Question about orientation

If you've been a RN in a nursing home, you have run your tail off and you've had to manage your time wisely, so it's probably just that you need to get used to the new environment with all its different technology and more acute patients.

I was a new grad 1 1/2 years ago after being a LPN for 3 years in nsg homes and Urgent Care clinic. Med surg was very hard to be new to and took me about 7 months.

I was on orientation for I think 5 weeks and had many different preceptors which I liked because I got to learn different ways of doing things, and some of the personalities I wasn't too crazy about so glad they weren't my only preceptor. Now that you've been there awhile, is there a certain preceptor you like and could be your sole preceptor?

Don't lose faith, you've got it in you, the hospital environment just takes a few months to get used to.

Lol.... My orientation where I am isn't so good. I moved to a town with no transportation and am on foot until I buy a car. I went in yesterday and my preceptor wasn't even there, and know one wanted to fit the bill to train me. Thankfully, the receptionist gave me a ride home. But, when I was oriented at the last hospital I was at (I was laid off surprisingly) it was great and with structure.

I haven't had much help, my preceptor gave me a whole assignment on the second day and I don't even know much about computer documentation, because I am use to the written documentation. It was a disaster, half the time I needed her she was out smoking. It was not a pretty day.

The thing I noticed about out East, is you could only precept if you have been there longer than a year and passed some kind of test to teach. Plus, if my preceptor wasn't there, they always set me up with another nurse. It was great. The hospital I am at now, has no organization and I wonder why 90% of the staff is travel. I am going to stick it out though and go back out east where the structure is best.

Unfortunately you have found out why there aren't enough nurses, especially in the hospital setting. Your orientation is inadequate and pathetic, but it is fast becoming the norm. Please speak with your nurse manager before things go any farther. Otherwise they will be trying to get you booted out the door due to you time management issues. And they don't care that the time management problem is due to their incompetent preceptors and not truly a problem with how you conduct yourself. All they see is that you are taking too much time, thus also too much money, and they will want you out of there to get a nurse with less experience that they can pay a lower salary to. Document your shift daily, including being unable to have a consistent preceptor, preceptor out smoking frequently, preceptor taking care of other patients instead of having your back. They are in desperate need of staff, which is why you were hired. They believe that since you have so many years of experience that you can just pick up the hospital stuff and run with it. YOU have to show them that the orientation is inadequate and it is THEIR problem. Stand your ground. They won't stand by you.

When I was orienting, I found that not only does each nurse have their own of doing things, but so does each hospital. Where I went to school, I was one of the top students. But I remember a specific experience which really made me feel bad. With the IV meds, we always hung a 500 bag of NSS as the primary bag, and piggybacked the med whatever it may be. The NSS was the flush. We were required to set a flush of 20 ml at 200ml/hr. This was the only way we were supposed to do it, they grilled into us each and every day! My instructor at the time didn't like the way that I programmed the pump... I would always out of habbit program the flush rate and then program the piggyback rate and push start. The instructor made a big deal of it... ranting, raving... she thought the flush wouldnt go through after the med, but by doing it my way would cause the flush to go first... I tried to explain myself, that the pump will always infuse the piggyback med first, but she didnt want to listen. it made me feel like I was dumb and incompetant. However, we checked with another instructor and she confirmed that I was technically correct... but they both said I should just do it their way to ensure "consistency".

Sorry for rambling on... to get to my point... I started orienting at my first job as an RN... they had no idea what a flush bag was and kind of gave me this odd look like I was dumb and incompetant. They just use a 3 cc pre-filled syringe of NSS once the med has infused.

I'd like to share a few more examples real quick. In nursing school... one of my instructors who was a very knowledgeable and competant instructor always made it a point that Lovenox SQ should go in the very outermost area of the lower quandrants. She was adament that Lovenox goes in the "love handles" and not closer the umbilicus where heparin goes. So during my orientation, my preceptor sternly corrected me and had me put the Lovenox 2 inches from the umbilicus. As for giving meds thru a Peg... We were taught to crush each med individually and put into its own little med cup with 5 cc of water. If the pt had 25 meds, then you had 25 med cups. Plus the 15cc or so btw each med and the 30 cc at the end. This is how they wanted it done. So at my new job, the preceptor again thought that I didnt have a clue as to what I was doing, since this hospital's policy is to put all the meds crushed into the same cup with some water, and a flush at the end.

Everyday I was so frustrated... it felt like everything I learned in school was a waste of time because I was relearning everything all over again. I went from being one of the best students recognized for my accomplishments, to a GN that no one respected.

