New grad training-typical?

[dannygirl04]

I have worked at my current job for 3 years, first as a Tech and now as an Extern. I graduated in December and am waiting for school to push the paperwork through so I can take the NCLEX. When I'm licensed I'm supposed to be hired at my current job as an RN. My bosses are considering my Extern time (since mid October 2014) as my orientation time and are hoping by the end of Jan that I will be licensed and they will set me free on my own.

Here's the thing.... I've been basically on my own since I started the Extern position. No one watches me at all. I do all of the nursing roles without assistance or supervision. The only time the RN is with me is to get me pain meds out of the pyxis (because I don't have access to those yet). Otherwise no one looks at my charting, no one does another assessment to make sure I'm accurate, no one is signing my charts so they look like an unlicensed person and the doctor are the only ones assigned to patient care for those patients. I feel like I have some experience from being a Tech but in my job the tech position is a lot less responsibility than the RN role. I don't think I need my hand held all of the time, but I feel like some supervision would be good. I'm worried because I don't know if I'm charting correctly or not and I feel like I'm being set up for failure.

How should a new graduate that is just starting in an RN role be trained? Is it typical to just start with no supervision at all? When I mention that I'm worried about how I'm doing, I'm always told "oh you're doing great", but how do they really know if no one is supervising me. Any advice?

[CTnewgrad826]

That seems like a major safety issue in my opinion and I'm a new nurse myself. During my internship before finishing school I was on my own a lot too but my preceptor always checked and signed off on all my work, I was working under her license so it would be foolish for her not to. When I got hired as an RN this past fall I was on orientation for about 9 weeks, I worked under my license at this point of course but worked with a preceptor. Being an RN vs. student nurse, whether it be an extern, intern, in a clinical group, is 100% different which you won't really come to realize until you start your job as an RN. It sounds like your managers are trying to save money by not using more of their resources, because in there eyes you have already been trained with those resources in your extern position. What is the orientation like for new hires in general at your facility? Whatever it is I would demand the same orientation.

[dannygirl04]

We had another Extern in our department about a year or so ago. She worked one on one with one of the RNs for months before they started letting her take patients all by herself and even then because she wasn't licensed yet, they always checked her charting and weren't far from her side. There is another Extern right now working in the same department that I am who is being treated the same way I am. In addition to the two of us who are Externs, there is a new hire who has been an RN for a while, but never worked for our hospital system. The new hire is getting her hand held every patient, every day. I'm not sure other than those experiences what is typical for training and I don't know how other departments in the hospital handle training. I just feel like it's a huge safety issue and worry that I'm being set up to fail. It's such a worry for me that I'm toying with the idea of finding a job elsewhere and hoping that I get better training.

[CTnewgrad826]

It sounds like you'll be a great a nurse and they trust you a ton which is great, however it will be your license at that point which you need to remember. If theres no clear orientation on your floor I would be concerned too. Definitely talk to your manager see what he/she can do for you, if you still feel unsure I would definitely look into other jobs. That being said I'd look into other jobs regardless, until you're officially signing the contract, you're not guaranteed this job. I think you have the right mindset so stick to your gut!

[applesxoranges, BSN, RN]

I'm surprised they let the externs pass meds. I would make them look at your charting to ensure that it is right because it'll be on you when it is incorrect and not the people who are supposed to be checking it.

[Lev, MSN, RN, NP]

If you feel comfortable with the pace and managing the patient load and doing all the nursy stuff, I think it would still be wise to have a preceptor check up on all your charting and assessments and work with you for 1-2 weeks on your unit. Ask the manager what she thinks. If this isn't an option, I would switch units and see if you can get an adequate orientation as an RN on a different unit. You will be a licensed professional and you and your manager have the ethical responsibility to make sure you are competent enough to take care of patients. Also, the Joint Commission requires proof of some sort of orientation and signed off skills checklist. What type of unit do you work on?