50 Things New Nurses Need to Know about Orientation

[Lynda Lampert, RN]

New nurse orientation is one of the most eye opening experiences in becoming a nurse. You shift from being coddled to experiencing what the real world is like. Even nurses who change jobs have difficulty with orientation because nursing is so detail oriented. If you are a new nurse or a nurse changing jobs, here are some tips for making it a little easier.

1. You will be overwhelmed. Expect it.
2. Nursing school taught you the basics, but orientation teaches you how to be a nurse.
3. Always be honest with your preceptor.
4. Don't be afraid to jump in and help if you are sure you know what you're doing.
5. Answer bells. Always.
6. Study the policies and procedures manual. They will come up at some point.
7. Don't be afraid to admit you don't get something.
8. Follow the watch, do, teach model of learning a new skill.
9. Be brave when trying new things that are asked of you.
10. You will have far more patients than in school, and this can be scary.
11. Get a brain sheet that works for you, not just for your preceptor.
12. Talk to your manager about how things are going in your orientation.
13. Don't compare yourself to other new grads because people learn differently.
14. Try to observe as much nursing care as possible, even if it isn't your patient.
15. Rotate to other departments that impact your own to get a feel for the other side.
16. You don't need to know everything the first day.
17. Chart as you go.
18. Let your preceptor look over your charting to ensure you are doing it right.
19. Get to know your floor's education specialist.
20. Take every opportunity to do mock codes or use simulators.
21. Don't do everything yourself. Learn the nuances of delegation.
22. Make friends with your fellow nurses and CNAs. You will need them.
23. Your charge nurse is your friend. You will turn to them when you are alone and confused.
24. Learn the most common drugs on your floor: generic name, actions, side effects, and so on.
25. Take any classes or seminars you are offered.
26. Be sure to go through your skills checkoff sheet, and ensure you are comfortable with the skills.
27. If someone needs an IV started, volunteer to try.
28. Spend a half shift with the same day surgery pre-op nurse to learn how to start a ton of IVs in a short period of time.
29. Get to know your crash cart, how to work the equipment, and what is on it.
30. Don't be afraid to ask for a new preceptor if you aren't gelling with your current one.
31. Use your nursing textbooks to brush up on skills you are using on the floor.
32. Take your NCLEX. NOW.
33. Find a nurse that you admire and befriend them. Ask them to become your mentor.
34. Learn the ins and outs of different shifts on your floor. You will be working them.
35. Don't stay after every shift for hours on end.
36. When you go home, spend some time studying, but mostly just rest.
37. It's okay to cry in your car on the way home.
38. Be prepared to hate nursing for a little while. This is normal and will pass.
39. Learn how to use all the equipment on your floor: O2 nozzles, IV pumps, the bed, suction, lights, and anything else you use frequently.
40. Don't increase your patient load until you and your preceptor feel you are ready.
41. Get to know the doctors as well as you can so you can work with them.
42. Don't be intimidated by cranky people: patients, doctors, coworkers, or supervisors.
43. Try to memorize the most common extensions you use, like the lab, the pharmacy, other departments, and the most called doctors.
44. Spend some time looking through the medical record online to keep track of recent orders, doctor's notes, and radiology results.
45. Shadow the unit clerk for a day to understand how the medical data is inputted and processed for admissions, orders, and discharges.
46. Get into the habit of reading the bulletin board in the breakroom for policy changes.
47. Learn how to lift safely and always use correct lifting procedures.
48. Decompress with other nurses to get your fears and triumphs off your chest.
49. Don't freak out if you have an emergency on orientation. Your preceptor is there to guide you through and other nurses will almost always help.
50. Take lunch, go to the bathroom, get off your feet, and allow yourself to breathe every now and again. We've all gone through orientation and survived. So will you.

Does anyone else have orientation horror stories or tips for new grads? Every bit of encouragement helps, so if you can think of something this list failed to mention, please post it in the comments. It may help a nurse adjust to their new surroundings.

[firefly84]

I totally agree with this list.

I would add that a lot of the doctors I have dealt with are a little more reserved until you have proven yourself to them. You can always tell once you've met their approval, because they are a lot more open and relaxed. It might be as simple as suggesting a medication or coming up with something they hadn't thought of.

One of our docs will quiz the nurses about meds and labs. It's his way of getting a baseline on the nurse and figuring out a trust level. He also turns everything into teaching moments, which is really helpful in return.

Along with the brain sheet, make out a mini schedule for the first few shifts. Break it down into 1 hour periods and use it to lay out your day at the beginning of the shift. It helps as a frame of reference for trying to stay on task. Even write in time for charting, for what you can't get done in the room. It will help you get into a habit of organizing your day.

My absolute, #1 tip though...DON'T LOSE YOUR BRAINS!!! (the piece of paper with all your notes for the day)!

You will look silly as you are looking in garbage cans and patients beds for that insanely important piece of paper. Don't feel bad though, everyone has done it multiple times before and you will too!

