Successful Orientees Vs Unsuccessful Orientees

KatieMI, BSN, MSN, RN · Feb 20, 2016

IMH(umble)O, it is a whole lot about EACH side. The orientee can be absolutely awesome in terms of skills and knowledge, but if his or her ability to wiggle the way into local gossiping circle is considered to be the prime responsibility, then the poor new one will not succeed doesn't matter what. Same about the opposite. It is an utter shame that it is easier to get the interviewer to speak about his or her intimate life during the interview than to get the truthful responce on a simple question: what exactly do you expect from every new hire? Or: what qualities make an excellent nurse IN THIS UNIT? Gosh, just let me know what you want, and if I cannot offer just that, we will happily part our ways!

(P.S. from my experience, even one time talk about "awesomeness" of another orientee as compared to another should let that another orientee to idea of getting the heck out of there STAT and SOS. Unless we are talking about some marvel of critical thinking which needs to be taught to everyone, it is absolutely unprofessional behavior and a clear hallmark of "targeting" that other orientee).

nurse1990 · Feb 21, 2016

I'm on my last month of orientation and some things I've noticed:

- I am the type that takes a while to open up to people. Those naturally outgoing "charismatic" people, have ALWAYS been preferred over me. They have made friends on the floor already and get enthusiastic hellos. Its easy to compare myself to them and feel down (which I do sometimes) but I understand that I don't have that personality type. I've slowly made a few friends, and had other parts of me recognized (apparently I'm good at de escalating conflict, yay!)

- I have had multiple preceptors (cause I'm being oriented on multiple floors) and I LOVE it. I get to learn different tips and tricks from each nurse. Also, the nurses who have been rude and generally unhelpful, well...I never had to see them again! So although having 1 preceptor is good for continuity, I've been VERY glad to get rid of a few of them.

- ASK PEOPLE IF THEY NEED HELP! This has been the thing that has helped people like me. If I ever have time I try and help the other nurses, they really appreciate that and see you are a team player.

- Realizing I'm not perfect. Some nurses will expect you to be and thats ok, just remember your a NEW GRAD, youre in orientation and your allowed to make simple mistakes (even big ones but I'm glad I havent made those yet lol).

Hoosier_RN, MSN · Feb 21, 2016

Based on what you have seen and experienced, what makes some new nurses successful during orientation while others are not? Why do some new nurses have more potential than others?
At my previous nursing job, in which I was not successful during orientation, there was another new grad who was. In fact, there were many new grads that were successful, and it appeared that I was the only new hire that wasn't successful. While I've heard that starting out on a progressive care cardiac unit can be tough on new nurses, and one of my former coworkers even commented to me later that many new grads don't make it on the floor, it obviously can be done. Because it has been. Just not by me.
What I'm trying to figure out is why this other person was successful and I was not. During my orientation, all I kept hearing about was how wonderful this other orientee was, how much progress he was making, and how I simply didn't compare to him. He was brought up frequently during my progress reviews as a comparison. Obviously, they were in favor of him more than me. They never really said specifically what he was doing better, they just said that he was progressing as expected. For them, he was their shining star. They loved him, while the majority of the other nurses wanted me out. Now, they are hiring replacements, and I can't help but wonder what their experiences are going to be like. More than likely, they have more potential than I do, and will probably be more successful. I have kept a list of names of the people that are joining the unit and/or interviewing for it, just so I can see how long they stay. If they make it through orientation, they were obviously better choices than I was, better nurses than I am, better people, really.
But, anyway...what I'm wondering is what makes some new orientees better than others.
Is it...
1. Personality. Can your personality make or break your job?
2. Coworkers. If your coworkers don't like you, is it more likely they will try to get you removed from the unit? Are people more successful when coworkers address issues with them, rather than immediately going to the manager?
3. Preceptors. Do orientees with consistent preceptors with consistent expectations do better than those who have a variety of preceptors? How about preceptor-orientee fit? How important is it that it is a good match, personality wise?
4. Skills and Critical Thinking. What are you, as preceptors and seasoned nurses looking for as far as skills and critical thinking? Is it expected that new nurses will need to be taught certain skills? Certainly there were skills on my old unit that had not been taught in nursing school. How fast would you expect them to be able to learn new things?
5. Fit. Are some people just not a good fit for a certain area/specialty?
5. Other ideas. What else makes someone more successful than someone else?

