new grads and orientation

~Mi Vida Loca~RN, ASN, RN · Jul 19, 2011

Mine is a bit different. I am on Peds and it's a small unit. 14 beds. We take adults to but it's very selective on the adults we will take and only if there is room. We are in low census season right now. I have worked 5 "real" shifts on the floor now and the most I have taken is 4. That will be the average but when winter comes it might be 5-6. This is night shift. My first shift my preceptor came with me with everyone. My second night she didn't come with me but she checked my charting and everything pretty much without me even knowing. The 3rd night she told me she wasn't going to even secret follow me anymore. LOL She is charge and there were some high acuity burn kiddos so the other nurse really needed her help a lot. So I took care of "our" 4 patients and she helped there. She checked my charting and that I had everything done towards the end of the shift and she said she couldn't believe how fast I picked up on everything. So since then I have pretty much been on my own without TRULY being on my own.

I am still on the calendar for precepting for 4 more weeks I think but they base it on you. It can be 12 weeks or it can be 4 weeks. Since I am on Peds though and it's like a mini med/surg I will always need "help" so to speak. I will always have the chance of encountering something I am unfamiliar with and this unit is extremely helpful when I do. Nurses that have been there a long time still ask for help. So I will always have the support even when I am no longer precepting. I am sure that will come in handy come fall when the RSV season hits and the unit stays pretty packed.

We have a really good burn center and if they are kids they come to my Peds unit because we also function as a pediatric ICU outside of Cardiac stuff. We just had kiddos from Montana (8 hrs away) and Nebraska because they were burns and we were the closest facility to handle the depth of them.

My last shift my current preceptor had the day off and I had the preceptor I will be getting in 2 weeks. (they like to give you 2 total since people are different and learn and teach differently, that way you get some variety) So with her she was more watchful then my other preceptor since she didn't know me. But mid way into shift she pretty much backed off too. We also carry phones so if I have a question I can call real quick directly to them.

So I am only 2 weeks in on the floor and feel like I am done precepting because I am doing it alone, but at the same time I know I still have that support right there if I need it. I am really glad it worked out the way I did so I get some good experience under my belt before the heavy season hits. So far I have had pretty much an equal number of Kiddos and Adult patients but the adult patients were pretty low acuity besides the fluke TB patient I got that wasn't supposed to happen like that.

Double-Helix, BSN, RN · Jul 19, 2011

I'm orienting in a large Pediatric ICU and my orientation is scheduled for 12 weeks, but I'm not sure I'm going to need the entire three months.

My first few days (which were really only about 5 hours each) I spent following a nurse, learning about the equipment and the policies. The nurses let me perform skills as I was comfortable with them. I'm kind of one of those "observe once, do it once" learners. One of the biggest challenges is adjusting to their paper charting system. I feel like I'm always going to forget when I need to fill out an additional form.

Everyone is extremely helpful and willing to teach- even the respiratory therapists and attendings. If there is ever a crisis, there is always at least one or more nurses who come in to help you, so you really are never alone. Just the other day we had an emergency come in from the ED and there were four or five nurses helping set up pumps and tubing, running for supplies and meds and stepping in to look after the other patients.

MeganNYRN · Jul 19, 2011

This doesn't sound like a good way to orient someone and your manger sounds as terrific as mine(my manager is AWKWARD and critical of everything). When I oriented almost 2 years ago I had a long orientation with 10weeks of orientation on days before going to nights with another week on nights with a preceptor. Keep in mind about three weeks of that time was classroom or clinical lab sessions provided by the education department. My manager orients us on 8hr days(meaning we work 5 shifts/week instead of 3) it does give us more patients every week but it means we don't give handover for real until going to 12hr shifts in the last few weeks. I work on a med/surg pediatric floor so the fact that you only have a few weeks for a progressive care unit seems inadequate. I got TONS of criticism from my manager we had a meeting six weeks in to talk about my inadequate progress and what they could do to help me, needless to say I cried and we set up a different preceptor and some skill sessions and a plan to move forward. All of my preceptors stalked me to some extent the first few were excessive checking everything i did not letting me do ANYTHING alone and reading all my notes, I couldn't do anything right. My second group of preceptors were more supportive and let me come to them, I finally worked up to my 6 patient load and I think I'm a pretty good nurse now but I struggled for the entire first year with 2 more you need to improve type meetings. But I followed the instructions doing practice handovers and focusing on just my own patients(they actually told me to stop helping other nurses), I didn't like it but I didn't want to loose my job. The point of all this is it takes a long time to be comfortable. Good luck and keep your head up everyone makes mistakes, I still do. We all overlook details but we just do the best we can. My manager hasn't touched a patient in years so I don't always follow her instructions for example she wants us to set our IV pumps with only 2 hours of fluid to force us to check them and avoid infiltrates but I work nights and beeping pumps drive parents and pts crazy so I set my pump up for the whole shift and just be diligent about checking my IV sites. You can do this don't let anyone tell you otherwise! PM me if you need more support

turnforthenurse, MSN, NP · Jul 19, 2011

Mine is a bit different. I am on Peds and it's a small unit. 14 beds. We take adults to but it's very selective on the adults we will take and only if there is room.