[mpoppym]

I used to wear the stockings, and then I discovered Zensah Tech+ Compression Socks! So much cooler looking, longer lasting and way more comfortable! I don't do a shift without wearing these!

[TeeKay12]

My mother is a nurse from the 1960s. Her theory has always been: It's their job. YOU are not in the wrong when you ask anyone to do their job, from the housekeeper being reminded to empty the trash to the doctor being called at 0300 for new pain meds.

Most preceptors will walk you through the first few calls. Don't forget - we all STILL ask questions. IF you're not sure if you even should call the doc, just run it by another RN. S/he will help validate your decision and may offer tips on communication or even actions to take before you make that call.

[TracyDarby]

Fear not! This is definitely a skill that is learned and taught during orientation. The key is to know your patient's history (diagnoses, procedures,meds and current assessment findings) and the ability to paint a clear picture with just the facts. Reheorifice what you will say before you call. Soon you will be able to anticipate what orders you will receive. For example: if your patient has CHF, the doc will want to know LOC,vital signs, oxygen saturation, how much oxygen is being delivered. by nasal cannula or facemask, lung sounds, presence and location of edema, any weight changes, EKG rhythm, current meds and any recent changes etc. Listen and observe other Nurses interacting with docs. Emulate the ones who do it well. Remember the docs were students once and put their pants on the same way we do! You will be fine!

[wannabecnl]

Work with your preceptor to get a fair number of "normal" cases and a number of out-there ones. I work in PACU, and there was real benefit to taking a bunch of healthy-ish, middle-aged, uncomplicated lap choles and vag hysts to learn the flow of the unit. But after 3 months of those, my preceptor said NO MORE, and we only took patients with lots of comorbidities, on multiple drips, etc., which are less familiar in PACU and require a lot more prioritization, critical thinking, and communication with the team. This can be applied anywhere. You can't just take the oddball cases at the beginning; you'll learn cool stuff but you won't learn how to just do your job and get through your day.

BTW, I made a report sheet for myself, and I still use it after 2.5 years. Some nurses/CRNAs think it's ridiculous; others ask where they can get a copy. Do what works for you as long as it doesn't hamper patient care (if you're looking at your sheet and not listening to your colleagues or looking at the patient, it has lost its point!).

[NewLife15]

You article was great. I am third year BSN student and I now know what to expect. Thank you!

[NewYorkerGirl]

Quote

17) Chart as you go.

This doesn't work for me at all. It slows me down. I'm required to chart 3 times per shift, and if I chart at 8 that they were hypertensive, by 4 I can't remember that I charted that, and have to open the 8 chart to see if I have to follow-up with a 4 AM comment about how the HTN progressed, just for one example. By 4 I don't remember what the heck I wrote at 8! So I started to write it all on my brain sheet and chart everything for a patient all at once, because all I have to do it copy and paste, unless I have to write a little note about how something, like HTN, progressed. That way, everything about a patient is fresh in my mind and I make fewer mistakes. Maybe if I didn't have so much charting to do, I could do it as I go...

[whofan, ADN, BSN, RN]

Knowing that doctors are people too, helps. I have been lucky at my work, at first on med-surg, then in ICU to have good even-tempered doctors and PAs. Be prepared when calling them is the best advice. If you know your stuff then even if they are mean they will loosen up over time.

[whofan, ADN, BSN, RN]

What charting system is that. Ours is more conducive to real time charting. Its a flowsheet and you can see what you charted and the previous shift too. I keep notes as well but our charting system makes is simple to see your task lists, meds to be given and orders without losing your place or having to search for everything.

[vnguyen3]

For a quick up to date plan of care, look for the most recent physician's progress note.

ALWAYS ASK "ARE YOU ALLERGIC TO ANY MEDICATIONS?" If you don't know the patient or giving them a medication for the first time. Repeat as necessary.

Have faith in yourself, and Google what you don't know.

[NewYorkerGirl]

whofan said:

What charting system is that. Ours is more conducive to real time charting. It's a flowsheet and you can see what you charted and the previous shift too. I keep notes as well but our charting system makes is simple to see your task lists, meds to be given and orders without losing your place or having to search for everything.

Some cheap junk the hospital IT people made up themselves. I can't see what was charted before without clicking on it. I can see a headline, like that cardiac was an issue, but not the detail of the chart, like that pt had high BP.

[anh06005, MSN, APRN, NP]

NewYorkerGirl said:

Some cheap junk the hospital IT people made up themselves. I can't see what was charted before without clicking on it. I can see a headline, like that cardiac was an issue, but not the detail of the chart, like that pt had high BP.

I always carried a highlighter and highlighted information I had charted on my brain sheet (assessment, I&O's, med administration times, rounding, etc). I would have stayed over every night if I hadn't charted some as I went! I always felt anxious about getting my charting done LOL.