In some parts, you seem to have a chip on your shoulder. Lose it! Realize that Nursing Jobs are like regular jobs, in that not everyone is meant to be a butcher, mailman, secretary, etc. Different areas of nursing require different personalities and skill sets. Like others have said, see if you can find some written critique of your work so that you can learn where you need to develop + see if another area works best for you. I wish you the best of luck.. don't be too down on yourself. You will end up exactly where you need to be, and this experience will help you appreciate it when you get there. If this was your 'dream job', maybe it's Fate's way of saying "ummm, maybe not so much". Just don't be afraid to get back out there and be yourself, and learn all you can, and most of all, be receptive to compliments and critique. Lastly, if you are told "Suzy is progressing so much more than you" don't be afraid to ask about what skills, areas, etc that are being discussed. Let them know that you can't fix it if you don't know it's broke!

Natasha, RN, BSN · Feb 21, 2016

One thing that's obvious: you already have insight and are receptive to feedback. That gives you lots of potential. You could be absolutely right about everything you mentioned.
The Golden Boy might just be a great schmoozer and manipulator. I've seen it more than once. Comparing you to him is very poor form unless they can provide you with specific examples that you can use.
Having a consistent preceptor is usually a lot better than getting passed around. The type of nursing done on that floor just might not suit your temperament and you will find a much better fit elsewhere.
Critical thinking is easier learned than taught. What that means is you have to be self-directed in developing your own skills. Ask questions any time you're not sure; beef up on theory on your own time; write things down that you need to remember. Develop a worksheet that works for you and make copies of it. Rely on it to help you stay current with your patients' needs, organize and prioritize your care and use as a running to-do list.
Not doing well on a particular unit may turn out to be a dodged bullet. Take whatever you have learned and move on. Your post is well-written and thought out. I think you have the makings of a competent nurse that many people would want for a coworker. Hang in there and good luck.

^^^THIS!!!^^^ Couldn't have said it better myself...

FurBabyMom, MSN, RN · Feb 21, 2016

I have to agree with the others. Some of it is personality and all of the other factors others have mentioned.

Some of it is personal (like the inability to take direction, apply knowledge, etc). I precepted someone last fall who was the first employee I've had to provide negative feedback on. I gave many chances, tried many explanations, worked very hard to help find the correct learning strategy for the orientee - and beat myself up. I felt like *I* had failed. My boss gave me the advice that she'd been given long ago - that as a manager you don't actually fire people, people make choices that lead to their own firing (or other discipline). I was asked to give examples of my observations to our director - and it seems like my observations may have been part of the "paper trail". I don't even care because at the end of the day - my job is to take care of people, to protect my patients. Sometimes that means telling the truth about coworkers or orientees.

I think that there are all types of people because there are all types of jobs. Maybe the type of nursing you tried isn't where you need to be. I did *okay* as a floor nurse, and I could do it again if I had to, but I've really done very well as an OR nurse. It's a different kind of chaos - not better and not worse than the floor. But it takes all types.

I would definitely solicit feedback if possible. Consider it - maybe it's honest, maybe it's not quite the truth, but somehow someone got that perception of you. Maybe talk to previous instructors to see if they have any insight?

Definitely be prepared to come into your next job with the attitude that there is something to learn from everyone. There is. Focus on learning, take things with a grain of salt, realize everyone has their own way of doing things. It's true. It's hard as a preceptor because you want to let someone learn and grow - so you let them do their way until it becomes clear that doing so could harm a patient or is breaking policies (generally these two are tied together). I tell my orientees that most people do things differently - and that more than likely they will take something from me, something from so and so, other things from another coworker, and make their own version. It's true for me - parts of my routine came from each of the folks who oriented me.

I don't know what else to say. I'm someone who has a lot to say but doesn't open up until I feel comfortable with people. Which made it easy not to say too much on orientation.

Ruby Vee, BSN · Feb 21, 2016

What I'm trying to figure out is why this other person was successful and I was not. During my orientation, all I kept hearing about was how wonderful this other orientee was, how much progress he was making, and how I simply didn't compare to him. He was brought up frequently during my progress reviews as a comparison. Obviously, they were in favor of him more than me. They never really said specifically what he was doing better, they just said that he was progressing as expected. For them, he was their shining star. They loved him, while the majority of the other nurses wanted me out. Now, they are hiring replacements, and I can't help but wonder what their experiences are going to be like. More than likely, they have more potential than I do, and will probably be more successful. I have kept a list of names of the people that are joining the unit and/or interviewing for it, just so I can see how long they stay. If they make it through orientation, they were obviously better choices than I was, better nurses than I am, better people, really.
But, anyway...what I'm wondering is what makes some new orientees better than others.
Is it...
1. Personality. Can your personality make or break your job?
2. Coworkers. If your coworkers don't like you, is it more likely they will try to get you removed from the unit? Are people more successful when coworkers address issues with them, rather than immediately going to the manager?
3. Preceptors. Do orientees with consistent preceptors with consistent expectations do better than those who have a variety of preceptors? How about preceptor-orientee fit? How important is it that it is a good match, personality wise?
4. Skills and Critical Thinking. What are you, as preceptors and seasoned nurses looking for as far as skills and critical thinking? Is it expected that new nurses will need to be taught certain skills? Certainly there were skills on my old unit that had not been taught in nursing school. How fast would you expect them to be able to learn new things?
5. Fit. Are some people just not a good fit for a certain area/specialty?
5. Other ideas. What else makes someone more successful than someone else?

