Published Feb 26, 2005
I have been offered a staff RN position in a 51 bed Level III NICU (Los Angeles area). I have no NICU experience, but have been a Nurse for 10 years. Currently I work at a small overseas military hospital on an LDRP unit and have some adult ICU experience. My main question is how long of an orientation do you think I would need? I want to make sure I'm not short changed. Also, is it reasonable to demand the same preceptor for the entire orientation (and also request that it is someone who really likes to teach)? Also, I still feel like I should research other NICUs in the area rather than accept the first offer I've received, but I'm not sure how to tell the difference between them all. What kinds of questions should I be asking? Any red flags to watch out for? Thanks so much for any advice you can give me.
Of course orienting and precepting in an NICU is going to vary widely based on the area of the country, type of hospital, size and budget.
Our unit is at a univ. affiliated teaching hospital. The total program runs 10-12 weeks depending on the size of the group. Classroom and beside training are taught by masters prepared RNs who have been doing it for 25+ years. That usually runs about 4-6 weeks and includes some testing-both hospital required and unit required. After this the nurses are in preceptorship for about 6 weeks, longer if they need it. They usually rotate shifts during this time and therefore, will have 2 or 3 different preceptors. This is actually a very good experience, because there is so much to learn on the different shifts and you can get a full appreciation for what you will be facing once you are on your own. We have trained preceptors for both shifts and they will help their preceptee get as much experience as possible. Once out of preceptorship. The charge nurse and experienced staff nurses continue to monitor the new nurses as needed. We will go on transports, run resus, and back them up during death and dying. Generally, the previously experienced nurse, as you are, is more organized than a new grad and is able to take in the learning and the doing without getting overwhelmed. Hope this helps. Good Luck!
llg, PhD, RN
For an experienced nurse (but not NICU experience) 10 - 16 weeks is typical, depending on how much time they spend on classes. Some units teach all their classes in the beginning. Some like to intersperse their classes with clinical practice so that the orientees can use their clinical experiences as a basis to better integrate the classroom content. I prefer that approach -- combining classroom teaching with clinical experiences so that they can reinforce and enhance each other.
It is not a good idea to have only 1 preceptor. Different people have different strengths and you are better served by getting to work with 2-4 prececptors on a regular basis. That way, you have enough continuity to establish a good relationship and can better build on past experiences ... but you also have little variety to learn from the personal strengths of each one and to be exposed to multiple ways of doing things. Too much of "one thing" and one perspective only often stiffles growth and limits a person's development.
Also, with a lengthy orientation, being "joined at the hip" to the same person every day can become unpleasant for both of you. Even in a great romance, you need to come up for air now and then. It's emotionally healthy to have a little time apart and to not become overly dependent upon 1 person to fulfill all of your needs. The same goes for preceptors.
llg (with about 15 years of NICU orientation/staff development experience)
Thanks so much for your input! After getting a really terrible orientation on my current unit (shuffled daily from one preceptor to the next--resulting in noone investing much time in teaching me anything but the bare basics), I'm really intent on not reliving that experience. In other words, I guess it's not that I'm deadset on having just one preceptor, but I am deadset against having 10 preceptors! Any advice on how to spot a "pit from a palace" before you start working there? Thanks again for taking the time to reply. I'm so excited to join the ranks of the NICU nurse and just want to make sure I get the best training possible.
Personally I do think the number of preceptors should be limited and I don't think you need to rotate shifts when you are first starting in the NICU. That way you get more consistent information and they really know where you are in the learning curve. 2 or even 3 preceptors is reasonable. I wouldn't want any more. Been there, done that. Rotating to other shifts can always be done later when you feel you've got your shift down.
I think the best way to spot a pit from a palace is to actually visit it and talk to someone who works there. You can also ask about turnover (if they are losing a lot of staff, there's a reason!).
The others have given you good advice about orientation. I'll just add my $.02 on a couple of other issues. After you interview, definitely ask to shadow a nurse for a shift before making your decision. You will learn a lot in 8 hours of observation!
Secondly, RUN, DON'T WALK away from any unit which doesn't have at least 50% of its staff with 2 years or more of NICU experience. Once orientation is done, you will need mentoring from experienced nurses in order to be successful. If you work in a unit (or on a shift) that lacks sufficient numbers of experienced nurses, you'll sink fast!
Also, ask what the average length of tenure is of the nurses on the unit. Most NICU nurses either love it or hate it, meaning they get out of the NICU fast, or stay forever. Any reputable unit should have a relatively long "length of stay" for its nurses.
BittyBabyGrower, MSN, RN
I agree with fergus...we usually have a person teamed with 2 preceptors. We orient on the shift the person is going to work on but we do have them go to days for a week or two just to be able to be there for rounds, etc. Very different atmosphere! You also get more experience with procedures and going off the unit for OR's and tests. Our orientation is about 12-16 weeks, depending on the person. We meet with either the AUM or the CNS once a week to go over how things are going and what our next goals are and to hash out any problems. Not everyone clicks with everyone else and sometimes we have to move around preceptors. After orientation is done, you are on your shift with a resource person. You don't do admits for the first few weeks, you don't get canceled or floated for 6 months. If you are given a one on one, the charge nurse is usually right there with you. I have to say our unit is excellent about not eating our young, we are very supportive. :)
Adding my .02 also.
Since you know your learning style I'd be sure to ask about the orientation process. Such as how many preceptors you are going to be with, how you are paired with a preceptor. This was important to me as one place I worked just picked whoever was available. Another place tried to match based on how we answered questions about how we learned best.
I'd also ask about job requirements. For example one NICU I worked at we had to take call (2 shifts per 4 weeks) we had to work every other weekend, we had to take STABLE and of course NRP and were required to attend 4 staff meetings per year.
Another place I worked it felt like I had to spend my whole life at work. We had to attend 6 staff meetings per year, we had to join a committee and stay active in that committee, we had to do projects and present them to the staff, no call and we had to work one weekend per month, we had a breastfeeding class that had 8 hours worth of class time then we had to go out and help 3 moms breastfeed, rotating shifts(2 weeks days; 2 weeks nights) had to have a certain number of CEU's etc etc etc
Ask what a typical assignment is
Are there NNP's, residents, respiratory therapists
Educators- class time (the first NICU I worked in had No class component and No educator; so if that's important to you make sure they offer it)
Floating- how often and to where are your going to be required to float- I worked for a hospital where a nurse is a nurse and we could float to ANY ICU- needless to say I only stayed there 4 months!
how are you evaluated
I second shadowing if you can.
Thank you all SO MUCH for your advice. You all brought up so many things that I hadn't ever thought of (or wasn't sure would be appropriate to ask). I feel so much better now. Thanks again. Just as a side note...I've been a NICU wannabe for some time and have spent many an hour lurking through this forum. Your advice and experience has really been a great source of inspiration and encouragement for me. Thanks again.
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