Orientation Length/Number of Pts

november17, ASN, RN · Sep 4, 2009

I did 8 weeks when I very first graduated. I don't think many people really ever feel comfortable when they are very first on their own. You can't expect to come off orientation and be the master of your job.

I recently changed employers after two years of being an RN, and they made me do 4 weeks of orientation; it was very frustrating for me because I was ready to do my own thing!

Seriously, you're going to have many days when the best you can do is make sure everyone is alive at the end of your shift. Eventually you'll get better at it. Btw are you working nights or days? Nights tend to be a lot less hectic and might give you more time to get acclimated to the workflow and responsibilities of the unit you work on.

tdrynelle · Sep 5, 2009

As a fellow new grad, I don't think you're overreacting. I think no one feels prepared to be out on their own without the security of a preceptor to help get you through the day. But once you go on your own, you won't really be alone either - your fellow nurses on your shift should be around to help you out (or point you in the right direction) when needed. As November17 pointed out, no one expects to be masters of our jobs once we come off orientation either.

Although I am still in orientation (have about 2 weeks left) I have just finished up with 7 weeks on the floor, mostly day shift. I too was up to 4-5 patients, and feeling overwhelemed on a daily basis. I did get some experience on PM's, and liked that much better. Last weekend I started on nights, and like that a lot too. The advantage to both those shifts is that there isn't as much going on (doctors, new orders, tests, OT/PT, etc.), so it's easier to keep ahead of (or last on top of) things. Although there are times those shifts can be crazy as well, my experience has been that they aren't as hectic on a regular basis. Were you hired strictly on day shift? Or can you work another? If you can, I would highly suggest you try either PM's or nights. As a new grad,I think it would really help boost your confidence level. I know it has helped me.

Best of luck and hang in there. I have been told, it will get better with time.

berquj · Sep 6, 2009

I can't thank you both enough for your responses and help with my situation. I was hired for day shift although I'm sure they wouldn't mind switching me to nights. However I am not a night person at all and I fall asleep at 9pm also I do not drink caffiene so I am scared I wouldn't last on night shift for very long. I start my first day off of orientation tomorrow and I am nevrous as all heck. During my last shift my nurse had to "bail me out" three times but I feel it was unfair because they had given me three total care patients and I felt very overwhelmed. One pt in particular was constantly getting new orders every hour and I could not just keep up. They say they will give me easy patients and they are letting all the nurses around me know I am new and to answer my questions. I pray I do well. Thank you again, here goes!

Student2Registered · Sep 6, 2009

I feel like I wrote this post! I cried in the bathroom today, choked up when my preceptor asked how I feel my day went. When I got to my car I just bawled my eyes out. I must have had the mother of all assignments today because there was no way I could get caught up. First thing in the morning my pt's BP was tanking and I had to call the doctor, do a bolus...all the while my preceptor is outside of the door pointing at her watch reminding me about "time management." Anyways, no matter what way I turned something was an obstacle. I'm supposed to be on my own 2 shifts from now. I'm so scared. You are not alone. Everyone tells me every new nurse goes through this. It still doesn't make it feel better. :banghead: :crying2:

paschick · Sep 6, 2009

I would recommend asking your preceptor to be more hands-off. If he/she is doing a lot of your work you're not going to learn how to prioritize and time-manage your self. With making sure I get everything done that needs to get done I make to-do list for each patient. This will might help you to not forget to do somethings.

Eiano · Sep 6, 2009

Yikes,

posts like these really scare me. I start my new job 3 weeks from Monday. Good luck, by now you are more than half way done with your shift. Let us know how it goes. I will be praying for you...:icon_hug:

shoegalRN, RN · Sep 7, 2009

I'm in a New Grad Residency Program and just finished up my month on a busy Med-Surg floor. I ended my last shift taking on 4 patients all by myself.

It's so overwhelming. I know. What helped me was I somewhat developed my own routine. After getting report, I would look up my patient's labs, meds, procedures, etc. That would take me about 30-45 minutes. I would write down on my report sheet what needs to be done and highlight it, then I would write the scheduled meds in blue (to match the MAR), then PRN's in green, and accuchecks in black. I would then go and see my patients, pop my head in, introduce myself and then take the patient with the highest acuity and assess them first.

I would take notes as I went along so I can update the day shift in report. I would do my own vitals along with my assessment and if a med needed to be passed, I would do it at the initial assessment if the patient was in pain and had a PRN scheduled. After I did all the assessments, I would then go and chart my initial assessments on all my patients. That would take about 45 minutes to an hour. By the time I was done with initial assessments, I would do my 21:00 med pass or accu check and give insulin if on sliding scale. Then I would go back and chart my second updated note on each patient. I would also write down I've passed the med, or if I needed to call the doctor, or if I had to take an order.

I would also have 0100 med pass and between the times of the last med pass and 0100, I would do vitals again if it's a patient has q 4 vitals. I would chart the vitals and also write them down. If I had gotten in report one of my patient's BP was running low, I'll keep a close watch on it and do a set of vitals just because I wanted to keep on top of it. At 0200, I do my chart checks and my second set of vitals. I write them down and chart them. I usually take a lunch break around 0300 and when I'm caught up, I help out others. If I have an AM lab to draw, I try to get it at about 0200 when I do the second set of vitals. I then check the lab values at about 0400 and if a doctor needs to be called, I call them for any orders. I also write down abnormals to give to day shift.