First, let me say that you ask an excellent question, and I think all of the factors you listed can contribute. It does seem, however, that you still have a chip on your shoulder about your experience. I'm not saying it's unwarranted, but you will want to lose that before you interview for future jobs. This bit about keeping track of the names of people "who have more potential than I do just so I can see how long they stay" -- indicates bad attitude and makes you an unattractive candidate for future positions.

Personality can definitely make you or break you. If your coworkers like you, they'll forgive some mighty big mistakes. If they don't like you, even small mistakes will get you in trouble. Nursing isn't any different in this regard -- but it seems to surprise people because nurses are supposed to be all about compassion and altruism at all times. Nurses are people, too -- just like butchers, do-nut bakers and CPAs, but no one expects THEM to ooze compassion at all times.

I'm not aware of co-workers trying to get anyone removed from the unit just because they don't like that person, but if you don't like that person it's easier to see their bad points and more difficult to see the good ones. That's just human nature. Most orienteers are more successful when issues are addressed with them immediately rather than having someone run off to the manager . . . But some orienteers make it difficult or impossible to address issues. If you are sullen or surly, if you are defensive, if you are a perfectionist it may be just too much trouble to address issues with you. If you have to hear five or six positives before anyone dares bring up a negative, most people are just too busy to bother. I've had orientees with these issues, and they fail. Nursing is a precise field -- giving 10 units of insulin instead of 100 units or .1 unit is an enormous mistake that can have life-threatening consequences. If you cannot take criticism well, you probably won't make it through orientation.

As far as preceptors go, you get what you get. It would be nice if you got a consistent preceptor whose teaching style was well-matched to your learning style, but that's not always feasible. In a unit with a high turnover, you'll get the preceptor(s) who are available. It is up to YOU to get along with THEM, not the other way around. If your preceptor sexually harasses you, is stoned every day or has mentioned more than once how you look just like her husband's mistress, talk to your manager about a change. But usually, your manager will view an inability to get along with your preceptor has a failure in your ability to get along with her staff. You can learn from a bad preceptor -- they may not deliver feedback in a manner that you prefer, but chances are they still have a message to get across, and you'll learn better by paying attention to the message rather than to the delivery. Sometimes multiple preceptors are a good thing. We all have our strengths and weaknesses. I understand pacers backward and forward, but I cannot explain pacer checks to save my soul. I refer my orientee to Betsy, who is good at teaching that. Betsy sends her orientees to me to learn rhythms.

We don't expect new grads to have skills, but critical thinking is a must. That is LEARNED, not TAUGHT. You can't really teach critical thinking; but you can surely tell when it isn't being learned. The orientee who have Mr. Smith's Coumadin right on time may have time management down, but her critical thinking was absent. Mr. Smith had an INR of 7 (higher than his hemoglobin) and was peeing bright red urine.

"Fit" is definitely a factor, but there are some things that stand out and make anyone a poor fit. Inability to take criticism well is one thing. Someone up thread mentioned ethics. An over abundance of classroom-appropriate ethics may not be possible on a busy nursing unit. Some things should be obvious, but the orientee who spent her first day telling me how all of the men who work on our unit "are immoral" turned out not to be a good fit, as did the orientee who insisted upon telling me that I was going to hell for "failing to honor my husband" when I left the abusive jackass immediately after he tried to strangle me to death.

In general, be friendly even to those of your colleagues who aren't friendly first, for they could be introverts whose opinion the manager greatly relies upon. Learn something the first few times it's brought up. Ask the right questions. There's a difference between "how do I hang blood?" And "I have the order here, and I've checked that there is a current type and cross, the patient has a patent IV and the consent is signed. What else do I need to think about?" Look things up and study on your own time. You may spend a lot of your own time studying -- I did when I was a new grad and every time I've changed specialties. Demonstrate that you've attempted to figure things out before asking for help. Ask "where can I find the phone numbers we use frequently" rather than "now what's the phone number for the blood bank again?"

