Orientation for Experienced Nurses

[Ruby Vee, BSN]

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!

[llg, PhD, RN]

Great post, Ruby.

I have spent a lot of my career working with orientees -- and have heard such comments WAY too often. They have become like fingernails on a blackboard. Sometimes, you just want to say, "Fine. If you hate it here so much, go work somewhere else."

[classicdame, MSN, EdD]

such high school attitudes! Orientation should be expected of anyone in a new environment. That said, you do not have to p rove anything to anyone other than your boss and preceptor.

[NickiLaughs, ADN, BSN, RN]

Truer words were never spoken....

[VANurse2010]

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.

[kngl]

People who are overly critical can be difficult to deal with. Sometimes the best thing you can do is redirect it. These types of people may not be aware of how they are perceived by others. In response to "we did things so much better at my old job..." you could say "It's appreciated to have a fresh set of eyes. Let's focus on getting you up to speed here then once you finish orientation you can come to the staff meetings and work with others to see if we could make changes." Or in response to her criticism of orienting with a young nurse you could say "Gretchen is a fantastic nurse and people here know it. It's great how nursing can encompass people with such different backgrounds and experiences. I'm sure you two will learn a lot from each other!" Kill them with kindness yet don't leave an opportunity for them to respond, hopefully she'll get it.

[LadyFree28, BSN, LPN, RN]

I feel your pain.

Sometimes those particular individuals go back to their old job. :)

Sending positive vibes that this person finds happiness, and that you and you unit can help her get it or move on without them!

[annie.rn]

As my father always taught me: when in a new job, keep your eyes and ears open and your mouth shut for the first 30 days. Gives you time to learn the culture and not make enemies before you've really gotten started. Has done me well throughout my life.

[icuRNmaggie, BSN, RN]

It was a little awkward when I had a travel job and was being oriented to the routine by this super nice super smart young girl. We were talking about about backgrounds and such and I decided just to say well Ashley, actually I was a nurse probably before you were born. :) It was a joke and it broke the ice, and we became friends and I dressed up as a potted plant for her halloween party.

I showed her the respect she deserved, and we had fun working together. She was a whiz with the Epic EMR. I was treated very well at this medical center and I will go back someday.

For what it's worth, when you are the new person, do not disparage the way they do things. It really is offensive. If they want your opinion they will ask for it.

[tyvin, BSN, RN]

Far to familiar with this topic. I have come to believe that most new hires that are experienced RNs are anxious to prove themselves.

In doing this they reply to comments to create a rapport. Yet, in doing so, when replying, they fall back on what they are familiar with and that's the last job they came from.

I feel also that most of them have no clue as to what they sound like. Trying to fit in at a new job is very hard. I try to give them a break and I rely on my gut when choosing to let them spread their wings in acquiring more responsibility as far as patient care in concerned.

Remember, it's not a personality contest, we are training them to work beside us. Smile, try not to be too offended when they show you a better way to do something, and most of all; be empathetic. Stress makes us do funny things.

[BSNbeauty, BSN, RN]

Great Post Ruby! I agree with every word.

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

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! :)