That is very interesting. My unit just recently started accepting peds and all of us will be responsible for taking care of them. For everyone coming on, the charge will ask who wants to take care of the pedi patients and usually someone will volunteer, but everyone is fair game. No one has had inservices on taking care of pedi patients, and we were told we could possibly take care of both adults AND peds in the SAME shift. It kind of seems like a safety issue to me. We have several older nurses on our floor who have been out of school for quite some time and don't remember anything from peds in school. I graduated in December and had pediatrics for my 1st 8 weeks that semester and since then I kind of threw that knowledge out the window because I had no interest in working in that particular field of nursing - I don't remember anything!

Every preceptor I have been with has checked my charting and everything (except for those 2 times I mentioned above where my manager spoke with me) and said I have been doing a great job. So I feel like I'm on my own and being autonomous, but at the same time someone is there to back me up. And I know that when I am truly flying solo in a few weeks, I can still ask questions. Many of our seasoned nurses still do.

This doesn't sound like a good way to orient someone and your manger sounds as terrific as mine(my manager is AWKWARD and critical of everything). When I oriented almost 2 years ago I had a long orientation with 10weeks of orientation on days before going to nights with another week on nights with a preceptor. Keep in mind about three weeks of that time was classroom or clinical lab sessions provided by the education department. My manager orients us on 8hr days(meaning we work 5 shifts/week instead of 3) it does give us more patients every week but it means we don't give handover for real until going to 12hr shifts in the last few weeks. I work on a med/surg pediatric floor so the fact that you only have a few weeks for a progressive care unit seems inadequate. I got TONS of criticism from my manager we had a meeting six weeks in to talk about my inadequate progress and what they could do to help me, needless to say I cried and we set up a different preceptor and some skill sessions and a plan to move forward. All of my preceptors stalked me to some extent the first few were excessive checking everything i did not letting me do ANYTHING alone and reading all my notes, I couldn't do anything right. My second group of preceptors were more supportive and let me come to them, I finally worked up to my 6 patient load and I think I'm a pretty good nurse now but I struggled for the entire first year with 2 more you need to improve type meetings. But I followed the instructions doing practice handovers and focusing on just my own patients(they actually told me to stop helping other nurses), I didn't like it but I didn't want to loose my job. The point of all this is it takes a long time to be comfortable. Good luck and keep your head up everyone makes mistakes, I still do. We all overlook details but we just do the best we can. My manager hasn't touched a patient in years so I don't always follow her instructions for example she wants us to set our IV pumps with only 2 hours of fluid to force us to check them and avoid infiltrates but I work nights and beeping pumps drive parents and pts crazy so I set my pump up for the whole shift and just be diligent about checking my IV sites. You can do this don't let anyone tell you otherwise! PM me if you need more support

I am sorry for your rough start! Being brand new is really hard, especially because nursing school does not equal real-world nursing! That's great that your manager and preceptors worked with you; I have heard horror stories of employees simply being thrown under the bus the moment they show they are struggling. I'm glad my manager has been understanding and accepting of my mistakes; she realizes that everything is very new to me and realizes that I must be experiencing some major information overload. But I'm still pretty disappointed because of those mistakes! Thank you for your reply!

Ruby Vee, BSN · Jul 20, 2011

your manager didn't call you out in front of eight nurses at the desk, did she? she privately told you that you missed a step. would you rather she'd have made a big deal of it in public? waited until you'd been there for six months and then said "by the way, you always miss this step when you admit and i'm going to mark you down on your evaluation because of it!"? it would have been great had your preceptor caught it, but she didn't. you needed to know anyway. believe me, your preceptor probably heard about it, too.

managers and preceptors aren't perfect people. we just do the best we can and in our imperfections, sometimes we shortchange our charges. i'd like to think that we get it right more often than we get it wrong, though.

~Mi Vida Loca~RN, ASN, RN · Jul 20, 2011

That is very interesting. My unit just recently started accepting peds and all of us will be responsible for taking care of them. For everyone coming on, the charge will ask who wants to take care of the pedi patients and usually someone will volunteer, but everyone is fair game. No one has had inservices on taking care of pedi patients, and we were told we could possibly take care of both adults AND peds in the SAME shift. It kind of seems like a safety issue to me. We have several older nurses on our floor who have been out of school for quite some time and don't remember anything from peds in school. I graduated in December and had pediatrics for my 1st 8 weeks that semester and since then I kind of threw that knowledge out the window because I had no interest in working in that particular field of nursing - I don't remember anything!
Every preceptor I have been with has checked my charting and everything (except for those 2 times I mentioned above where my manager spoke with me) and said I have been doing a great job. So I feel like I'm on my own and being autonomous, but at the same time someone is there to back me up. And I know that when I am truly flying solo in a few weeks, I can still ask questions. Many of our seasoned nurses still do.