Good luck finding and succeeding at your next job.

woundnurse4u · Feb 22, 2016

I was a designated preceptor (it has been some years). You can be the nicest orientee in the world, show up on time with a smile on your face, get along with others, and that doesn't mean you will make the cut. The worst orientation I ever had to give a nurse? She was all over the place. She couldn't manage her time. She couldn't handle a crisis. She would take little initiative to find answers (such as looking up a policy). I didn't mind giving her the answers but after a while, I felt that she needed to also look at other available resources. Bear in mind, it was also a very tough unit and not all of the nurses were very kind. I tried my very best to get this nurse to a place where she could function but to be honest, she was re-entering the workforce and she could not keep up with the pace ( which I also found to be ridiculous but could manage). She didn't last and she was actually relieved to leave the position. I felt terribly about it but the unit and patient acuity wasn't for her. She would have done great in home care, a clinic, as a school nurse, or maybe in special care or procedures or pacu.

ClaraRedheart, BSN, RN · Feb 22, 2016

I think that tenacity is a big part of making it as an orientee. Do not accept failure. That's easy to say... I hated the first year, but refused to give up. I'm the only one of 4 of my cohort still on my floor. Two were gone in the first year. The 3rd was awesome at Med-Surg/Tele as well, but left for a floor more suited to her after 2 years. Med-Surg can be overwhelming, as I'm sure many others can be. I'm sure that some of my preceptors disliked me. I was awkward, bumbling, asked too many questions. I'm pretty sure that one asked never to precept again after me. I think that, despite my hard time getting started, I'm a decent nurse now. I have an interest in precepting in the future, maybe eventually teaching WAAAAYYY down the line. Some preceptors can overwhelm and discourage, others can teach and encourage... use your failures as ways to learn. I am fortunate that I had a GREAT preceptor that took each mistake that I made and made me come up with a plan to NEVER make that mistake again. She did that in a very kind, patient way and I am grateful to her.

chacha82, ADN, BSN · Feb 22, 2016

Do you like where you are now? It sounds as if you have been very mature about the entire process. I was let go from a position at a different job as it came down to me and 1 other person and they chose him, not me. The hardest part was they let me know in December but I didn't leave the position until July in order to not screw them over. For a long time I questioned why they picked him and not me. In the end it just hurt more as I tried to figure it out.

I think you can identify behaviors, but beyond that, it may not always work out. Certainly personalities do factor in. I work on a busy cardiac floor and we have had some people go, either their choice or let go. I don't know all the details and it's not my business. But if it isn't working for them then why force it? I think you should give your all to what you want to do, but sometimes it is just not a good fit.

I think on a cardiac/tele floor some issues could be people who did not respond appropriately to EKG changes, people who did not notify doctors of vital sign changes, if you're just giving meds without checking parameters, not adhering to fluid restrictions, it's hard to say. Someone who did not want to deal with high acuity or escalation of care might not be a good fit for the floor. They can still be an excellent nurse.

Are you successful where you are now? Sometimes you just have to be ready or in the right environment. I worked in an urgent care center for 2 years and it was great at the time. I left when I finished school because I wanted to work as a floor nurse. Good luck to you and if this is a constructive path for you to go down, you can pursue trying to find out why. But if it hurts you, I would give it back to the universe.

bebbercorn · Feb 22, 2016

I started on a Step down unit. I was one of a half dozen or so in which 4 of us really were successful and 2 were not... they were kept on, but with extra orientation. Here is one thing I noticed about one of them... She was super personable, friendly, smart... but she "kept getting patients that crashed."

Or did she?

I was a new grad, so I can see not listening to my concerns as much as others, but this orientee constantly brushed off concerns from many others with more experience when there were subtle hints that a patient was decompensating... changes in mentation, bp, etc. She brushed off the unit secretary/telemetry monitor, who could read a strip better than any of us, when he would say "I think this guys trying to flip into a fib... I'm noticing too many PVC's... this guys rhythm is changing..." whatever it was, she would say "He's fine, the patient has been like that" or "OK, I'll check on it," then go on sipping her latte. She would roll her eyes at senior nurses that would try and give her advice, or say 'I'd watch that". Later, as we are frantically coding or transferring her patient she would say something like "Just my luck to have my patient take a nosedive."

I am NOT saying that this is you. Just giving my own 2 coppers.

RNator · Feb 22, 2016

^^^THIS!!!^^^ Couldn't have said it better myself...

I'll 2nd that!

Julius Seizure · Feb 23, 2016

If they make it through orientation, they were obviously better choices than I was, better nurses than I am, better people, really.

No, no, no. Every nurse has different skills and weaknesses. Your puzzle piece didn't fit in that unit. It will fit somewhere else.

I "failed" orientation on 2 floors, and was able to fail on a 3rd floor....until they hired me into a PICU internship and suddenly, my puzzle piece fit. I had zero issues during orientation (to everyones surprise - they had been "warned" about me). I just needed to find the right place.