ONLY 6 week orientation for New Grad?

RNBelle · Jul 20, 2008

One rule of thumb I have heard is never take less than 8 wks of orientation. Now with that said, my first nursing job gave me 4 wks orientation. The only reason I didnt as for more was because the other nurses were strong and helped me enormously. If you need more orientation, tell your NM. Dont not speak up. If you get off of orientation too soon you might feel way too overwhelmed and become unhappy. Look out for #1.

Toquay · Jul 20, 2008

I went to ER from ICU and was given 2 weeks orientation (6 night shifts with preceptor). Thank god I had a few years adult ICU experience that had given a critical care course (3 weeks). However, I had no experience with OB/gyn, peds, basic ortho, and many other ER type presentations. If I had been offered back my ICU position back, then I would have ran from the ER as fast as I could.

Ideally IMO, all new nurses should have a critical care course and 4-6 months preceptorship to develop a good foundation. Things move fast in the ER and while feeling inadequate as a new nurse is common, the hospital and senoir staff should provide an atmosphere that will allow new nurses to become strong team members. Its sad to see promising nurses get discouraged with the "fly by the seat of my pants" orientation.

Toq

Enfermera85, BSN, MSN, NP · Jul 20, 2008

I don't want to add fuel to fire but if I were you I would be concerned that the hospital is only orienting you for 5 weeks in the ER of all areas. I have heard that a decent orientation is AT LEAST 8 weeks! As far as your interest is concerned and making sure that you thrive as a new nurse in a tough specialty I would definately express some type of concern now (in the beginning) and ask exactly what is expected of you at the end of your orientation...

Just as another comparison for you I am a new nurse and I begin my orientation in 2 weeks in a NICU which consists of an intermediate floor and a critical floor and I am receiving a total of 16 weeks of orientation which includes 10 classes related to the care of critically ill neonates...

Hope this helps :twocents:

clairebearrn · Jul 20, 2008

Hi. Thanks everyone! I spoke to my NM and she said the most she can give me is an additional week and that if I can't handle ER I should go somewhere else. I will give it a try. I plan on doing my own part and trying to take classes and reading books.

Dolce, RN · Jul 20, 2008

Hi. Thanks everyone! I spoke to my NM and she said the most she can give me is an additional week and that if I can't handle ER I should go somewhere else. I will give it a try. I plan on doing my own part and trying to take classes and reading books.

Try to keep in mind that NM and HR usually present the best possible image to the job candidates. If the BEST that she is offering is a total of 6 weeks on the floor training you have a problem. Her statement that you should go somewhere else if it doesn't work out is easy for her to say but let me relate to you what can happen to a new grad thrown into a specialty unit without proper training. I used to work with a brand new grad hired to a PACU unit. After 3 months of orientation/training they decided she was ready to be independent and left her alone with a patient. The patient coded and she unfortunately reacted very badly and left the patient's side to get her NM. Thankfully the patient survived but she didn't. She was fired after that incident. It really wasn't entirely her fault. She should never, ever have been cut loose in the PACU after 3 months of orientation. Now she has a permanent mark on her record that she was fired from a job. It was hard for her to find another nursing position because other places were hesitant to hire a new grad who had been fired.

I'm not trying to scare you out of taking this position. Only you will know whether or not you can function safely after 5-6 weeks. But, please consider other options that are available to you. Best wishes. :)

kmoonshine, RN · Jul 20, 2008

ClaraSicRN:

What I'm about to write might seem harsh, but please hear me out.

For a new grad in the ED, 6 weeks of orientation is not enough. I started out in the ED as a new grad myself, and had 3.5 months of orientation. This did not include ACLS, PALS, etc. I had a week of ED core classes, and the remainder of the time was orienting in the department. I graduated top of my class, consider myself very intelligent, and I really had a rough time starting out because of all the uncertainty. I spent alot of time reading about ED medicine, parcipating in online discussions, and was always looking things up on the internet at home. I felt ok to be on my own after orientation, but I didn't feel COMFORTABLE until well over one year. During orientation, I didn't even have my IV skills down in 6 weeks!

Because the ED is very unpredictable, you might be put with various preceptors (which isn't ideal) or have some "off" days. You need more than 6 weeks to offset the possibility of multiple preceptors. Also, you might go awhile without having any codes and all of a sudden "BAM", you'll get 3 in one hour. Having a longer orientation increases the likelihood that you will get exposed to more variety. During my orientation we didn't have any traumas come in. However, over a year later, we had one night where there was three level-1 traumas within 2 hours (GSW to the head, GSW to the abdomen, and knife stabbing to the chest).

In the ED you have to know a little about everything and yet be an expert at nothing. I posted this earlier but I'll state it again: the Emergency Nurses Association (ENA) states that new grad orientation must be 3-6 months at a minimum. It is my professional opinion that 6 weeks ED orientation is not sufficient and is setting you up for failure. It doesn't matter how smart you are, or how motivated you are. The patient populations that roll through the ED are unpredictable, and the only thing that will prepare you to safely caring for your patients is time. And this "time" should come from a strong orientation, not "on the job, on your own" learning.

If you are set on accepting this job, ask about their staffing model (team nursing, primary nursing, etc). Ask what the patient-nurse ratio is. Ask how often they divert, how many ICU holds do they have a week, and find out what their staff turnover is. Also get a feel of the patient populaton: is it frequently patients with chest pain, asthma, MI, sepsis? Or is it frequently patients with headache, earache, sore throat? Go ahead and print this out from the ENA (http://www.ena.org/careercenter/SoYouWantToBeNurse.pdf) and bring it to your NM and ask "Why don't you follow the ENA's guidelines for length of orientation for new grads?"

My professional advice would be to look elsewhere. If you do take the job, make sure to carry malpractice insurance.

I was recently job searching and I have about 2 years of ED experience. One ED that I interviewed at wanted me to be on orientation for 12 weeks. And that is with previous ED experience!

Good luck with whatever decision you make, and remember that your license is with the state, not the hospital...

LeesieBug · Jul 21, 2008

I spoke to my NM and she said the most she can give me is an additional week and that if I can't handle ER I should go somewhere else.

That statement in itself is a REALLY good indication of the level of support you are going to receive (crappy).....I can't stress enough how important it is to have a supportive environment as you start out, and that "sink or swim, kid" kind of mentality many units have does NOT make for an environment conducive to learning how to be a good nurse.

You might want to poke around at other hospitals just to see what else is out there.

Good luck whatever you decide.

loricatus · Jul 21, 2008

Hi. Thanks everyone! I spoke to my NM and she said the most she can give me is an additional week and that if I can't handle ER I should go somewhere else. I will give it a try. I plan on doing my own part and trying to take classes and reading books.

This is one very bad manager. I would suggest getting your own malpractice policy now & not saying a word to the hospital about it.

6 weeks of orientation for a new grad IS NOT ENOUGH. Most places I have worked at give 6 weeks orientation to new hires with prior ER experience because that's how long it takes for one to be accustomed to just the new environment (and these nurses have had prior Emergency Room experience and even board certification.

What this manager is doing borders on incompetency. It is just an unsafe practice to allow a new grad to be on their own in 5 weeks. This is nothing against you, it is just that there is a lot involved in learning the basic nursing skills when you are right out of school. You will not see the number of cases necessary to be even minimally competent in that short of a time; and, she should certainly know this.

Either this manager has no concern for staff and patients or the ER orientation is a ploy to fill up med-surg openings. I have seen this for those hired in the ER and ICUs-tell them that the area is too acute and they can't cut it, then graciously advise them that they would be better off in med-surg. Well, if this does happen, bear in mind that it was a plan all along & has nothing to do with you and your ability to handle ER work. If I were you (and I really was in this situation a while back), I would be looking for a backup position that would really train me the correct way. trust me when I say that you are being set up to fail by a very shrewd manager-she has already shown some of her true colors.

Do you really feel comfortable and secure with a place that has made an assumption that you can't handle it before you have even shown them what you can do, only because you asked for something to assure you are going to be practicing in a safe manner? I don't think any new grad can effectively learn with the thought that questioning something will result in being expelled from the department, do you?

Another thing to think about, would you want to be a patient during an emergency situation and have, as your nurse, a person that has only had 6 weeks of nursing under their belt?

You are certainly correct in feeling concerned about this lack of training. You will be a good nurse because you have already learned the value of intuition. It is a shame that this ER isn't willing to give you the proper foundation for you to shine.

clairebearrn · Jul 21, 2008

So I talked to my NM and she said that she would also send me to classes which are given after I'm off orientation. All the units in the hospital give 6 weeks orientation! and the other hospitals have only night shifts which I can't do due to my baby! This is the only position that is convenient for me...I will definetely see a lot...we get traumas (GSW,MVAs,etc) daily...pray for me! I start next month! THANKS! I will try my best!

kmoonshine, RN · Jul 21, 2008

So I talked to my NM and she said that she would also send me to classes which are given after I'm off orientation. All the units in the hospital give 6 weeks orientation! and the other hospitals have only night shifts which I can't do due to my baby! This is the only position that is convenient for me...I will definetely see a lot...we get traumas (GSW,MVAs,etc) daily...pray for me! I start next month! THANKS! I will try my best!

I don't understand why each unit only gives 6 weeks orientation, because each unit is different. ICU is different than ER, which is different from ortho/med surg, which is different than peds. Each unit should have individualized orientation that is modified for each new hire.

clairebearrn · Jul 21, 2008

I know! I agree with all of you! Orientation is extremely short, but I will have to make the best of it. Like some of you say, I will ask questions, be motivated, and speak up! Some of the nurses are new grads and tell me it was hard, but possible. According to nurse recruitment, having a preceptor for 6 weeks is short, but after that time, you can have others help you...I am undecided now, but this is the only job in LA that is day shift and ER! and trust me I applied like in 10 hospitals. They all are night shift and in medsurg/ortho areas. I want to try it, if I fail, I will at least know I tried...Thanks!

Dolce, RN · Jul 21, 2008

Some of the nurses are new grads and tell me it was hard, but possible.

Do you know how many new grads they have compared to their number of experienced nurses? In a crisis your new grad coworkers will not be able to offer you the support and guidance that you need during your first year of nursing. I hate to sound negative, but this just really sounds like a bad deal to me. Every time you add more details about the job I just keep getting a worse opinion of them. :mad: