Orientation As A Semi-Experienced Nurse is Aggravating

Jedrnurse, BSN, RN · May 20, 2020

Bear with it; it'll be over soon. Actually, it's surprising that they didn't cut your orientation short. Think of explaining your actions as a good self-review of theory.

The switching patient assignment thing is pretty annoying, I imagine..

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN · May 20, 2020

Orientation as an experienced nurse is a joke. Preceptors delegate the ‘dirty’ tasks that they don’t want to do, such as changing colostomy bags, trach-suctioning, anything dealing with the homeless, grimey poor souls, and of course, let’s not forget, you’ll go solo on your own patients if they’re c-diff, HIV+, TB +, etc.

They are so transparent, it’s pathetic. Oh I can go on and on. But like the previous poster said, it’ll soon pass.

Been there,done that, ASN, RN · May 20, 2020

You have less than a years experience, and describe yourself as :"semi-experienced". You have much to learn grasshopper.

Learn what you can and appreciate the opportunity.

CharleeFoxtrot, BSN, RN · May 20, 2020

7 minutes ago, Been there,done that said:
You have less than a years experience, and describe yourself as :"semi-experienced". You have much to learn grasshopper.
Learn what you can and appreciate the opportunity.

Took the words right out of my mouth. An experienced nurse knows what she/he doesn't know. A semi-experienced nurse might not have reached that point as of yet.

Tait, MSN, RN · May 21, 2020

My first job was four years on a complex med/surg floor (non-titrated cardiac drips, insulin drips, whipples, pre-open heart, post cath etc). When I went to a new hospital after two years out with kiddos and school, and before I got my first education job, I was dropped onto day shift where I just followed the other nurse around, and then went into night shift. My first night my preceptor got pulled to charge on the cardiac PCU they planned to transfer me to later, and I got someone who did precept. She abandoned me until 6am when I was treating a hypoglycemic patient with juice and crackers and started railing on me for not using glucose gel. I was like "well I guess you should have been here to make sure I knew the appropriate protocols for this hospital."

Take the time to make sure you vet out all the kinks in what works for this hospital, but I agree the swapping teams part way through the shift is not useful.

AlmostThere19, BSN, RN · May 21, 2020

2 hours ago, Been there,done that said:
You have less than a years experience, and describe yourself as :"semi-experienced". You have much to learn grasshopper.
Learn what you can and appreciate the opportunity.

I definitely see what you mean. I know I have a ton more to learn, especially with this being a completely different hospital with a different way of doing things. I just meant that it's a strange adjustment to go from caring for all my own patients for so long and now I'm back to how it was when I first began nursing last year.

TriciaJ, RN · May 21, 2020

I've had so many cut-short orientations and hit-and-miss orientations. Don't waste energy feeling insulted by anyone's hovering.

Savour every minute someone is willing to spend with you. Your job right now is to earn their trust and make them glad they hired you.

Serhilda, ADN, RN · May 21, 2020

My orientation drove me crazy. I was coming in with experience and made that clear, but this one preceptor refused to let me even so much as start an IV without hovering. While I tried explaining how important I felt it was to allow me some autonomy, that concern wasn't mutual.

It's really difficult when you have them pressuring you to do something that's unsafe or bad practice too, such as recapping needles, which I was instructed to do (and refused). Some preceptors feel it's not your place to refuse to mimic their actions, so you end up on their poop list pretty quickly. My advice is to pick your battles with this one and weigh the pros and cons. Obviously don't endanger anyone but just keep that in mind.

I'd say the number one pet peeve I hear though has to do with preceptors trying to teach their personal habits instead of skills and appropriate interventions for a new patient population. While some tips are nice, how well you adapt to their personal habits is irrelevant.

My advice is to just nod your head and appear enlightened every day.

JKL33 · May 21, 2020

2 hours ago, Serhilda said:
My orientation drove me crazy. I was coming in with experience and made that clear, but this one preceptor refused to let me even so much as start an IV without hovering. While I tried explaining how important I felt it was to allow me some autonomy, that concern wasn't mutual.

At least part of this is due to other factors, namely the fact that nurses are taught that they are responsible for others' actions. Responsibility is an important value in nursing but it has been applied inappropriately and taught in extremes to the advantage of various entities. Throw in a situation where a nurse is actually assigned to something such as a preceptor role (in addition to generically being "200% accountable" for everything) and you should expect all the more that nurse is going to feel a degree of responsibility to see that things are being done right/according to usual expectations.

