Orientation and Socialization into Nursing: What was it like for you?

kellykelly · Feb 8, 2009

I was inducted into a den of wolves when I first started orientation. They were absolutely horrible, bad mouthing everyone and even each other when their backs were turned. I thought I'd never make it there until I miraculously had my weekend switched and started working with a whole new bunch of people. Suddenly it all became so much better. Unfortunately, nothing exciting ever happened when I was on orientation. The s*** hit the fan when I got off orientation. I wanted to cry a couple times but didn't, I hung in there and relied on help from my more experienced co-workers.

It was rocky at times but I can't tell you how valuable good co-workers are--you should feel comfortable asking questions!

As for Benner's, never heard of it, sounds like something they made up to give students something useless to write a paper on. I don't know that I'll ever feel like an "expert", though I am a good nurse. I still learn something new every day and I'm not too proud to admit I sure don't know everything.

suni, BSN, RN · Feb 8, 2009

Patricia Benner's book Nursing Novice to expert is an excellent book.

I read it as a staff nurse and it was very valuable to me when precepting new grads and gave me a whole new perspective.

I would think if you are being introduced into the culture of nursing it is never too early to non-judgemental tell your co-workers how they are coming across.

and no I am not in management.

rgdavisRN · Feb 8, 2009

When I was new, I was fortunate to work with a group of nurses who wanted to help me learn. I still remember asking for their opinions when my patients got complicated. Even the nurses who weren't my preceptors would teach me stuff and give me advice.

I remember feeling competent and less lost after about a year or so, and like I really knew what I was doing most of the time after 2-3 years.

I hate to call myself an expert even though I now have a master's and work as a clinical instructor because I feel like I am always learning in nursing. I have noticed, however, that even before I became an instructor, I slowly went from asking a lot of questions to answering a lot of questions. In my last couple years of staff nursing, I've become one of those nurses that other nurses use as a reference.

pagandeva2000, LPN · Feb 8, 2009

My facility sponsored a full time leave with tuition pay to elevate from Patient Care Associate to Practical Nurse (got my license in 2006), so, while I was familiar with the nurses, I saw them from a different perspective working with them as peers. Some of the ones I loved as a PCA are the same ones who, now, I question their nursing judgement, while the ones I hated, I discovered that they are phenomenal nurses, dedicated to their position.

My orientation sucked; they basically dumped me in places and I was expected to function. Many of the nurses assumed I knew more than I did because I worked with them before, but I had to remind them several times that I was a new nurse with no experience...never had a reason to watch what they were doing in the past because at that time, I was more concerned about my own duties. Most of the time, they just plopped us in front of videos and gave us the answers to most of the quizzes they gave. Did not review policy and procedure with us, so, I had to learn as I went. This is scary because plenty of times, I almost did things out of my scope of practice! Thank goodness I had common sense about something...

At this stage of the game, I am not judgemental, I see that many are just weary, so, I know who to approach about what.

eriksoln, BSN, RN · Feb 8, 2009

Guess I'm the exception. Well, maybe not.

I was oriented on a unit where the whole process of bringing in new grads was thought out and planned for. The preceptor I had is a friend of mine to this day. She remains the nurse I aspire to be like some day. I want to be able to do so many of the things she did naturaly.

I had good and bad co-workers. Some were..........I dont want to say burnt out cause they were semi-new.........some were major fussy britches. You know the types: the schedule is never to their liking, the assignments never fair to them, no one did anything right except them. A lot of that on the unit I learned on. I learned not to be that way.

The good co-workers were personable. They cared about how you were doing as a nurse and in life. They were the types of people that you could see right away why they were nurses. They just wanted the best for everyone, always assumed the best of people.

Where do I consider myself after 3 years? Competent. Thats all. Being a travel nurse has kickstarted my growth and now I have the confidence to seek out my real dream, ICU.

MB37 · Feb 8, 2009

I have two weeks left on my 16 week new grad orientation into an ICU, and mine has gone very well so far. I work with the same preceptor about 80% of the time (barring callouts, schedule conflicts, or days when they have to make her charge) and have had a few great backups who have given me other perspectives when I've worked with them. One night nurse has been rude to me on one night when I gave her report, and I wrote that off to her having a bad day - otherwise the staff in general has been welcoming and eager to teach. Several people have offered repeatedly for me to come ask them for help once I'm on my own. It seems my experience has been the exception not the rule, but it is a very large teaching hospital that hires many new grads into specialty areas. I knew going in that while the pay was the lowest in my area (by a dollar, but still) the hospital had a great reputation if you really wanted to learn.

I've never read Benner, so I can't help you with that. Maybe I'm nearing competent? I do feel I'll be OK on my own when I'm off orientation, at least most of the time.

