Training a brand new nurse

lvnhopeful · Oct 19, 2008

I am a graduate nurse and have not had a job as yet, however, I think the best thing would to be a longer training period so whomever you train doesn't feel overwhelmed. Sometimes an extra day or two for someone new is enough for them to get the gist of what the job entails and added confidence that they know what they are doing and haven't been abandoned.

Us older people especially like a little more time:)

StephanieS321 · Oct 20, 2008

I'm not a nurse yet, but something I think is helpful is to ask your student to carry a little notebook. Anytime, she/he has a question, concern, comment- write it down. Towards or at the end of the shift, you two can go over what happened over the course of the shift. You can explain things you did and why you did them, she/he can ask questions. My friend did this and said it worked well because it did not interrupt the nurse during critical times and there was more time at the end to answer questions without interruption.

lpnflorida · Oct 20, 2008

Having recently tried LTC for only 2 shifts mind you. What might have worked for myself would have been number one she needs to have the same consistent preceptor during her orientation. She needs the same consistent hallways ( patients). I would the first day let her follow as you make your rounds set up medications and such. Second day again if it were me. I would give her say 5 patients to medicate . Let her get the feel of finding where the meds are located and what the MAR's look like and where to fill in the vitals signs on the MARS and what meds will need vitals and temps. 3rd day I would again give her the same 5 patients but add also doing the treatments on them perhaps chart on one of the patients. From there you can add patients to help her gain proficiency and speed. I can tell you the thought of 20 people was way overwhelming for myself and I have experience, but not in LTC. Good luck to you both.

lvnhopeful · Oct 20, 2008

I think thats a great idea Stephanie, then the new nurse will also have a reference to refer to later on when he/she is on the floor alone after training is complete.

CoffeeRTC, BSN, RN · Oct 20, 2008

Time. If you want to keep new nurses a while, they really need a good orientation time.

I like to first start off by seeing just how much experience they have had...what do they thing are thier strengths, what scares the !@#$ out of them. Were they a CNA before. They we go from there.

First day is always just a shadowing day. I encourage them to carry the notebooks and we review halfway thru the day at lunch then at the end. Depending on how day one went, we might repeat that again. Just the thought of answering a phone or even calling the doc is overwhelming.

Those days they get an earfull. Hopefully before that they would have had a good general orientation and got the basics of the facility down.

After they...I try to start them slow with a few pts. Maybe 2 rooms? Passing meds can be incredibly slow and we know this takes the most time.

Explain everthing you are doing and offer your tips on what can work and save time while still doing things by the book.

JB2007, ASN, RN · Oct 20, 2008

Thanks for all of the helpful tips on how I can orientate this new nurse. I just hope that management will work with me so that one nurse does most of the orientation. I really want some good nurses to stay at my facility and the only way this will happen is if we can give them a good start. Oh well I will do the best I can do.

Gizmo44 · Nov 20, 2008

I hope everything went well for your training. I am a brand new nurse starting PRN in LTC and thought I would add my 2 cents based on my training experience & the changes I would make. First of all, Michelle126 & StephanieS321 have great ideas. The one about carrying a notebook to jot down questions to go over later is one I wish I had.

In my facility, we had 3 days of orienting/training - 1 in each hall before being out on your own. I asked for an extra day because 2 of my days were very chaotic - I was urged by two of the nurses that I followed to do it. Because of this I had 4 different nurses training me so I got 4 different ways of doing things. I believe being oriented in each hall is a good way to learn the facility but not a good way to know the residents. Therefore, an additional 1 or 2 days, at least, in the hall on the shift they will work is in order. As a new nurse, and working PRN, I would have loved to have twice the amount of training days at the very least, and a variety of shifts - all my days were Day shift, no evenings. Now I realize that you may not have control over the number of training shifts they get.

As Michele said, take a minute to find out their experience level. