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?
I wonder how many newbies understand that it is up to them to fit into the workplace. It is not up to the workplace -- or the established staff -- to rearrange itself/themselves to suit the newbie.
That's a really interesting point but I think it goes both ways. I think the newbie should definitely try very hard to adapt and fit in, they will have an easier time if they do. However, I think the workplace and the established staff definitely have a responsibility to help new staff adapt. Aside from it being a nice thing to do, self-interest can be applied. The more the existing staff are welcoming, approachable and willing to help, the more likely they are to retain the staff they have invested time and money in.
Surely preceptors and mentors in particular should build rapport and adapt to the learning style of the person they are teaching to try to help someone learn and develop? I don't think I am being too naive and optimistic here, I thought this was a given? Thinking about it, whilst writing this, I've just realised that I believe that if you are a preceptor then you are supposed to be a role-model for the new person, a point of contact if they are struggling and...here comes the really sentimental bit...you are supposed to represent the best of where you work in order to promote great standards of care. A lot to live up to! No wonder people don't always wish to do it.
Specializes in Med/Surg crit care, coronary care, PACU,.
I have found that new grads are a mixed breed. Personality definitely helps to succeed in any job, but I have found by personal experience that it is almost impossible to teach a new grad adequate critical thinking skills in an average 6 week orientation. Oh yes, and if you cannot grasp that concept, you will feel like you are not pulling your weight, and may feel the scorn of some of your more cynical, jaded co-workers. Horrible position to be in constantly pushing that boulder uphill. Unfortunately in the busyness of most highly skilled nursing units, there is very little post orientation mentoring done. I understand the draw of wanting to work on a critical care unit, but managers do a grave disservice to new nurses by not making sure that you are given the supportive skills to succeed. Nurses who are clinically supported have extremely high job satisfaction...no surprise there.
1. Personality is definitely a big factor. I'm not a schmoozer myself, and I'm rather introverted by nature, but I can be pleasant and conversational. That's really the minimum I feel, just develop a few points of innocuous small talk. Unfortunately, just being reserved and harmlessly quiet can make you seem aloof.
2. It's always best to address issues with your coworker first. No one likes or trusts a tattletale. Unless it's a serious and dangerous issue, don't immediately go to the manager. I like most people, and personally don't have the mental energy or spite in me to try to get someone fired just because we don't click. What goes around comes around, too. To me, it's ridiculous to sabotage someone's livelihood because they're not your BFF. And eventually people notice and distance themselves from nasty people.
3. It really depends, I don't know if there's a concrete answer as to what is the best preceptor set-up. Depends on both you and your preceptors. A few things I can almost guarantee will be bonus points with any preceptor: ask deeper questions, research things for yourself (you might need to skim policy and protocol on days off, but it'll pay off once you've acquainted yourself with your facility's foundation), don't constantly whine "but, in nursing school..." because you've got to move past that to adapt to real life, take initiative and help others, and do not be a know-it-all. A particularly twitchy, nervous oriented recently chimed in during report in an attempt to inarticulately stutter-question me on an irrelevant CT from two weeks ago--her preceptor cut her right down at the knees for it. It was painful to see. She was trying to look smart, but came across as foolish. Honestly, a really big tip is don't try to outnurse others. It's silly, and you'll never win because this is a team effort. There are ways to prove that you're intelligent that don't involve coming across as a ridiculous kiss-a**. Lol.
4. I want you to show signs of developing your own process. There's many ways to do it, and I like to see orientees work out their method. Get into a habit of tracking the basics: vitals, intake/output, skin, labs, general survey, etc. Acquaint yourself with the medicine you see most. Train yourself to look for oxygen, IV access, and what drips are up when you enter a room. Don't chicken out and pass on every needle stick, and if you find you need it seek remediation on invasives.
5. Fit is very important. For example, do you like cardiac? Do you care to really dig in and learn more about your population's pathophys? When you're passionate, it shows. Even if it's not your ideal specialty, as long as you make some effort and aren't visibly miserable with it, you should do fine.
