For new grads/when you first started out, how long was your orientation? What kind of unit were you on? Did you do an internship or no?
I'm a new grad in progressive care, but I am also cross-trained to work in the ICU. I have been given 6 weeks to orient. I am starting my 4th week this week. I made sure everyone I've precepted with knew that I am a brand new nurse. I learn by actually doing things, not just by watching people do them, so on my first night, that's what I did! And that is what I have been doing since.
The nurse to patient ratio is 1:4. I have been slowly increasing my patient load. I am now up to 3 patients and I had my very first admission last week, which went very well, but the patient loooooooved to talk...the patient was very lonely and had no one to talk to so I let the patient vent their feelings/frustrations, but seriously, this patient had a whole life story with EVERY SINGLE QUESTION I asked! I was in there for well over an hour and when I was finally set free, it threw my whole night off. I had meds that were very late, another one of my patient's IV infiltrated while I was away and the arm was swollen (though I will admit I have seen worse)...I spent from 2300 until about 0400 playing "catch up" between giving meds (a lot were IV abx, thankfully no vanc!) and charting everything. I ended up delegating the IV stuff to another RN because I just couldn't get to it.
Regardless, everyone I have been with have told me that I am doing a great job. I have been told I have great organizational skills for a new grad. Yet I don't feel this way. I feel like there are things I should know, but don't. I realize that one can never know everything and I never pretend to know everything. If I am the least bit unsure, I ask.
I have already been "talked to" about two things from my manager. My hospital partakes in "quality measures" for things such as chest pain, CHF, pneumonia, etc, and I'm sure many other hospitals do the same. On my second night on the job, we had a new admission. The day shift nurse did the admission stuff and then gave report to me and my preceptor. I was looking through the chart and pointed out that the patient qualified for quality measures but they haven't been initiated, so I did. I did everything right, made sure I documented the med compliance part because that is very important, but of course I got a call from my manager saying that I failed to convert home meds to inpatient. My preceptor is also at fault for failing to tell me to do that important step, since she was sitting right there next to me walking through the steps...but it was MY patient that I was assigned to and I felt pretty disappointed when I got that call! And I didn't tell my manager "well, so-and-so was with me that night and didn't tell me that." It is really disappointing because that was my SECOND NIGHT. My manager told me that she does not want me to feel discouraged or feel like I am being "singled out" in any way and realizes that I am new and everything here is new and everything is information overload. I was reassured that she sometimes forgets to do things and she has been with the hospital for awhile now. Then today I got a call for not initiating orders on a patient I had a few nights ago. Some orders were not initiated on day shift whom I received report from and I obviously didn't initiate them either. I thought I had everything but I obviously missed some stuff. Again, it was just a reminder, and was told again that yes I'm new so it is okay (but the day shift nurse is NOT) and yes, we all make mistakes and thankfully I didn't make some potentially fatal med error or anything on my fourth week, but it is still pretty disappointing to me. But you live and you learn, right? Ultimately patient safety was maintained and there was no harm done. I just wish my preceptor would have also pointed this out to me.
"How" were you oriented? Like I said, the first night I just sort of observed and wasn't given any actual patients, yet I still just jumped right in and did things because I felt stupid for just standing there and watching my preceptor do an assessment and other things. My patient load has gradually been increased. I am with a preceptor each time, but pretty much with a different person each time. Everyone has been super helpful and super patient and receptive to all of the questions I ask. Even though I am "with" someone, they still let me do my own thing and periodically check up on me to see if I am doing okay, or see if I have any questions, and encourage me to ask them! When you were orienting, was your experience like this as well? Or did you have a preceptor constantly over your shoulder watching every little thing you do?
Sorry for the length. Thank you for reading; I would appreciate your thoughts.
We have CPOE, too, but we find that a lot of times the nurses are the ones putting in the doctor's orders and then the doc signs off on it. In a staff meeting the other day our director mentioned that a patient in the past had 40 orders; all but 7 were entered by a nurse! We're trying to change that. Still, I think it is one of the greatest things ever done for nurses - no more having to try to decipher crappy handwriting and call the doc up asking for clarification on the order!
Specializes in Emergency Dept. Trauma. Pediatrics.
The Docs have already got a "talking to" regarding it all. We are told once in a while is ok. We will see how it goes. Another facility that is the same company has done it for a few years now and its going good. Was definitely nice when I did clinicals there. I can't read the docs writing at all and I hate chart checks!!!!
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turnforthenurse, MSN, NP
3,364 Posts
We have CPOE, too, but we find that a lot of times the nurses are the ones putting in the doctor's orders and then the doc signs off on it. In a staff meeting the other day our director mentioned that a patient in the past had 40 orders; all but 7 were entered by a nurse! We're trying to change that. Still, I think it is one of the greatest things ever done for nurses - no more having to try to decipher crappy handwriting and call the doc up asking for clarification on the order!