Precepting in the ICU

[RN-ing, BSN, MSN, NP]

On my unit, we usually do 6 weeks of orientation to the unit, regardless of experience. About four weeks on days, two weeks on nights. Orientees can have more time if needed. Recently, we have had a "wave" of new grads that need more time, and still aren't prepared to work the floor alone.

What orientation practices do you use on your floor? What helps and what doesn't?

[CNA2day]

I am curious to hear the answers in this post... I have no ICU experience and am a cna in a nursing home as of now. I do train the new cna's and I wanted to see if they were the same sort of learning issues. We give 6 days of training and it seems like one in every 7 or so new aides are still clueless after that point. In 7 days it is really not hard to learn to care for approx 25 people(cna duties). The issues I run into seem to be people that either do not pay attention or can not pay attention(not sure which). Some people are just scared to death but some it seems you almost have to FORCE to do a duty... those people do not catch on so fast.

The things people have the hardest time with...

learning equipment

time managment(35 minutes in a total care, comatose residents room is not acceptable when you are just getting them changed and in their chair for dinner!)

Knowing what step to take next(even though you do the same sequence of steps with about everyone)

obviously the issues wont be the same task, but i am curious to see if they are the same kind of task...

[meandragonbrett]

New Graduate nurses should be given 12 weeks of orientation when coming to critical care! They don't even have the basics of nursing down yet.

Make sure they are with nurses who know what they are doing and are able to teach and nurture the new grad. The new grad should work the preceptors schedule so that they aren't working with 4 different people as that can provide a lot of unnecessary anxiety for the new grad.

We have a critical care didactic portion that we also do that helps to provide a good foundation on the classroom basics of critical care. They do the classroom work along with clinical work. Usually 3-4 hours of classroom per week in addition to their 36 hours at the bedside with their preceptor.

[Creamsoda, ASN, RN]

When I was a newer grad 7 years ago, we had about 6 weeks classroom, andmaybe 8 weeks of bedside with a preceptor. I could not imagine though being an experienced critical care nurse and being made to do 6 weeks. 2-3 would be more than enough. As a traveler you get 1 day- which that is usually not enought, but I would die of boredom with 6 weeks of being oriented.

[RN-ing, BSN, MSN, NP]

Thanks for all your responses!

Some new grads need longer than the prescribed six weeks, and it seems those same orientees struggle when they finish orientation and start as regular staff. I'm wondering if some kind of follow-up with these staff would be helpful --- maybe two or four weeks off orientation.

[Kitesurfing bum]

I'm a new grad in an ICU. Started a residency program in Sept 2011 and will be independent March 2012. For nearly 5 months bedside orientation with 4 preceptors, and classes between shifts. I have absolutely loved this orientation. The hospital has invested a ton of time and money in me, and I have been extremely well received by my coworkers. Could I have been working on my own sooner? Yea maybe... but I learn more every day and would be a fool to not take advantage of time with preceptors. I have been with each preceptor for 1-2 months, and I work their schedule so there is no switching around. They are nurses who have volunteered to precept and have gone through additional training. There are hospitals out there who train new grads appropriately...that said I'm the second new grad that's been hired in the ICU in over 2 years. I'm very thankful for all you experienced, patient, willing-to-teach nurses out there!

[CCRNDiva, BSN, RN]

I think your orientation is too short for new graduates. Our orientation averages 6 months for new ICU nurses and includes several weeks of mentorship (they take an assignment independently with the educator as "distant" back up). They are expected to work their preceptors schedule (they typically get two). I don't think 6-8 weeks is sufficient. They are still learning how to be nurses, let alone learn the particulars of critical care nursing. We have been able to retain our graduate nurses since switching to this format.

[turnforthenurse, MSN, NP]

I work in progressive care and my orientation was 6 weeks. We also "cross-trained" to ICU and with our old director, all we needed apparently were 3 days for ICU orientation Our new ICU manager upped the orientation period to 4 weeks, but that still isn't enough, in my opinion.

[Amagoo]

Kitesurfing bum!!!

Sounds like you are at an amazing hospital, Where do you work?

THanks

[RipeTomato]

I am in a nurse residency program as a new grad in the ICU. We are given 12 weeks of orientation that includes both floor time with a preceptor and classes. I'm three weeks into the program and my schedule includes two 12 hour shifts with my preceptor and two 8 hour education shifts per week. I'm also given independent study and homework assignments. It's a lot to take in, but I hope I will feel better prepared to work independently when the time comes.

[scifihippie]

I'm a new grad in the ICU. I have to complete 400 hours with my preceptor working her shifts. I also have to complete about 250 classroom hours. It should cover about 15-16 weeks overall.