5. Last of all, even if the new hires do better than you, it's not fair for you to attribute that to them being better than you. You must have confidence. Don't be hard on yourself, and don't assume the worst. Brush it off and strive to do better next time.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
That's a really interesting point but I think it goes both ways. I think the newbie should definitely try very hard to adapt and fit in, they will have an easier time if they do. However, I think the workplace and the established staff definitely have a responsibility to help new staff adapt. Aside from it being a nice thing to do, self-interest can be applied. The more the existing staff are welcoming, approachable and willing to help, the more likely they are to retain the staff they have invested time and money in.
Surely preceptors and mentors in particular should build rapport and adapt to the learning style of the person they are teaching to try to help someone learn and develop? I don't think I am being too naive and optimistic here, I thought this was a given? Thinking about it, whilst writing this, I've just realised that I believe that if you are a preceptor then you are supposed to be a role-model for the new person, a point of contact if they are struggling and...here comes the really sentimental bit...you are supposed to represent the best of where you work in order to promote great standards of care. A lot to live up to! No wonder people don't always wish to do it.
It is up to the new person to adapt to the workplace and the established staff; it is not up the the workplace or the established staff to rearrange itself/themselves to accommodate the newbie. It isn't a matter of the staff or the workplace meeting you halfway. YOU are the newbie, it is up to YOU to fit in.
While you're correct that the established staff being welcoming, approachable and willing to help will make the newbies more comfortable, it is also true that the millennial so have just about worn us out with their job hopping. It gets old being warm and welcoming to new staff, to bust your butt to orient them into the kind of nurse you want to work with only to have them leave once they're barely out of orientation because "this isn't my dream job," or "I want to be an NP" or "I'm going to anesthesia school." It used to be that a new grad stayed in her first job until she became competent -- about two years -- and then started looking around for the next great thing. These days, they'll tell you on their first day that they don't need to learn all that because they're only staying until they get into grad school, get promoted to manager or (and I swear this is true) marry a doctor. The core staff gets tired of all the churning, and start waiting with the welcoming to see if it looks like this chick will stay. You can hardly blame them.
Preceptors usually aren't asked if they want to precept; they're told. Some of them don't like to teach, some of them are horrendously bad at it, and some of them could use a break from precepting because they've been on the continuous precepting plan for the last two years and have trained four nurses (for six months each), two of whom are in NP school, one of whom went to anesthesia school and another who found her dream job (MRS. DR.) and quit without notice. While it is a nice fantasy that your preceptor should build rapport and adapt to the learning style of the orientee, the more reasonable expectation is that the preceptor is burned out on precepting and that the orientee needs to build the rapport and adjust the the teaching style of the preceptor.
Most of us preceptors have striven for the idea you describe, but have been worn down by the continuous turnover of barely competent staff moving on to follow their dreeeaaaaammmmmms and newbies coming aboard expecting to sit back and be taught.
It's not my job to teach you. It's your job to learn. My job is to keep you from killing very many patients before you do learn.
It is up to the new person to adapt to the workplace and the established staff; it is not up the the workplace or the established staff to rearrange itself/themselves to accommodate the newbie. It isn't a matter of the staff or the workplace meeting you halfway. YOU are the newbie, it is up to YOU to fit in.
While you're correct that the established staff being welcoming, approachable and willing to help will make the newbies more comfortable, it is also true that the millennial so have just about worn us out with their job hopping. It gets old being warm and welcoming to new staff, to bust your butt to orient them into the kind of nurse you want to work with only to have them leave once they're barely out of orientation because "this isn't my dream job," or "I want to be an NP" or "I'm going to anesthesia school." It used to be that a new grad stayed in her first job until she became competent -- about two years -- and then started looking around for the next great thing. These days, they'll tell you on their first day that they don't need to learn all that because they're only staying until they get into grad school, get promoted to manager or (and I swear this is true) marry a doctor. The core staff gets tired of all the churning, and start waiting with the welcoming to see if it looks like this chick will stay. You can hardly blame them.