By 0600, I'm doing I & O's and completing my rounding sheets and charting them as I go. At this time, I'm charting my third patient care note on all my patients. I make sure my care plans are all signed. I do a little bit of research on history on all my patients for the next shift to pass off in report.

The longest I've ever had to stay past my shift has been 15 minutes, and that's because my patient had to go to surgery at 0630 and I was running around making sure she had vital signs, I had to do an pre-op interview on her, give report on her to the OR nurse, and make sure her transport slip was filled out prior to being transported to the OR.

I have come home plenty of mornings exhausted because some nights can be worst than others, especially if you have someone getting IV Dilaudid q 2 hours and they KNOW it, therefore, on the call light at the EXACT time it's due.

Next week, I go to the ER and I'm looking forward to it. I can say my month being in Med-Surg has given me a better view of how to time management and be able to juggle several patients at a time.

BBQvegan · Sep 7, 2009

Berquj,

It is very frustrating in the role of new grad. I had 12 wks orientation and I felt that was just the right amount of time. Everyone said I could have stopped orientation long ago, but I am glad I had the time I did. I work nights, and we are so busy. There is nothing "laid back" about it. During orientation, I always felt like I was behind, and I often stayed late to finish charting and getting everything done. I have been off orientation for just one week, but it was a great week. I don't know if it was the patient assignment or if I just finally am getting the hang of nursing. One very simple, but excellent tip that was shared by an experienced nurse is this: Just stop and think. When you are in the middle of something, and someone calls you to do something, just stop, think, and say, "I'll be there in a moment." Finish what you were doing, then focus on the new task. Interruptions are the biggest problem that interferes with our time management. Unless something is an immediate emergency, it can wait until you finish what you were doing.

Also, if a patient calls you to the room, try to combine tasks with your trip in there. If you have some meds, go ahead and bring them along. If you need to recheck a BP or assess urine output, or inform the pt about a test tomorrow or whatever it is, combine as much as you can into that visit. It may make your visit longer than you expected to spend, but it prevents you from needing to go back and forth several times. Just stop and think. Ok, I have to see Mr. X. Here is what I need for Mr. X..... Keep yourself organized with checklists. I created a wonderful tool that I would be happy to email to anyone who needs it. I use a new one for each pt for each day. I check off when I have given and charted meds, I write down the patient's diet, VS, time to give meds, accuchecks, I&Os, IV site and gauge, and any other reminders necessary. They get crossed off as the shift goes on, and before I go to report at 7 am, I make sure all was done.

Those are just my tricks I have learned in the past few months. And I must say it is all so much easier when I am on my own, instead of with a preceptor. Good luck to you!

knewb · Nov 27, 2009

Berquj,
It is very frustrating in the role of new grad. I had 12 wks orientation and I felt that was just the right amount of time. Everyone said I could have stopped orientation long ago, but I am glad I had the time I did. I work nights, and we are so busy. There is nothing "laid back" about it. During orientation, I always felt like I was behind, and I often stayed late to finish charting and getting everything done. I have been off orientation for just one week, but it was a great week. I don't know if it was the patient assignment or if I just finally am getting the hang of nursing. One very simple, but excellent tip that was shared by an experienced nurse is this: Just stop and think. When you are in the middle of something, and someone calls you to do something, just stop, think, and say, "I'll be there in a moment." Finish what you were doing, then focus on the new task. Interruptions are the biggest problem that interferes with our time management. Unless something is an immediate emergency, it can wait until you finish what you were doing.
Also, if a patient calls you to the room, try to combine tasks with your trip in there. If you have some meds, go ahead and bring them along. If you need to recheck a BP or assess urine output, or inform the pt about a test tomorrow or whatever it is, combine as much as you can into that visit. It may make your visit longer than you expected to spend, but it prevents you from needing to go back and forth several times. Just stop and think. Ok, I have to see Mr. X. Here is what I need for Mr. X..... Keep yourself organized with checklists. I created a wonderful tool that I would be happy to email to anyone who needs it. I use a new one for each pt for each day. I check off when I have given and charted meds, I write down the patient's diet, VS, time to give meds, accuchecks, I&Os, IV site and gauge, and any other reminders necessary. They get crossed off as the shift goes on, and before I go to report at 7 am, I make sure all was done.
Those are just my tricks I have learned in the past few months. And I must say it is all so much easier when I am on my own, instead of with a preceptor. Good luck to you!

Thanks for your advice. I am on a med/surg floor 7p-7a and the nurses have 6 patients. I am orienting for about 6 weeks and it feels way too short for me. Last night we had two admissions, and the patient acuity seemed high for most of the 6 patients. I really could not imagine myself being able to handle that load in 4 more weeks of my remaining orientation. Chest tubes that needed to be hooked up, PEG feedings, total care, PICC lines that wouldn't allow blood draws- so much that I have never even done yet! I am stressed about being thrown to the wolves, but I will make it clear if I don't feel ready. Anyway, your organization tool sounds so helpful; would you send it to me? Can you PM me?

Thanks so much!