So it sounds like your orientation is very similar. I start my new grad residency classes tomorrow. It's one class every other week. Total of 5 classes and 1 simulation day on code situations. (not like simulation in class though).

Every Peds unit I have seen can take some adult overflow. Usually womans care stuff like post hysterectomy. We take a little more then Gyn stuff but like I said, it's pretty strict criteria and the adults are kept on the other hall of our unit. Any patient under 16 will come to our unit no matter what it's for. Including 1:1 for Psych and Withdrawal. 16-18 can go on other units but if we have the room we will take them first.

I don't think Peds should be mixed in with adults, like Peds going to adult units. They need a different environment that is kid friendly. Special beds and so on. As far as their actual care, it's not a lot different. You just have to remember to get on their level mentality wise when providing care. Procedures are on a much smaller scale, there is no room for error with medications and we have a lot of precautions in place to prevent errors. But the clean up is a lot easier and turning!!! LOL We do a lot for our peds patients though. Every kid admitted on our unit get age appropriate goodie bags (with nice stuff) and a handmade blanket and pillow case made by volunteers.

Crazy enough I didn't have plans to work in Peds either but now I love it and can't imagine having to work anywhere else. (except maybe the ED someday)

turnforthenurse, MSN, NP · Jul 20, 2011

your manager didn't call you out in front of eight nurses at the desk, did she? she privately told you that you missed a step. would you rather she'd have made a big deal of it in public? waited until you'd been there for six months and then said "by the way, you always miss this step when you admit and i'm going to mark you down on your evaluation because of it!"? it would have been great had your preceptor caught it, but she didn't. you needed to know anyway. believe me, your preceptor probably heard about it, too.

managers and preceptors aren't perfect people. we just do the best we can and in our imperfections, sometimes we shortchange our charges. i'd like to think that we get it right more often than we get it wrong, though.

i'm not complaining because she told me about my missed step - thankfully i'm glad she told me now instead of waiting so that i can make sure i don't miss steps in the future. she privately told me about it :)

turnforthenurse, MSN, NP · Jul 20, 2011

So it sounds like your orientation is very similar. I start my new grad residency classes tomorrow. It's one class every other week. Total of 5 classes and 1 simulation day on code situations. (not like simulation in class though).
Every Peds unit I have seen can take some adult overflow. Usually womans care stuff like post hysterectomy. We take a little more then Gyn stuff but like I said, it's pretty strict criteria and the adults are kept on the other hall of our unit. Any patient under 16 will come to our unit no matter what it's for. Including 1:1 for Psych and Withdrawal. 16-18 can go on other units but if we have the room we will take them first.
I don't think Peds should be mixed in with adults, like Peds going to adult units. They need a different environment that is kid friendly. Special beds and so on. As far as their actual care, it's not a lot different. You just have to remember to get on their level mentality wise when providing care. Procedures are on a much smaller scale, there is no room for error with medications and we have a lot of precautions in place to prevent errors. But the clean up is a lot easier and turning!!! LOL We do a lot for our peds patients though. Every kid admitted on our unit get age appropriate goodie bags (with nice stuff) and a handmade blanket and pillow case made by volunteers.
Crazy enough I didn't have plans to work in Peds either but now I love it and can't imagine having to work anywhere else. (except maybe the ED someday)

That's different for me...every peds unit I have seen admits peds and only peds! And for my pediatric rotation I was at a children's hospital, so of course everything there is pediatric-based. I have had teenagers (16-17yo's) come to my unit at my previous institution, but that was it. We never had peds patients, because the children's hospital was right down the street. As for my floor, we primarily have a cardiac focus, but of course we get patients with all sorts of diagnoses. We have designated pediatric rooms that are all right next to each other, but we can and have had adult patients next to those rooms, as well. We are primarily an adult floor that recently started accepting pediatric patients. We have all of the equipment ready, but I still don't think my unit is adequate enough to be a pediatric floor. We don't have a play room to help foster their development, which I know is very important to pediatric patients (THAT I do remember from peds! :)) and EVERY peds unit I have been to has a play room of some sort.

That's so nice that all of your patients get goodie bags and handmade blankets and pillow cases!

I still have no desire to work in peds, but maybe one night I will be assigned the patients and that will all change...who knows!

