Some advice on "Orientation"

[Birdsofprey, BSN]

Hi All-

I am a new grad RN who accepted a position at a large hospital. When I interviewed, they really played up how well they were going to train me (14 weeks total) and outlined how it would go. However, I am now in Week 6 of my "training" and have barely been shown how to do anything, have had to figure out everything on my own, and when I ask questions, people are not very helpful. No one is supervising me at all, and the "Clinical instructors" are too busy to spend much time with me. No one is even reviewing my EMR notes or anything. I have not gotten any feedback on my performance at all (and frankly no one would even know it seems). I am taking care of 3 "easy" patients at a time at this point, and each week it is supposed to progress by 1 additional patient until I reach 6 patients. Then I will begin a new phase of "training" on the floor they actually hired me for- At this point I feel like it's going to be another situation where I am winging it.

I try very hard to ask questions and to advocate for myself, but this gets very exhausting on top of learning the EMR, etc, and I can't yet do anything fast as I am a new RN without the advanced time management skills. I am concerned that I will drown when this "orientation" is over and I have to care for at least 7 complicated patients with even less support.

My question is...

Is this normal in a hospital setting?

Is training usually this bad?

Because this is really crazy. I have been bringing this to the attention of the those in charge of training new hires, but they say they cannot help me due to short staffing. I will try to keep advocating for myself and perhaps bring this to a higher level of management if need be, but I just wanted to see what insight other nurses may have. I know it is hard for new nurses but the lack of training and supervision is surprising to me.

[myoglobin, ASN, BSN, MSN]

Very normal. My first "orientation" was at Methodist hospital in Indianapolis and was known as a "magnet hospital". I did great in the critical care classes, and thought I was doing "okay" with the revolving door of preceptors that I was with (some better than others). After about two months I was basically told I "wasn't right" for critical care. I was allowed to interview and hired on a different medical surgical unit which eventually became a PCU (where I was lucky enough to work with two great nurses that I went to school with). My SO was hired from Med/Surg to CVICU at the same hospital and was basically "fired" after four months of orientation on Christmas Eve after being "set up" by her preceptor (the preceptor disconnected suction on a chest tube for an hour and busted my SO for not getting down on her knees to "catch" the error"). She wasn't even able to go back to her old unit despite being loved by her former manager. Then after we moved to Florida I had to "reorient" on a critical care unit at Florida Hospital where I was basically told after 8 weeks "that I wasn't right for critical care", and transferred to PCU. Then, I went to a different hospital where I've been an ICU nurse for about 8 years. The lesson is that the main goal of orientation is to survive orientation. Of course you should learn what you can, but you will find that lessons learned "on your own" are often less punitive than those learned with a preceptor. Why is this? I don't know. I have considered everything from "cycles of oppression (people treated poorly tend to perpetuate the cycle) to "nurses eating their own" to sociological explanations such as in groups/out groups which are seen as survival strategies ethnographic studies of cultures around the world. Ultimately, the solution is simple treat others as you would wish to be treated and "break" the cycle when you become a preceptor in the future. Just focus on surviving your orientation and leaning over time.

[TriciaJ, RN]

Yes. This is normal. This is the standard line: "Oh, I'm so sorry we have to take you off orientation temporarily. We're just so short right now. We promise we'll resume your orientation as soon as we can." And you're lucky if you even get that much acknowledgement.

Just be self-directed, find someone to ask about anything you have the slightest doubt about or want double-checked. If you're doing something wrong, you'll hear about it. No feedback: you're doing it right.

Hang in there.

[Davey Do]

11 hours ago, myoglobin said:

The lesson is that the main goal of orientation is to survive orientation.

The state hospital I worked at nearly 30 years ago had a great orientation program, but I truly disliked the job, primarily because of the administration.

The state hospital is is, like, always in need of RNs.

I thought that if ever I were in dire straights for the need of money, I'd go there and just be paid by going through orientation.

And then say, "iAdios Amigos!"

11 hours ago, TriciaJ said:

Yes. This is normal.

Really, TriciaJ? Do you think it's always been that way? Maybe it was just the hospital where I began my medical career at 40 years ago, but orientation was great.

Is it because things were different back then or did I just luck out?

Birdsofprey- I have nothing to add that would be any better than what TriciaJ and myoglobin posted.

Best of luck to you, and this just may be one of the Warhols you have to kiss before you find, and stay with, your Rembrandt!

