orientation for experienced nurse

[Joankim]

I have not worked in an ICU since 1992 and am returning to this setting. Since '92 I have worked cardiac cath lab until '97 and then tried various "office" setting jobs.

My question is what do you all think the time frame should be for orientation. I have only been on the unit 2 days( with a preceptor) and on day 2 they tried to leave me alone with a septic peritonitis , multisystem failure pt. The pt care had not changed however since it is a new hospital to me, I am unfamiliar with their charting( electronic : Care MAnager), their way of ordering things and so forth.

I am thankful I had the insight to request working nights since days is very hectic.... It is a 16 bed unit with Open hearts and general surgery and trauma. The coronary pts ( MI's and CP'S) all go to CCU. I was told on orientation the "usual " pt mix on nights is 1:2, but occasionally 1:3. However, I am seeing at least 2-3 nurses in days taking 3 pts to free nurses up to admit hearts and then these pts are doubled up within 4 hrs.

It looks like their staffing usually 5-6 nurses on nights and 6-7 on days.

I am a little concerned about all this, and naturally, am "feeling sorry" for the nurses currently working. However I do not want to be rushed into this whole scene, and feel frustrated because I cannot even chart adequately, and safely, or find supplies which are in an omnicell, etc.

I will working 1 more week on days (5 8 hours shifts) and then go to nights. And maybe I am overreacting and panicking prematurely and this is the current standard for staffing a unit!

Any and all comments would be welcomed, if any of you have been through this, or felt you were released to work on your own when you did not feel ready please let me know.

One last comment, the entire night staff is inexperienced nurses, all there for 1 yr or less. The charge nurse in retiring in October and apparently needed to retire several years ago! There is also no PCT or unit clerk on the night shifts, so the nurses are responsible for ALL work related to the pts!

[justanurse]

You should still get the same orientation as anyone else. As you said, you are new to this facility and need to learn everything about it, just as a new nurse would. Don't let them short-change you, it will burn you out even faster. Staffing in the ICU/CCU is becoming worse than it ever has been. Everyone likes to say their ratios are 1 nurse:2 pts. But on many days there are 1:3 & the charge nurse has a full load just like everyone else. Good luck in your new job. Take care and demand the time and training that you deserve to adequately care for your patients.

[B.Ashcroft]

This 2:1 and 3:1 nurse patient ratio must be a phenomena of American nursing. Here in Canada a critically ill intubated patient on inotropes is singled. Doubled assignments in big teaching hospitals are the exception as appposed to the rule. Doubled assignments apply to non vented patients or a chronic vent and an unvented patient. Never triple assinments. The beds would be closed before making that type of an assignment.

[mdslabod]

Hi. I was in a similar situation and did not last long. I am an experienced ICU nurese and because I had that attachment, I was given an abreviated orientation. I never felt comfortable and burned out early.

I also had a unit manager who was "different".

Happy ending, though. I went agency. A different hospital bought my contract for their ICU and I have doing great ever since.

Suggestion, if it is not going well, bail early. Don't let them short change you. Life is hard enough.But, give it all you got until then.

MichelRN

Critical Care

Columbus, Ohio