Old New Grad w/ 4 weeks orientation

[shakeela1027]

I have been a psych nurse for about a year. It was the only job I could get right out of nursing school. The facility that I worked in had a structure where the RN was the charge nurse and the LPT/LVNs pass the meds to all the patients. While I was working as a charge nurse on the unit, all I did was paperwork. The vital signs were done by my floor staff and I just ok'ed or confirmed whether the patient was okay to be admitted on the unit. Most of the patients that came in the unit didn't have any acute issues and about 30% of them had chronic health issues. I did not have to provide any medical care whatsoever. I did apply for medical jobs throughout the year but I got no responses. Now that a year has passed, I applied again and got a job offer to work in the telemetry unit. Of course, since I already has worked as an RN for a year in locked psychiatric unit I was no longer considered a New Grad. My only problem is that because it has been so long since I practiced my skills on a skill level I am very much a new graduate. On top of that, the telemetry job will only provide me with 4 weeks orientation. I am really contemplating whether it is going to be enough time for me. I am technically at a disadvantage since I have experience as an RN but not in medically-related sense. On top of that, it is hard in general to find jobs in a hospital coming out of a psych hospital so I know that I have take this opportunity. In addition to that, I was contemplating asking for extra weeks of orientation but the DON that interviewed me that I won't be granted extra weeks unless my preceptor suggested to her that I won't be ready to work on the unit by myself. I am nervous and anxious about this job. I have already accepted the offer and will be starting at the end of this month. Did I make the right decision? What should I do to prepare for the job? Should I keep looking for another job that would offer me more orientation days? I'm not sure what to do since I am so ill-prepared and rusty. Any advice or suggestion will be much appreciated. Thank you

[13grad71]

Go for it. The nursing skills will come back or can be relearned. Hospital jobs aren't easy to come by. The transition period will be hard but that is expected

[Green Tea, RN]

Why don't you go PRN for the psych job and take the tele job? By doing so, you can most likely go back to the psych job even if the tele job does not work out if it's not too late though..

[turtlesRcool]

I think your tele job sounds like a great opportunity, but agree that 4 weeks is painfully short for a new grad orientation. Before you start, get yourself in the mind set of a hospital nurse. Review all your cardiac stuff from nursing school. Make sure you're up to date on common medications (beta blockers, calcium channel blockers, diuretics, ace inhibitors, etc.). I'm sure you knew them all at one point, so just brush up on the "-lols" vs the "-prils" and so forth. There are lots of resources online to practice rhythm interpretation, so do some exercises since you will undoubtably be expected to read the telly strips and EKGs.

If it's been a while since you took a manual blood pressure, get out your cuff and your stethoscope from nursing school and practice on family members and friends. Heck, see if you can talk them into listening to their lungs and finding their pedal pulses. On telemetry, you'll come across a lot of people with lower extremity edema, and sometimes it can be tough to palpate their pulses. Don't be afraid to ask your preceptor for his/her tips on assessments for acute cardiac patients, and realize that even seasoned RNs sometimes have to get a doppler.

Of course, your cardiac patients will also just be regular med-surg patients, so check out YouTube for videos of common procedures. Since you haven't placed a foley in a year, review those steps. Little things like that can help you feel better prepared when you come across them at the hospital because the visual will be fresh in your mind.

Also realize that you're not expected to know everything or have done everything. We weren't allowed to start IVs when I was in nursing school, and I got very little training in that when I was going through orientation, so I frequently ask someone else to start one for me if a patient has tricky veins. To be honest, lots of experienced floor nurses kind of suck at IVs.

Lastly, be honest with your preceptor. Tell him or her that you're a bit out of practice with some of the hands-on nursing you learned in nursing school, and maybe talk through the steps before you go into a patient's room to perform certain tasks. For me, the biggest change between student nursing and floor nursing was the organization and prioritization necessary to take care of 5 or 6 patients rather than 1 or 2. I remember asking for feedback and advice on this because it was clearly my weak spot. One nurse told me, "You're already a safe nurse. Now you need to become an efficient nurse." You don't have much time with your preceptor, so be really proactive about asking for help and be diligent about putting it to practice.

Now breathe. You CAN do this!

[elkpark]

My only problem is that because it has been so long since I practiced my skills on a skill level I am very much a new graduate.

I think your tele job sounds like a great opportunity, but agree that 4 weeks is painfully short for a new grad orientation.

I understand the OP feels insecure about her basic med-surg skills and knowledge, but the reality is that she is in no way a "new graduate" and I don't see why it would be the new employer's responsibility to treat her as one. OP, nursing is a process of "lifelong learning," and, as turtles suggests, the onus is on you to brush up on your basic skills and knowledge in preparation for starting the new job. Your new employer must have confidence in your abilities to have offered you the position. It's likely that much of it will come back to you more easily than you expect. Best wishes!

:balloons:

[Nurse Beth, MSN]

Your only choice is to go for under their terms, and it's an opportunity. Best wishes

[Ruby Vee, BSN]

You have been a nurse for a year. You know about paperwork -- that it needs to be done, it needs to be done by you and within the appropriate time frame. You know how to talk to patients, to visitors, to physicians, to administrators . . . and so forth. You know the crushing responsibility of being "the nurse." You've got skills. You just don't have med/surg skills. You'll learn them in orientation.

Four weeks isn't long for orientation, so you'll have to concentrate and do your best. Your preceptor and your manager aren't going to let you loose on their patients unless they've got some confidence that you'll be a safe practitioner. You already know not to pretend to know something you don't, what to do when you've made a mistake and with a year's experience, you know that everyone makes mistakes. You've a lot to learn, and a fabulous opportunity to learn it. Go for it!

[beekee]

Definitely go for it. If you need more orientation after the four weeks, it sounds like you'll get it, they just don't want to agree to it before they know if you need it. You likely know far more than you give yourself credit for. Once you are off orientation, it doesn't mean you are completely alone. You have the other nurses on your floor and the charge nurse if you need help. Brush up on your head to toe, read up on cardiac issues, and familiarize yourself with the cardiac drugs. You'll pick up on the rhythms after seeing them over and over.

Good luck! (It'll be hard, but just keep plowing ahead and you'll get it)

[shakeela1027]

Thank you guys so much. Im going to take all of your advice and I hope for the best.