Thanks for sharing your story Nrs Angie. I also have those similar stories happening right now with the way I have been doing certain nursing procedures for the last 10 years as an experienced nurse and what I learned in school compared to how the nurses want me to do things in the hospital. I am glad for the nurses to show me their way, but at the same time it is quite frustrating as I am learning my new job.

I have another comment about my orientation. I feel so frustrated trying to get done with everything managing 3 patients. I had 2 heavy load patients plus one demanding young adult patient. It took everything I had to get done with everything before the end of the shift. 15 minutes before giving report to the next shift, all 3 of my patients needed time consuming needs, plus I had to finish my I & Os and end of shift notes. So of course, just one patient nearly took 15 minutes and I have the nurse on the next shift standing there waiting for report looking at me as though I am incompetent.

I asked my preceptor how she handles this type of situation. But got no response! Yes, I was assertive when I asked. By the end of my orientation I am supposed to be able to finish my shift managing 4 to 5 patients. I don't feel like I am getting good instruction to help me reach this goal.

I have another comment about my orientation. I feel so frustrated trying to get done with everything managing 3 patients. I had 2 heavy load patients plus one demanding young adult patient. It took everything I had to get done with everything before the end of the shift. 15 minutes before giving report to the next shift, all 3 of my patients needed time consuming needs, plus I had to finish my I & Os and end of shift notes. So of course, just one patient nearly took 15 minutes and I have the nurse on the next shift standing there waiting for report looking at me as though I am incompetent.

I asked my preceptor how she handles this type of situation. But got no response! Yes, I was assertive when I asked. By the end of my orientation I am supposed to be able to finish my shift managing 4 to 5 patients. I don't feel like I am getting good instruction to help me reach this goal.

Dont worry! You will get the hang of it... this is your first job in a hospital setting right? It takes time to get your routine down but trust me you will be taking on all 5 patients by the end of your orientation. When I started, 2 patients seemed alot and i thought i would never handle all 6... but after orientation I was doing just fine with all 6. But like you... I was always running late and didnt have my notes done by the end of the shift. The way to handle this situation is:

set limits with these "demanding" patients... go in and tell him that the new shift is coming on, so I am going to give your the meds which are due now and if you need anything else, the new nurse will be right in.

1) Finish up giving all the meds due on your shift. Never leave anything for the next shift unless they "ok" it.

2) Then you give report. Always make giving report on time a priority. If you hold up the next shift they will be running behind on their work too and they wont like you for it.

3) Now that you are relieved from your duty... quickly do your I&O... if anything is abnormal, tell the new nurse before you leave.

4) lastly finish your nurse's note and any documentation you need to. this way saving this for last... you aren't holding anyone up... you have no duty to the patients now that you have reported off... and you can sit and relax to finish this last bit of paperwork.

Boy did I struggle for a while... but after some time it was all like second nature to me. You will get it... keep a positive attitude.

Just an update. Now that I started my true shift at nights, the preceptor I have now is great! It does depend on the nurse you are with. I can take a whole assignment and be good with it. I don't know what happened the week before. But, I am almost ready.

Futhermore, I realized along time ago that being a nurse is nothing like what they taught you in school. I was not the best student, but my clinical skills are always good. Hospital policies vary from place to place. I can take what my work experience has taught me.

Thank you, thank you, thank you for giving me such inspiration! I had another really bad day today and my weekly evaluation by the supervisor. She said I am doing good but need to work on time management. And she told me again today I need to be taking care of 4 people next week and manage them well. I get so far behind because I am not sure about certain policies that take forever to read and not sure who I should contact for certain things. Anyway, I will hang in there!

Sounds like the situation I plan to soon be in. 12+ yrs of LTC, no acute care. What types of procedures are you needing help on? What do you find is the most difficult transition?

I feel confident in my LTC time managent skills and some of my assessments and the delegation and dealing with docs.....just wondering.

Thank you, thank you, thank you for giving me such inspiration! I had another really bad day today and my weekly evaluation by the supervisor. She said I am doing good but need to work on time management. And she told me again today I need to be taking care of 4 people next week and manage them well. I get so far behind because I am not sure about certain policies that take forever to read and not sure who I should contact for certain things. Anyway, I will hang in there!

No problem! Glad I could help... If you have any more situations or dilemas and you want any opinion on how to handle it differently... please feel free to ask or email me. I had the same problem too... I was always running late because my preceptor was never around when I needed to ask a question... If i wasn't sure on a specific policy I couldn't find her and didn't know who to ask... After some time, I started getting more assertive... Also If i knew something was going to come up later on that I wasnt sure on... I started telling the Preceptor that she may want to stick around because I am going to need help with the XYZ or ABC... Keep us updated!