Orientation Length

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I am trying to find my first nursing job and I've been surprised by the huge variety of orientation lengths between hospitals. I would love to find a position in critical care and/or pediatrics but I know they're hard for new nurses to get. The nurse residency programs that I've looked into at children's hospitals around me have orientation lengths as long as six months for critical care units (I haven't been able to even get an interview at these places) while other hospitals that have called me in for interviews have an orientation length of around 12 shifts (3 weeks!) for a new grad in the (level III) NICU. I guess my question is…is there any possible way for me to survive as a new grad on a critical care unit with an orientation like that? If I were to get offered a position by one of these hospitals I would have a really hard time turning it down. Thanks in advance!

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That sounds way too short to me! Do you have prior experience in NICU (i.e. a capstone course)?

I started in a Level III NICU and my orientation was awesome--10 weeks precepted with Level II babies, then four months on our own with Level II babies only, followed by 6 weeks precepted with Level III (i.e. vented/drip) babies before we were let out into the wild with our own Level IIIs. Additionally ~50 hours paid classroom time on info specific to NICU.

Neonates are so different from adults: only about 5% of the stuff that you learn in nursing school applies to NICU. When adults HRs shoot up, babies' plummet; adults become tachypneic, babies become apenic; adults gradually decompensate, babies fall off a cliff.

IMHO, there's no way you could be adequately prepared in 3 weeks. You definitely wouldn't see/practice everything that you'd be expected to do as a Level III staff RN in 3 weeks (vents, drips, IVs, labs, extensive parent education, tube feeds, etc.) It took me about two weeks just to get totally comfortable with the routine of stable feeder growers (don't even get me started on doing their labs...).

I absolutely love NICU, and I'd hate to suggest that anybody turn down a NICU job, but I'd be wary of such a short orientation. Before you accept, I'd try to do the following: a) ask if you can talk to current staff who have oriented on that unit as new grads, b) clarify if you can have additional orientation time/support as necessary, and c) try to figure out if the staff on the unit is generally supportive of new grads (i.e. if your baby is acting up, would your colleague across the hall be willing to drop in and assist).

Sorry you're in such a tricky position! Best of luck to you!

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Thank you for your response!! I did have my senior capstone in a level III nicu but I feel like I know less not more since now I know how very much there is to learn ;) I will be shadowing as part of the interview process next week and I plan to ask the nurses on the floor the questions you suggested. I am hoping that the 12 shift "orientation" only includes the one on one time with a preceptor and that there will be a longer orientation to more critical babies as you mentioned. Thanks again for your help!

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Specializes in Critical Care, Education.

You may be dealing with a confusion of terms. "Orientation" does not mean that that is the sum total of the initial transition period. An organization's defined 'orientation' period may just be the standardized onboarding time that is provided to all new hires... to accomplish all of the initial competency validation & other training. That does not mean that new grads are not provided with an additional time period and different "action plan" to accommodate their needs.

Any organization that hires new grads will have some sort of transition plan in place to support them.... but they may not be able to give you a quick description of it because it isn't labeled as a "residency" or an "internship" or some such thing. You can get more detailed information from the department educator (if there is one) or manager.

Good luck to you.

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I just got offered a position on an IMC unit. As a new grad they have 2 weeks of full time orientation in a class room. Then 12 weeks of on the floor training. If needed they will extend the training, is what they told me. It's considered critical care nursing where I am.

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I got clarification at the interview and the orientation is now (recently changed) more like 12 weeks. Thanks for all the advice!

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