2 hours ago, Serhilda said:
I'd say the number one pet peeve I hear though has to do with preceptors trying to teach their personal habits instead of skills and appropriate interventions for a new patient population.

I'd suppose the two become a little difficult to separate at some point, don't they? I think I've been guilty of this some; it's because I do things X way for Y reasons because it is how I have been successful in caring for Z condition/population, etc. ??‍♀️ I don't think these preceptors are always just trying to hear themselves talk or bestow their superior wisdom and expertise upon the orientee. Although I can see how it could easily come off that way.

Long story short: Anyone who becomes aggravated and disgruntled with a hovering preceptor should go to the manager and advocate for their independence.

13 hours ago, AlmostThere19 said:
I'm used to taking my own patients and working on my own. I'm definitely not used to having another nurse follow me around and having to explain myself and what I'm doing.

Let your manager know that you don't need this kind of assistance and that you can/will seek out a staff member if you have any questions.

NurseNelly24, BSN · May 27, 2020

I’ve had the same experience many times. I’m the type of person that eventually likes to find their rhythm on how to do things without having to do things the exact way my preceptor does.

Not to mention, My most recent orientation in a small community hospital ICU, I literally had 8 different preceptors because each person I was assigned to was either charge or not working the unit that day. I had some preceptors who pretty much made fell back and let me do most of the stuff, and then I had others who literally asked me if I’ve ever participated in an Intubation, placed in Foleys and IVs, familiar with sedatives (as a ER nurse from a level 1 trauma center??).

What I try to do is keep a good balance of asking questions and also making it clear of what I’m experienced in/comfortable with from the get go.

I am extremely vocal of what I am capable of doing without oversight and in many ways will let them know exactly what I am going to do before I do it so that they know I’m experienced in this particular skill (until they get tired of me LOL)

But whatever I don’t know I make sure to ask a lot of questions. I think some preceptors get wary when they have a preceptee who asks very few questions and then they end up finding out you’re not doing something correctly or making a straight up mistakes.

so just find that balance in the remaining weeks and hopefully your preceptor will get the idea to back of a little.

Closed Account 12345 · May 27, 2020

Yesterday, you posted that you've been a nurse for 8 months. If you have already been at this job for 3 weeks, you only had 7 months of experience going in.

You are still a new graduate. Is your new job in the exact same kind of unit with comparable patient loads and available resources? If not, you're an even newer grad.

I love working with new grads, BUT if I was assigned to precept one who left her first job after 7 months, I'd be extra cautious. Did she leave because management was hinting it wasn't going to work, and it's better to quit than be fired? Did she leave because she was easily overwhelmed by patient load, time management problems, group dynamics, etc. and thought those would change with a new job? I'd be watching you like a hawk.

Good preceptors DO ask for explanations of a new grad's actions and thought processes. That helps them understand if you correctly understand the rationales for what you're doing and if you have critical thinking skills to safely handle situations. For example, if you're asking a patient about allergies before giving Amoxicillin, I'd want to know if you knew which allergies were contraindications for the med. If you're about to draw labs with a butterfly needle when the patient is due for a new IV that day, I'd want to know your thought process on not combining the two actions.

If you aren't independently responsible for a patient load, then your precepting nurse's primary duty is to her patients and keeping them safe- not to protecting your pride by letting you go it alone before she can assess your competence and observe you in action.

Is it annoying to switch preceptors and patients partly through the day? Yep. Is it also exposing you to more patient situations and styles of nursing? Yes.

Even experienced nurses need orientation in new jobs. You don't just walk into a hospital understanding its policies and procedures, how to access them, who to contact for various scenarios and how to reach them, how to go about getting blood from the blood bank, where x-ray is located, documentation system and unit-specific documentation requirements, and having access codes to everything you need on day one.

You don't know what you don't know. I don't mean that in a rude way; it's just factual.

It's also perfectly OK for you to say "Hey, now that I've been on the floor for 3 weeks, I feel pretty good about my ability to handle most patient situations here. Next shift, I'd like to take 2 patients myself to see how I do independently. I'd still come to you with any questions or concerns, but this way we can start working me towards caring for a full patient load independently."