Preceptors usually aren't asked if they want to precept; they're told. Some of them don't like to teach, some of them are horrendously bad at it, and some of them could use a break from precepting because they've been on the continuous precepting plan for the last two years and have trained four nurses (for six months each), two of whom are in NP school, one of whom went to anesthesia school and another who found her dream job (MRS. DR.) and quit without notice. While it is a nice fantasy that your preceptor should build rapport and adapt to the learning style of the orientee, the more reasonable expectation is that the preceptor is burned out on precepting and that the orientee needs to build the rapport and adjust the the teaching style of the preceptor.
Most of us preceptors have striven for the idea you describe, but have been worn down by the continuous turnover of barely competent staff moving on to follow their dreeeaaaaammmmmms and newbies coming aboard expecting to sit back and be taught.
It's not my job to teach you. It's your job to learn. My job is to keep you from killing very many patients before you do learn.
Oh wow, taking all that into account, in those circumstances you describe ...yes, any preceptor would absolutely be burnt out and hacked off. Those comments about getting better jobs and marrying Drs!! I didn't understand the circumstances for you and my comment was probably pretty aggravating considering your experience, I'm sorry, thanks for explaining. Hopefully new staff reading this will gain a better sense of why they can't just sit back and passively be taught.
Is this the same in every area? I get a break between new staff and students and they don't say stuff like that (although they might think it) so that's why from my perspective my ideas aren't a "nice fantasy" they are part of my job. In your context I would swiftly burn-out and adjust those ideas however.
Crack on then, orientees! Bring all your interpersonal skills and proactivity with you to work as you can't expect the existing staff to mentor or precept in any sense of the words in the situations they are in, no-one can operate well in those conditions. It is up to you to make the best of it all.
Specializes in Critical Care; Cardiac; Professional Development.
I precepted on both cardiac and ICU progressive care (stepdown) units. There were a couple who didn't make it. Most did. From my perspective, those who did not make it had the following issues:
1. Poor time management that never improved.
2. Inability to recognize when they needed help and when they needed to push through on their own (ie very basic critical thinking)
3. Inability to look for answers on their own when appropriate.
4. Anxious. So very, very anxious. Beyond the point that my patience and pay grade would/could/should have to deal with at work from another nurse, even a new one. A little anxiety? Sure. Normal. But this was not a little anxiety.
5. Inability to take constructive feedback and apply it to their own practice. They would either argue with it or just ignore it completely.
6. Poor communication and organization in general. Took forever to give and get report. Took forever to get their day up and running. Often not done with morning (8:00 AM) med pass and it is time for noon meds.
None of these had to deal with "schmoozability". It was all to do with the ability to make the transition from school to real world and the ability to manage their stress.
It is up to the new person to adapt to the workplace and the established staff; it is not up the the workplace or the established staff to rearrange itself/themselves to accommodate the newbie. It isn't a matter of the staff or the workplace meeting you halfway. YOU are the newbie, it is up to YOU to fit in.
While you're correct that the established staff being welcoming, approachable and willing to help will make the newbies more comfortable, it is also true that the millennial so have just about worn us out with their job hopping. It gets old being warm and welcoming to new staff, to bust your butt to orient them into the kind of nurse you want to work with only to have them leave once they're barely out of orientation because "this isn't my dream job," or "I want to be an NP" or "I'm going to anesthesia school." It used to be that a new grad stayed in her first job until she became competent -- about two years -- and then started looking around for the next great thing. These days, they'll tell you on their first day that they don't need to learn all that because they're only staying until they get into grad school, get promoted to manager or (and I swear this is true) marry a doctor. The core staff gets tired of all the churning, and start waiting with the welcoming to see if it looks like this chick will stay. You can hardly blame them.
Preceptors usually aren't asked if they want to precept; they're told. Some of them don't like to teach, some of them are horrendously bad at it, and some of them could use a break from precepting because they've been on the continuous precepting plan for the last two years and have trained four nurses (for six months each), two of whom are in NP school, one of whom went to anesthesia school and another who found her dream job (MRS. DR.) and quit without notice. While it is a nice fantasy that your preceptor should build rapport and adapt to the learning style of the orientee, the more reasonable expectation is that the preceptor is burned out on precepting and that the orientee needs to build the rapport and adjust the the teaching style of the preceptor.
Most of us preceptors have striven for the idea you describe, but have been worn down by the continuous turnover of barely competent staff moving on to follow their dreeeaaaaammmmmms and newbies coming aboard expecting to sit back and be taught.
It's not my job to teach you. It's your job to learn. My job is to keep you from killing very many patients before you do learn.
No one is saying that newbies do not have responsibility in their orientation, or that staff members or the unit should change all their ways just because of one new person. However, unit members and preceptors should at least have the decency to make their expectations clear, so the new nurse has an idea of what he or she is expected to do. Not knowing what staff members want from their orientees can make it difficult for them to "fit in." It's not that hard to say, "Here is what we are looking for," and "by this time in your orientation, you should be able to this, this and that." Also, if you make promises that you will assist a new nurse in something, you should either keep them or not make them at all. If you simply do not have time to help the person, say so.
I can completely understand how frustrating it must be to put in a lot of effort to train a new person, who ends up leaving soon. At the same time, preceptors should make an effort to treat each new person the same, and with as much enthusiasm as possible, because you never know when you might be training one of the best nurses on your unit. If someone absolutely hates precepting, maybe they should find an area where they will not be expected to do so or where they'll have the option to refuse. Jobs like that do exist; in my old area, only the people that were interested in precepting did it. I realize that it's not the same everywhere else, but the preceptor could do him or herself a favor by adjusting their attitude on the task or, like I said, finding a job where they do not have to participate. Also, the attitude that you are not there to teach the orientee at all is a poor one, because you should at least be willing to show them tricks that make working their more efficient. Certainly, the preceptor shouldn't have to reteach Human Anatomy or Nursing 101, but some things on each unit are specific to that specialty, and the preceptor certainly is obligated to at least teach those things.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I can completely understand how frustrating it must be to put in a lot of effort to train a new person, who ends up leaving soon. At the same time, preceptors should make an effort to treat each new person the same, and with as much enthusiasm as possible, because you never know when you might be training one of the best nurses on your unit. If someone absolutely hates precepting, maybe they should find an area where they will not be expected to do so or where they'll have the option to refuse. Jobs like that do exist; in my old area, only the people that were interested in precepting did it. I realize that it's not the same everywhere else, but the preceptor could do him or herself a favor by adjusting their attitude on the task or, like I said, finding a job where they do not have to participate. Also, the attitude that you are not there to teach the orientee at all is a poor one, because you should at least be willing to show them tricks that make working their more efficient. Certainly, the preceptor shouldn't have to reteach Human Anatomy or Nursing 101, but some things on each unit are specific to that specialty, and the preceptor certainly is obligated to at least teach those things.
I don't think you do understand how frustrating it is to put in a ton of effort precepting a new nurse who leaves just as soon as possible. You certainly don't understand precepting, nor do you "get it" that preceptors don't have options NOT to precept in MOST workplaces. If someone absolutely loves SICU, they should work in SICU whether or not they like precepting. Changing jobs from a place you really enjoy to work in a place where "you won't be expected to precept" is a nice fantasy for someone who has never been in the position -- but it's essentially impossible. And again, why should the senior staff be expected to make changes for the sake of an unknown potential orientee who is CERTAIN she's entitled to an enthusiastic preceptor who has endless patience and compassion for her and expects little in return?
Your attitude that the preceptor is there to "show them tricks to make working their (did you mean there?) more efficient" is also wrong. And who are you to suggest an attitude adjustment on the part of the senior nurse who gets stuck with you? The preceptor is there to make sure you aren't harming or killing any patients as you learn to become a nurse. The preceptor is an experienced nurse who was hired to take care of the patient population that unit sees. The preceptor is a NURSE who was hired to TAKE CARE of patients, not to baby sit new hires who aren't paying attention in their hospital orientation classes and won't study the policies, procedures and disease processes of the patient population on their own time.
It is wonderful if you, as a newbie, get a preceptor who loves to teach, has some actual tips and tricks to share (and is willing to share them). You will get the preceptor you get, and it is up to you to adjust your attitude to work with that person, not the reverse. If you go around suggesting that senior staff adjust their attitude to whatever you prefer, change jobs if they don't like precepting and have an obligation to show you tricks to become more efficient, I'm thinking you probably won't like the preceptor you'll get. There aren't many of those paragons of precepting out there.
