Orientation for Experienced Nurses

[Ruby Vee]

So you're an experienced nurse, and suddenly you find yourself, once again, in orientation. Maybe you've lived in Seattle and you want to live somewhere with more than 65 days a year of sunshine; maybe your husband just got transferred to Omaha or Anchorage or maybe you've just decided that you'd like to try a new specialty, a different hospital or a new city. Anyway, you find yourself orienting for a new position and whether you've chosen it or been dragged into against your will, you are now the know-nothing newbie.

You want to show your new colleagues that you AREN'T a know-nothing, that your previous experience was valuable, that you've learned a lot, you know a lot and you can teach them something. I've always said that if I don't learn something new from every orientee, I'm not doing it right as a preceptor. But there are limits.

Last night, I worked with an orientee who is doing it wrong. And so, for those experienced nurses out there who are going through, about to go through or may someday go through orientation again, here are some tips.

"I don't know why they paired me with GRETCHEN. She's ten years YOUNGER than me. She has practically NO experience. I don't think she can teach me ANYTHING."

Gretchen is in her twenties, but she's a solid intensive care nurse, and if nothing else, she can teach you how we do things HERE. I know you were the expert at your old job, that you have a decade more experience as a nurse than Gretchen and there are hundreds of things you can teach her -- and me -- but that's not why you're here. You're here to learn how WE do things, how to take care of our patients, how to work with our equipment (not the wonderful stuff they had at your old job, but the pieces of junk we have here) and our surgeons. Blathering on and on about how it's terrible that you're paired with such a young and relatively inexperienced nurse isn't going to impress me, is going to make Gretchen feel terrible and isn't going to go well with our management team who chose Gretchen to be your preceptor for a reason.

"I can't BELIEVE that make you go to meetings here and not get paid overtime."

"We get straight time for meetings."

"Then they pay you overtime for the first two hours of your next shift."

"No, meetings are additional straight time. No overtime."

"At my old job, we got paid overtime for meetings. It's not fair. How can they require you to come in above your hours and not get paid overtime? I won't do it!" (Repeat X 2 or 3.)

This is how we get paid. I don't make the rules, I don't even like the rules. I don't want to defend the rules, but it is my responsibility to explain them to you and make sure you understand them. If you don't like them, I get that. But you're going to have to make a choice: do you want to work here with our pay schedule? Or do you not? Because believe me, the institution isn't going to change the rules just for you.

"At my OLD job, we had a much better way of doing things. Your way sucks." OK, the first time I hear that it might be interesting. Perhaps the second or third time -- it depends upon how interesting you make it. But by the fourth, fifth or seventeenth time, I'm bored, irritated and perhaps downright angry. If your old job was so much more wonderful, why aren't you there now?

"I can't believe you guys put up with such substandard equipment! We had all the best stuff at my old job."

"You have too many new grads here. That's dangerous!"

"I can't believe they're letting residents in the ICU! At my old job . . . '

"I know, I know. But at my OLD job, we . . . "

Again, if your old job was so wonderful, why aren't you there? I'm beginning to sense a theme here. Perhaps you aren't at your old job because you didn't fit in to the unit culture. I'm starting to see how that could happen, you being so all-knowing and perfect and all. Maybe you are right, and no one here likes you. Gee, I wonder why not.

If you're experienced, that's great. But we don't want to hear all about your old job until after you've proven you can learn this job, you're off orientation and we're all sitting around at 3 AM telling stories because all of the patients are st**** and there's nothing to do. Just keep your eyes open, your mouth shut and SHOW us what you know rather than TELLING us. And don't diss your preceptors.

Now if I'd known all that at 25, I would have had a much smoother transition into MY second job!

