New hospital with agency...no orientation?

Specialties Agency

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Specializes in ICU.

I have been agency/float full time for almost a year now and have floated to probably 30 different units, but wanted to bounce something off everyone. I just finished paperwork for a large multi-hospital system and also completed a single 4 hour orientation at one of their hospitals. I am now eligible to float to ALL of their hospitals without any more orientation anywhere. Would you be comfortable with it?

Here's my thing...I'm an ICU nurse, and never knowing what kind of assignment I might end up with, this just feels really unsafe to me. Yes, I am flexible and good at figuring things out on my own, but what if I walk into a critical patient situation and haven't had time to get Pyxis access, know where the code carts are, etc...? Even stable ICU patients are still ICU patients for a reason. I don't think I should be expected to come in early on my own time to learn all this, either, even though orientation pay is lower. My agency is very willing to sign me up with more orientations. I feel like I want a couple of hours at each new hospital just to knock out the basics.

Or am I being overly cautious?

Your thoughts are appreciated.

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Specializes in Med/Surg, LTACH, LTC, Home Health.

Float nurse here! My manager and I had an 'exchange' of words because I have a right and she has an obligation to make sure that I have propers orientation to every location in which she expects me to perform, ESPECIALLY if I have never worked a particular area in my entire career. Recently, I was floated to the ER after having NO experience in that area since LPN clinicals back in 1985. Although I'm an RN now, I've still ONLY worked med/surg for the majority of my 27 years of nursing. Things are different in the ER. We are fast-paced on the floor, maybe to to the extent of the ER, our documentation system is different on the floor, we are not expected to interpret rhythm strips on the floor as we don't have monitors there, and the list goes on. Not only was it not fair to me or the patients but IT WAS NOT SAFE!

To answer your question, you better believe you deserve an orientation. It is YOUR responsibility to safeguard YOUR license!

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I would feel the same way. I recently hired on as agency and even though I am used on different floors, it's crazy how even some of the staff do not even know how to do some of the usual routine items on that floor. Nursing, at any hospital, in general-----is zany and we never know what to expect. Par for the course. I think it's great you've worked ICU as it's quite specialized therefore you probably know quite a bit than the usual floor nurse, although on other floors there are so many more patients you'll go crazy trying to do the usual very focused assessment per pt that you are used to.

If MORE orientation is available, and you don't mind the cheaper rate you are paid for that time, go for it!

Take care

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I think I agree with you, there should be an orientation because one has to be careful too.

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I wouldalso want to be oriented. I'd hate to need somethin in a hurry and not know where to go

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Specializes in Alzheimer's, Geriatrics, Chem. Dep..

I worked agency (just one assignment) and got a very good orientation - I can't imagine just walking in. If you are a float, too, you will get at least a good hospital orientation. :( does not seem very safe to me! Hope you do well. ...

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Hi! I have been an RN for 26 years and an agency nurse for the past 6 years. I have never received what I considered adequate orientation at any job I've ever had, no matter what was promised. As an agency nurse, you might get 8-24 hrs orientation, by the facility, IF you are taking a contract for 6-12 weeks. If you just accept assignments on a PRN basis, you are expected to hit the ground running from a cold start. That's why we get paid the hourly wage that we receive. When I go to a facility for the first time, I try to get there 30-45 minutes early, so that I can get myself oriented. Change of shift report time is not the time to try to orient yourself. Prior to accepting the assignment, ask your agency to find out staffing ratios, staff style (primary care vs team nursing), what computer system they use, specific department you will be assigned to, etc. The agency should be able to give you enough information to help you decide if you want to accept the assignment. I know going in early is a drag, but this is your license we are talking about! Agency nursing is not for everybody. It takes a great deal of experience and self-confidence. It is becoming more and more difficult as Obamacare is forcing electronic records. It seems that few facilities are using the same computer programs (and there are a lot of bad ones out there). In the days of paper charting, everyone wanted the same information. You just had to read the forms and fill them out. Nursing is nursing, no matter where you are. It is up to you to orient yourself to the surroundings and find out as much as you can before accepting the assignment. If you arrive at the facility and find that things are not as they should be...phone your agency immediately and let them handle it. Many facilities will try to give you the most patients, the sickest patients, the hardest to care for. After all, you are the "high-paid agency nurse". Also, some agency nurses have given all of us a bad name by their poor performance. Stand up for yourself - before and after accepting the assignment. It is a very stressful way of life and I am looking for a permanent position for less pay. Trying to juggle 8 different computer programs has just about done me in. Don't you just love technology? A lot of us older nurses will be leaving the profession because we are tired of it taking 30 minutes to give one pill because of a computer glitch. Unfortunately, nursing is not what it used to be. Good luck to the poster and everyone who made entries.

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Specializes in peds palliative care and hospice.

Run.

Run fast and far.

Good luck.

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Specializes in ICU.

Great, I feel totally vindicated. :) I've set up some additional orientations at these places and feel totally solid that it's the right thing, not just for me but for my patients. Thank you everyone!

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your not asking too much for the safety of yourself and your patients. A little orientation makes you a better team player. I am a traveler and have been in the situation only 1 time in 5 years that the orientation was not worked into the first 2-3 days. made my contract frustrating for me as well as co workers. I now ask up front the orientation planned and share my comfort level of 2-3 day shifts and 1-2 night shifts or a combination

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agree with "mawheels1" poster...i do per diem icu work and my 'orientation' is arriving to the facility at least 1 hour early to figure things out...where to hang my coat, where to put my lunch, medication cart & code for it or grab a nurse to log me into pixys, where supplies are, write down most important hospital numbers -- lab, pharmacy, dietary, md on call, and how to dial them (yes, some phone systems are that complicated!!!) iv pumps and where to get my piece of paper so i can paper chart (cuz if they required an agency staff to do computer charting then they def. should have oriented you to that).

this amount of time is the minimum required to orient yourself to a new place, and in most agency circumstances its expected that you would do that to get familiar...i consider myself lucky at times, that they let me just come in as early as i want and start lurking/poking around to figure things out, so my advice is to use that precious time to help your shift go smoothly. you mention you have icu experience, so you know, many things run similarly from icu unit to unit and having that experience helps. if lower-pay orientation is available i would DEFINITELY take that...in fact i would do it for free to help myself and ensure a smooth shift, especially if there is opportunity for lots of work in that particular department...then its really kind of like paid training, considering i'll be getting lots of work over time.

you'll do fine. good luck :)

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It is becoming more and more difficult as Obamacare is forcing electronic records. h

Electronic medical records is a product of the Bush Administration. The purpose of them being put in place is so the patient would have more portability to seek cheaper medical care.

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