NeoNurseTX, RN · Feb 9, 2009

I've been with one nurse for most of my orientation to a new hospital and she's great. She gives both postive feedback and constructive criticism which is what I want. Other coworkers are pretty great. Very helpful..only came across one hostile nurse (getting report from her) and she seems to have a reputation for being annoyed by new people.

Home Health Columnist / Guide · Feb 9, 2009

patricia benner’s work “novice to expert: excellence and power in clinical nursing practice” published in 1984, has been instrumental in defining and highlighting clinical nurse development.

patricia benner's model of novice to expert (2001) describes five stages of nurse development:

1. novice
• no experience with situations in which they are expected to perform

• rigid adherence to taught rules or plans

• little situational perception

• unable to use discretionary judgement

• focuses on pieces rather than the whole

2. advanced beginner
• guidelines for action based on attributes or aspects

• situational perception still limited

• can demonstrate marginally acceptable performance

• notices change but cannot cope with it

• all attributes and aspects are treated separately and given equal importance

• needs help setting priorities

• unable to see entirety of a new situation

3. competent
• aware of all the relevant aspects of a situation

• sees actions at least partly in terms of long-term goals

• conscious of deliberate planning

• can set priorities

• critical thinking skills are developing

4. proficient
• sees situations holistically rather than in terms of aspects

• sees what is most important in a situation

• perceives deviations from the normal pattern

• decision-making less laboured

• uses guidlines and maxims for guidance

5. expert
• no longer relies on rules, guidelines or maxims

• intuitive grasp on situations based on deep tacit understanding

• analytic approaches used only in novel situations or when problems occur

• vision of what is possible
(registered nurses' association of ontario. (2005). educator's resource: integration of best practice guidelines.)

benner's stages of clinical competence

from novice to expert to mentor: shaping the future -- dracup and ...

looking back on my first lpn nursing positon had good combination of classroom and on unit orientation. critical care training in 1979 was combination nurse and physician lectures with hands on equipment use. upon graduation with rn in 1982, orietation was shorter with focus on policy and procedures---no nursing unit mentor as all 6 rns were new grads but we still had unit based head nurse who did a lot of coaching. it was after the 1yr mark, getting my first eval as rn (broke down sobbing in hn office) finally realized i was competent.

today, a homecare referral can cross my desk and just sense it has issues: look at one part and find 6 other things that need investigation/correction in order for nurse to have info they need to locate patient and willing pcp to sign orders.... referred to by nursing mgmt as "homecare expert" so feel reached expert level in that setting. re birthing babies: would be back at advanced beginner stage.

lpnflorida · Feb 9, 2009

Ah, 1978 I was as green as they come. While I had good training, I started in the field I felt least competent in. Psych. Why? as I wanted my foot in the door in a hospital. I would have taken any job offered.

I did not feel like an advanced beginner. I just knew I was willing to learn. My co-workers were wonderful people. They shared their knowledge with me.

I was the only LPN on the unit. When hired I had been told. They had eliminated LPNs from the psych unit in the hospital. ( reason, it unimportant at this time). I was told I would be hired as a trial to see if in fact having an LPN would be /could be an effective team member. Ask me if I felt some pressure.

It was scary, it was exciting. Not a day went by that I did not feel I did not know enough to be working in that field. One year later, I had gained confidence and reputation as being competent and a good team player. They then started to hire additional LPNs. At the end of 20 years after taking many additional classes I finally felt like I was on the verge of being expert. I say that as there were days I was the go to person there were days I asked many questions of others as was up against something I had not prior encountered.

Next job, new field of nursing. Back to feeling like a novice again. Orientation less than stellar, although they were very good at getting someone up to snuff on policies of the hospital. One year later felt competent but still learning. 10 years later I am still learning. I know I am a go to person again on the unit along with some other well seasoned nurses. We pool our knowledge together, as each of us has our own expertise. Mine happens to be stroke , urology, renal , wound care and yes psych patients.

I thank God that others are specialized in other areas. I will never reach expert for every diagnosis/co morbidity which we care for. I just keep learning, I keep on attending anything in which I am interested in to gain additional knowledge. I pick anyone's brain who is around me. I learn from fresh grads and the seasoned nurses and doctors and Cna's I come in contact with.

dhames · May 22, 2009

There have been many articles published on socializing the new nurse grad so that hospitals may have a higher retention rate, but I am wondering about the seasoned nurse.

1. If you are pulled to other floors, how much orientation[socialization] did you have on that 'strange' floor compared to those who work there full time? How does the floor staff treat you with assignments?

2. If you change units of interest, what kind of socialization did you get in the new field before being expected to 'be on your own'?

Does any person know of any professional articles that deal with this subject? [not for new grads, but for seasoned workers]

Extra-3.Before becoming a nurse, where you aware of the type of work, the hours, and the system?[yes, this deals with new grads :0)]

D