[Birdsofprey, BSN]

Thank you for your feedback, I'll do my best to keep plugging along.

[TriciaJ, RN]

3 hours ago, Davey Do said:

Really, TriciaJ? Do you think it's always been that way? Maybe it was just the hospital where I began my medical career at 40 years ago, but orientation was great.

Some places were better than others. I've had jobs where I got an absolutely great orientation (well, one anyway). Most, however tend to fudge a bit on the orientation. They give you a checklist which you faithfully check off and no one ever asks to look at it. Your preceptor has urgent business elsewhere. Or goes off to have surgery and isn't replaced. Etc. etc.

I've learned to be very self-directed when it comes to orientation. It served me well when orienting to retirement. ?

[Workitinurfava, BSN, RN]

I remember having 6 weeks of training on the floor but throughout that having to take days off to do classroom training which shortened my training. Training for the dayshift at the start of training and flipping to night due to that being my set shift (basically having different people show me 20 different ways to do something). I also remember no one having the time and outright telling me, they don't want to, "orient someone". Next thing I know after 7 shifts (the start of 4 weeks), I was given a full load of patients. Only because I knew what I was doing and picking it up, I was able to handle it all. I also took a lot of notes, asked a lot of questions and would test myself on things during down time. Having prior experienced help me survive. It is so sad what is happening this day in age. People are quitting or getting fired and it is hurting people like you. Not only that but the hospitals don't want to hire someone just to train you properly. The hospitals also want to give the preceptors full patient loads and expect them to have the time to train you, when it should be that as you progress the patients should be added on, to where at the end of your training you have all of the patients. The other thing is people who don't want to train and are being made to train, not given a choice or even a heads up. Some are not qualified, and will show you the wrong way of doing something.The charge nurse can barely help because he or she has patients and is trying to run the unit. Here is the thing, many places are like this however if you have concerns about your license, then consider another place. Try to make it work, because many places are hanging on by a thread and short staffing is being forced. I had a situation to where I was being passed off to nurses that weren't assigned to train me and I told them, no I was not assigned to you, and I had to confront a person who was assigned to train me, not in a disrespectful way, but a um, you are assigned to me and until soemthing changes, I am following the policy.

[Quota, BSN, RN]

Sorry your orientation is going poorly. I’ve only been off orientation about 1.5 months but my orientation went very well. Very supported, lots of people on the unit willing to answer questions or help when needed, etc. So no, it’s not always horrible.

[organichombre, ADN, BSN, MSN, LPN, RN]

During the last quarter of my students program we talk extensively about ensuring that your preceptor/s are people you can talk with who give you valuable feedback. Obviously not all orientation experiences are the same, however, until you feel ready, it is within your rights to not take patients. Because once you do, it's all on you.

Your board of nursing should be your next contact.

[chulada77, ADN, BSN, MSN, APRN]

Normal -unfortunately. Best advice is once u get to ur unit ask questions and watch ur well respected experienced nurses. But watch several of them, you ll take a little something from each one. Growth happens over many years so don’t worry. I learn something learn all the time and I m “experienced”.

[egg122 NP, MSN, APRN]

I wish I could tell you that this is not typical, but that is what every orientation I've had since starting in healthcare has been like. I had more training on the job (and the computer system) when I was working in a pizzeria. I'd advise reviewing videos online for any procedures you may feel you need to improve or learn. Youtube has a lot of videos produced by medical and nursing schools that are pretty good. If your hospital has a subscription to UptoDate.com, it is worth looking up the most common disease states on your floor to familiarize yourself with them and the possible treatment plan. It is a learning curve but you can do it.

[JKL33]

On 6/16/2019 at 1:48 AM, Birdsofprey said:

I am a new grad RN who accepted a position at a large hospital. When I interviewed, they really played up how well they were going to train me (14 weeks total) and outlined how it would go. However, I am now in Week 6 of my "training" and have barely been shown how to do anything, have had to figure out everything on my own, and when I ask questions, people are not very helpful. No one is supervising me at all, and the "Clinical instructors" are too busy to spend much time with me. No one is even reviewing my EMR notes or anything. I have not gotten any feedback on my performance at all (and frankly no one would even know it seems).

You need to go to the educator or person in charge of your orientation and request a meeting for the purposes of receiving meaningful feedback about your progress thus far.

This may be par for the course as described by previous posters, but it is not okay.