[firstinfamily, RN]

I will be the newbie starting next week, general hospital orientation will begin, so I most likely will not be on the floor until the 10th. I do try to let the preceptor show me how things work etc, this particular facility was one I had worked before, so there probably are not many changes. I however, do not want to just follow someone around for weeks on end. For me to learn I have to perform the task myself, sometimes preceptors just want to get it done and do not allow time for the orientee to do the tasks. I will mostly need to get the computer skills down, I know how to assess and give medications, so hope my orientee will understand this. It is hard being the newbie no matter what skill level you are. Plus, there is the generation difference and you are trying to fit into a group that is already established. Then the high school mentality comes into play and that is when I start to lose it. I just have learned over the years to keep to myself unless I am asked. I am rather opinionated, but try to look at things from a variety of perspectives. I do not usually go with the flow just because it is the popular flow. If I have questions, I will ask. I do not assume anything!!! I however, cannot believe that anyone with as much experience as I have will need 4-6 weeks of orientation. I will see how it goes, but I most likely will want to come off before that time. I want to get established in my routine on the shift I will be working. I was hired as weekend option 7p-7a, working 5 out of 6 weekends. I am looking forward to it, I think by having a routine schedule will help me adjust better to night shift. Last time I worked 12 hour nights was over 22years ago!!! I worked day shift or evenings 8 hours after my last child was born, so it will be a huge adjustment for me. I will remember this post and the input from everyone while I am orienting and hopefully I will not rock the boat too much and come out with a positive attitude.

[starlane]

There are some relevant points here. However, sometimes people have to change jobs not by choice, but by circumstances, and sometimes things really can be done in a better way. Respect an outsider's perspective.

That is true, however if you are newly hired you do have to show some respect to the people working there and even if this job is not ideal, the person should be thankful they HAVE a job.

[VANurse2010]

Of course, but a little bit of understanding on the existing unit employees' part goes a long way.

[Ruby Vee, BSN]

That is a great technique! It is one of the best things you can do is to encourage new orientees, or really any surly staff, that have a lot of negative input is to offer them to be a part of the committee or workgroup that has created a policy. It allows them to be a part of change, if they choose, and if they choose not to, (at least in my eyes) it takes away their right to complain! :)

I think it's a good idea to encourage the complainers to be a part of the solution, but I'm thinking it's probably better to wait until they're off orientation and have been around long enough to have a good idea what's going on on the unit.

[Ruby Vee, BSN]

Of course, but a little bit of understanding on the existing unit employees' part goes a long way.

There's a little bit of understanding on the existing unit employees part, and then there's putting up with a nasty new employee who constantly belittles and puts down her new unit and new colleagues. I'm saddled with the latter.

[Bridgid Joseph, BSN, MSN, APRN, CNS]

firstinfamily, it is interesting that you refer to the "high school mentality" of established staff, it has become something that is now termed "lateral violence" and I know a lot of hospitals are trying to stop it altogether, but it is a tough one to end; it is a cultural shift. It's true some of the different personalities you walk into on various units sometimes, but there are always a few welcoming people, so good luck an I am sure you will wow them :)

[Bridgid Joseph, BSN, MSN, APRN, CNS]

Ruby, of course, you are correct. I was thinking as my role as CNS, if I saw or heard about that behavior from an orientee, I would encourage them to be a part of the solution to the problems once they were off orientation and in the groove a bit. It's one of the techniques I use with all my staff, to be honest with you.

[bagladyrn, RN]

Being a traveler I am the perpetual newbie. You make good points, some of which I emphasize when talking to new travelers - especially the part about shutting up about "where I came from".

I'd like to pass along a couple of things from the other side of the equation and get your take on them:

Since I am an experienced nurse in my specialty you can assume I know how to do the basic tasks - for example I do not need you checking after me on a lady partsl exam. I'm not going to participate in putting the patient through that and increasing her risk of infection. However if you want to stand and watch me perform basic care you are welcome.

I will only get 1-2 shifts at most of "orientation" so it would be helpful if you ask me "What do you need to know?".

If I ask you to review a procedure or go over a piece of equipment with me do not exclaim "I can't believe you don't know that!". Realize that you (the generic you) have been working at your one facility since graduation and the rest of the world may do things differently or use different equipment. That being said I will do things any way your facility wants it done as long as it is not potentially harmful.

If you want to know what my background or level of experience is just ask. I have no problem with that. I won't bring it up myself though because I don't want it to be taken as putting down the young nurse orienting me or trying to boost myself.

Any feedback on this?

[dudette10, MSN, RN]

If I ask you to review a procedure or go over a piece of equipment with me do not exclaim "I can't believe you don't know that!". Realize that you (the generic you) have been working at your one facility since graduation and the rest of the world may do things differently or use different equipment. That being said I will do things any way your facility wants it done as long as it is not potentially harmful.