You're stalking the nurses that replaced you? Not creepy at all, no...
Update on my replacements:
One of them is in her senior year of nursing school and is on my former unit for her immersion experience. Once I found out that she was interviewing for the position, I kept my eyes out, and, sure enough, she is now listed on the unit's webpage as being hired. She's obviously doing well and is a better fit than I was, because why would they hire someone they have already met, if that person was not doing a good job?
As for the other two new people, I don't know much about them, because their names are common and their pictures aren't posted yet.
The other orientee, who made it through orientation, is also still on the floor.
Well, stalking aside, I think you do still have good insight and are asking the right questions to try and improve your next orientation experience. As others have said, let it go and move on, you seem to have potential but if you let this experience bog you down you won't get anywhere.
I have been involved in orienting almost every new hire on our floor in some way or another for about a year and a half, so I have a few relevant observations. I have had orientees that were a PERFECT fit, I had one who almost failed but it turned out to be a personality clash between preceptor/preceptee, and I have been the primary preceptor for a new grad that didn't make it through orientation (this turned out to be as difficult for me as it was for her). So item by item I'll try to share my experiences.
1. Personality. Can your personality make or break your job?
The job? Hopefully not, but your orientation? YES! Some personalities do not work together, some preceptors do not understand the preceptee's learning style. While resources are often limited, hopefully your manager can work with you to find a preceptor that you mesh with and can learn from. If not, it is on you to try and understand your preceptor's teaching style, and learn how to communicate with them in a way that they know you are learning. Take responsibility for your own learning, it is the only thing you can control
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?
In a learning situation we try to address issues as a group. As an example, if I am precepting and the report is subpar, and my coworkers sees me jumping in to fill in all the gaps, it is appropriate for that coworker to approach management who decided if it is an issue that needs addressed (they are responsible for your orientation and can help identify patterns). The issue will then be addressed with the manager, preceptor, and preceptee. If it seems that they are "talking about you," they are, but it should be constructive and geared towards helping you succeed. The coworker's involvement should never go beyond identifying issues that your preceptor may have become blind to.
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?
I've noticed that having a consistent preceptor through the first half of orientation, and then having several preceptor's on the second half seems to work best. But it never happens. There are simply too many things to coordinate.
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?
I expect to see effort in critical thinking, but not expertise. You shouldn't know how to do everything, but if we have already done something together or talked about an aspect of pathophysiology, you need to have good recall and be able to independently come up with some of these things next time we come across a topic, even if weeks have gone by. You need to know your resources, and try to find out answers and solutions to problems on your own before coming to me, as I'm not a walking dictionary that will always be around to regurgitate policy
5. Fit. Are some people just not a good fit for a certain area/specialty?
Definitely. The nurse that failed my orientation was not a bad nurse. She did the right things, she tried hard, but ICU simply wasn't clicking which is okay. She is now successful on another unit in the hospital. Had I started in the ICU as a new grad I suspect I may have had the same outcome. When picking a job you need to do a little bit of self reflecting and make sure you know what you are getting yourself into.
I hope that is helpful, and not to hard to read as my phone formatting skills are limited.
Hollybobs
161 Posts
That's a really interesting point but I think it goes both ways. I think the newbie should definitely try very hard to adapt and fit in, they will have an easier time if they do. However, I think the workplace and the established staff definitely have a responsibility to help new staff adapt. Aside from it being a nice thing to do, self-interest can be applied. The more the existing staff are welcoming, approachable and willing to help, the more likely they are to retain the staff they have invested time and money in.
Surely preceptors and mentors in particular should build rapport and adapt to the learning style of the person they are teaching to try to help someone learn and develop? I don't think I am being too naive and optimistic here, I thought this was a given? Thinking about it, whilst writing this, I've just realised that I believe that if you are a preceptor then you are supposed to be a role-model for the new person, a point of contact if they are struggling and...here comes the really sentimental bit...you are supposed to represent the best of where you work in order to promote great standards of care. A lot to live up to! No wonder people don't always wish to do it.