Oriented x 0!

Hello,

No! Not normal! Especially for a new nurse. Also, one of my pet peeves. I've had to work through a lot of orientation issues over the years especially when I did some travel nursing. So, here's my 2 cents: Regardless of the terrible support or lack there of they showed you in the beginning, this really is about employment negotiation. From your comments, it sounds as though the residency was not discussed previously as terms of your employment. Also, it sounds as though the unit director decided after you were employed that you would take part in the residency. This is a change in the terms of your agreed upon position, pay, and contract vs traditional employment, all without your approval. In that case, I would sit down with the Unit Director and discuss the fact that upon agreement of the terms of your employment, you were not made aware or agreed to enter a residency program, less pay, and a 2 year contract. You agreed to enter employment under a preceptorship for ? months and there after ongoing support from a resource nurse on the unit for ? months, etc. If you can't get the director/ human resources to agree upon acceptable terms, then you can always say I'm going to have to rethink my employment with your unit/hospital. Leave it at that and let them think that you might leave, and they will lose a person with your experience. (In my case as a new grad RN years ago, I had some trouble with Human resources, so I called the unit director and told her about it and said I was thinking of withdrawing my application and applying to such-n-such hospital system, and she was able to help pull some strings.) If they don't change their position or their hands are tied due to a new hospital policy for new grads then you've got choices to make. Keep these things in mind: 1) Your initial training at the hospital is very important and serves as a career long building block. Don't take less training then you deserve. You have to be trained and fully supported enough to fill comfortable on the unit. It's your License you are protecting by demanding a good and thorough orientation. 2) Find out the reason for the change. Is there not a quality preceptor willing to orient you? If not, and you don't have other options for employment, then the residency may be your best offer with the best training/support option. 3) What your employer has showed you so far is that they failed you right from the beginning and they are already comfortable jerking you around! Consider if that is an employer you want to enter into a long term relationship. Be confident! The corporate culture of hospitals is challenging. They move people around like chess pieces to make it work mostly for themselves. From the get go, teach them your one to be respected and you dictate your career... not the other way around. Good Luck! I'm rooting for you!!!!

Thanks so much for your validation! I did speak to the director and she assured me that I was not being transferred, rather that was an option available to new nurses. She also advised that the night shift had no actual preceptors, unlike days and explained her decision to place me there. She registered me for a class on the charting system and suggested I just shadow for a month. I think this is a communication issue between leadership and nights and there is no set orientation protocol in place. This unit apparently hasn't hired a new graduate recently. Also, each nurse has 11 very acute patients so not a lot of time. If anyone has a suggestion or a reasonable idea of how orientation typically progresses, I would appreciate the feedback. It looks like I am going to have to create my own process as I get assigned different staff every shift...I just need to know what is reasonable to expect in terms of responsibility. I told the nurse I worked with last night that I would take 3 patients and that he would have to administer meds with me watching. He was way cooler and really did help a lot.

Hi! Happy to help and support new nurses. We have all been there. I hope someone from a psyc unit will respond on the format of a good orientation. I started in the ICU and I'm sure the process was much longer. I've heard of nurses on Med-surg just having 3 months of preceptorship and then turned loose. Watch out for a few things: There are variances between nurses and trying to keep up with it all from one nurse to the next can get difficult. Doable but difficult. I've had alittle bit of that, one nurse will tell me one thing and another will refute it. It left me leaving the shift like I had to start all over with my training. Definitely, not a confidence builder. Drove me crazy, and left huge holes in my training that I didn't discover until later. Second, the nurses don't have a lot of time. Meaning, they are mostly too busy to train you properly. Sounds like you are learning trial by fire. For a new nurse, risky business when it comes to your license. Every nurse has training horror stories and some do need more training then others. Thirdly, do you see the nurses supporting each other when there is a crises on the unit or is it every one for themselves. You'll take on more responsibility whether your ready or not, if it's every man for themselves. I see your trying to make it work for you. So, just be aware of possibly having to work through these issues. Again, good luck, and hopefully a psyc nurse will respond.

You might get a clue about what kind of orientation you need if you look at your job description. You will likely be evaluated on each point. I would try to structure learning opportunities for yourself, like you did with the med nurse, to make sure you are competent in each area. It would be good to find some role models or mentors as you go along. Also, this sounds boring but read the policy book. If anything happens, you have to make sure you are following the units policies. Safety is very important, so is seclusion and restraint, and searches for contraband. The suicidal patient. Deescalation and crisis management. There is a lot to learn. .

She also advised that the night shift had no actual preceptors

suggested I just shadow for a month. I told the nurse I worked with last night that I would take 3 patients and that he would have to administer meds with me watching.

What is your learning style? Are you a reflective learner? Many nurses are predominantly active/tactile learners, the best way for them to learn is by jumping and doing as a result they may teach in their preferred learning style.

With all due respect, regardless of learning style, a new graduate nurse should not be placed in the position of having to work independently on their fourth day on the unit. That is the scenario I faced when I came to work the next day. I was given a temporary Omnicel password, three patients and left completely to my own devices. I got no supervision, no p/p's, nothing. Rather, I was directed to "back up" another nurse, a float who was completely overwhelmed with thirteen psych. patients. This included administering insulin to a patient I had never met and giving out meds that she had previously accessed, charted and scanned. If this is how hospitals are orienting new graduates, I pity the patients!

meet with the unit director to go over your needs and your concerns...in meantime consider this may not be a good fit for you and start looking around...i agree with you as a new nurse you should have a structured orientation so you learn things correctly the first time. They may or may not be able to give you this. Ask her for the p/p book. do not give meds you haven't pulled.. "backing up" someone should be shadowing her and see how she organizes her assignment etc...Keep your practice safe and by the book..