I'd like to ask you a question on this because I want to know the best way to approach education of an experienced nurse. Would it be helpful to ask you how you did it before so that I have a frame of reference from which to explain a procedure or piece of equipment? For example, I could say, "Ok, we do everything you've done except the X step. The reason why we do that part differently is Y."

Would that be the most helpful approach to it? Or is there a different way that you prefer?

[bagladyrn, RN]

I'm pretty proactive in saying "I haven't used this model (of whatever equipment) before" and in looking over the policy for various procedures when new on a contract.

The best way I think to approach this is to ask - "Have you used this model before?" or "This is how they like us to do this - is this what you are used to?" and show the traveler where the p&p manuals and instructions for use of equipment are kept.

My biggest problem area is quickly learning new computer systems at each place. I find myself inadvertantly trying to use commands from the previous one that are still stuck in my head. Be patient when the new person asks "How do I enter this again?" especially those of us that didn't grow up on computers - it isn't instinctive the way it is for youngsters - we have to learn it each time!

The main point is not to "put down" someone who hasn't done it your way. (Again, the generic you)

[Ruby Vee, BSN]

Being a traveler I am the perpetual newbie. You make good points, some of which I emphasize when talking to new travelers - especially the part about shutting up about "where I came from".

I'd like to pass along a couple of things from the other side of the equation and get your take on them:

Since I am an experienced nurse in my specialty you can assume I know how to do the basic tasks - for example I do not need you checking after me on a lady partsl exam. I'm not going to participate in putting the patient through that and increasing her risk of infection. However if you want to stand and watch me perform basic care you are welcome.

I will only get 1-2 shifts at most of "orientation" so it would be helpful if you ask me "What do you need to know?".

If I ask you to review a procedure or go over a piece of equipment with me do not exclaim "I can't believe you don't know that!". Realize that you (the generic you) have been working at your one facility since graduation and the rest of the world may do things differently or use different equipment. That being said I will do things any way your facility wants it done as long as it is not potentially harmful.

If you want to know what my background or level of experience is just ask. I have no problem with that. I won't bring it up myself though because I don't want it to be taken as putting down the young nurse orienting me or trying to boost myself.

Any feedback on this?

We've had a run of travelers lately, and some of them, despite their claims to have had years of experience in our specialty, aren't safe when it comes to some of the more specialty-specific care. We have to ensure that they're safe before we allow them off orientation and give them free rein with our patients. Some of the more experienced (and proficient) travelers are insulted that we need to watch them perform nursing care tasks, yet half of the most recent batch of travelers were NOT proficient, despite their claims, in our specialty. It's not a matter of not doing things our way -- and you're right, many preceptors have been in the same job since graduation and do not understand that there are other ways of doing the same thing -- it's a matter of not being safe.

Because of our acute staffing needs, we've let some travelers off orientation with a note to the charge nurses to assign them only to patients who are stable and perhaps close to transfer and then to watch them carefully. That puts a lot of burden on the charge nurse.

Traveling is a specialty of it's own, and most experienced travelers (the ones who have traveled for a while and aren't just fresh from "my hospital") are very astute at getting the information they need in a short amount of time from even the greenest preceptor. I've been having more problems later with the new hires who have years of experience at the same job, and have been used to doing things a different way. They seem to have a lot of difficulty understanding that there are different ways to do things and that they need to change their thinking a bit to fit into their new job.

[Ruby Vee, BSN]

I'm pretty proactive in saying "I haven't used this model (of whatever equipment) before" and in looking over the policy for various procedures when new on a contract.

The best way I think to approach this is to ask - "Have you used this model before?" or "This is how they like us to do this - is this what you are used to?" and show the traveler where the p&p manuals and instructions for use of equipment are kept.

My biggest problem area is quickly learning new computer systems at each place. I find myself inadvertantly trying to use commands from the previous one that are still stuck in my head. Be patient when the new person asks "How do I enter this again?" especially those of us that didn't grow up on computers - it isn't instinctive the way it is for youngsters - we have to learn it each time!

The main point is not to "put down" someone who hasn't done it your way. (Again, the generic you)

I feel you on the computer systems! In the nearly ten years I've been at my current job, we've changed computer systems four times and are about to make a fifth change!