~Mi Vida Loca~RN, ASN, RN · Jul 20, 2011

That's different for me...every peds unit I have seen admits peds and only peds! And for my pediatric rotation I was at a children's hospital, so of course everything there is pediatric-based. I have had teenagers (16-17yo's) come to my unit at my previous institution, but that was it. We never had peds patients, because the children's hospital was right down the street. As for my floor, we primarily have a cardiac focus, but of course we get patients with all sorts of diagnoses. We have designated pediatric rooms that are all right next to each other, but we can and have had adult patients next to those rooms, as well. We are primarily an adult floor that recently started accepting pediatric patients. We have all of the equipment ready, but I still don't think my unit is adequate enough to be a pediatric floor. We don't have a play room to help foster their development, which I know is very important to pediatric patients (THAT I do remember from peds! :)) and EVERY peds unit I have been to has a play room of some sort.
That's so nice that all of your patients get goodie bags and handmade blankets and pillow cases!
I still have no desire to work in peds, but maybe one night I will be assigned the patients and that will all change...who knows!

It's crazy how much it can vary. I have never been in Childrens Hospital. We have one an hr away. But when I had my hysterectomy at a different one then the one I am working at I was in for 4 days and back in for 2 days (complications) and I was on the Pediatric floor. We don't have a play room but they play in our halls. My unit was originally going to be an ICU from my understanding. It has really large rooms, all the fake wood flooring in the halls and rooms. Hydrolic lifts in the rooms. Our Halls are really wide and we have a little cubby section with toys and little push bike thingy and stuff that the kids can ride in the hall. I like that I still usually have adult patients every shift, but I like that they aren't high maintenance and I think the children area easier to work with and satisfy (except when drawing blood and stuff. LOL ) At times the parents can be a little harder to deal with though and I just went through that my last shift. But then lots of parents if you are giving their kiddo good care are so grateful and it's the area of nursing that you truly get that Thank you. Anyway, that's just been my experience so far. I don't have a lot to base it off os with 5 shifts but so far I love the unit I am on.

The problem you ran into although yea it's good the manager told you, I would think that with you being SOOO new, that this should have been relayed to your preceptor and them go over it with you. It's nerve wracking enough being new and only makes it worse I would imagine to having the big boss keep calling you that missed stuff when it was stuff your preceptor had the responsibility of letting you know. Now had it been weeks you were on the floor and something you kept missing, sure I can see the manager calling. But 2 days????

turnforthenurse, MSN, NP · Jul 20, 2011

The problem you ran into although yea it's good the manager told you, I would think that with you being SOOO new, that this should have been relayed to your preceptor and them go over it with you. It's nerve wracking enough being new and only makes it worse I would imagine to having the big boss keep calling you that missed stuff when it was stuff your preceptor had the responsibility of letting you know. Now had it been weeks you were on the floor and something you kept missing, sure I can see the manager calling. But 2 days????

Well, QM is very serious about getting "100%" on all of our quality measures at our hospital. QM was the one that demanded an "action plan" be done because I failed to convert home meds to inpatient. I'm sure my preceptor that night got a call, too. My manager told them that her and I will work together and I will be shown how to properly convert those meds, which is perfectly fine. It's hard when everything is so new, you forget to do things. And when we took our computer class on this stuff, I remember our instructor stressed the importance of documenting med compliance, which I did correctly...but of course I forgot that last step.

QM wants more, though. They are making me write a paper what happened -_- That is what QM wants, though. And I didn't get that call until last week, though, so it wasn't like I worked my second night and got a call that next morning. Like I have been telling myself...you live and you learn, right?

~Mi Vida Loca~RN, ASN, RN · Jul 21, 2011

Well, QM is very serious about getting "100%" on all of our quality measures at our hospital. QM was the one that demanded an "action plan" be done because I failed to convert home meds to inpatient. I'm sure my preceptor that night got a call, too. My manager told them that her and I will work together and I will be shown how to properly convert those meds, which is perfectly fine. It's hard when everything is so new, you forget to do things. And when we took our computer class on this stuff, I remember our instructor stressed the importance of documenting med compliance, which I did correctly...but of course I forgot that last step.
QM wants more, though. They are making me write a paper what happened -_- That is what QM wants, though. And I didn't get that call until last week, though, so it wasn't like I worked my second night and got a call that next morning. Like I have been telling myself...you live and you learn, right?

I guess, that still seems excessive for a really new grad though. We do the QM stuff also. Our scores are emailed out weekly or bi-weekly and we get bonuses every year if we meet certain scores. Something like that.

Most of it is repetition, thankfully my preceptor has been really good on catching anything if I miss it. We will see how it goes tomorrow. Our facility just implemented CPOE (away with charts for good and docs enter their own orders) so it's been a bit crazy. They have been implementing it in their other facilities and it's finally reached ours.