good points to present.

[Double-Helix, BSN, RN]

I think you should start by getting some more information. Find out exactly what types of patients you would be caring for as a float. There is a huge difference between a patient admited with r/o a-fib, post MI, or post cardiac surgery, post pacemaker insertion, etc. Find out which patients/skills would you need to know and spend more time on those during your orientation. Chances are, you already care for patients with cardiac issues on your surgical floors.

Your facility knows you are a new graduate, and they hired you for this position, so I'm guessing they expect you to be able to work on all the floors you were hired for. There are also new grads hired directly to cardiac floors at other hospitals (and maybe yours).

1. Really, this is a question for your educator. She knows the acuity and conditions of the patients on that floor and those of us responding do not. We also don't know where you are at with your nursing skills. Those factors determine the needed length of orientation.

What do you mean by courses? College courses? I would just suggest you brush up on your knowledge of cardiac conditions, heart sounds, and cardiac meds. ACLS might also be appropriate and it would give you a better understanding of cardiac rhythm.

2. Since you were hired to work on all five floors, I don't think it's professional to refuse to be oriented there. Since you don't know what the floor is like, why would you refuse an orientation? If you still feel uncomfortable AFTER the orienation, that would be the time to talk to the educator about a longer orientation or not floating there.

3. Just sit down with your educator and tell her you're concerned about the cardiac floor because of your lack of experience in that area. Ask her to describe specifically what sort of patients you will be caring for. Ask her if she has any suggestions for making the orientation easier and ask if you can have a longer orientation if needed.

Lots of floors and hospitals use telemetry. Floating to this floor will give you a very well rounded experience and great skills for your resume. If you ever want to do to cardiac or ICU nursing, this floor could give you the experience you need to land a position.

[Florence NightinFAIL, BSN, RN]

Thanks so much for the reply. That gives me a lot to think about.

P.S. I was not going to outright refuse to work on that floor - but insist that I would need a couple more months or a year of experience before heading there. I'm will already be juggling 4 floors as a new grad and I think that adding cardiac into the mix is just too much at this point.

[HouTx, BSN, MSN, EdD]

I'm glad that you are concerned about patient safety and are obviously motivated to improve your skills to care for more acute patients. However, as an ICU nurse I would like for you to consider something you may not have thought about.

Tele patients are monitored... that means you have more accurate information about what is going on with them. This is a huge advantage over all those (shudder) unmonitored patients. To me, the more monitors attached to the patient, the less stressful it is!!! srsly. After all, if you're able to have a continuous data stream on all vital functions, there's very little opportunity for anything to sneak up on you. Telemetry serves as a great early warning system... just about any change in in the patient's condition will be reflected in heart rate/rhythm.

[serenity1]

In my hospital, new grads go straight to tele and get 8-12 weeks orientation. If you feel uncomfortable, absolutely let your manager/educator know. The previous posters gave great advice. Good luck!!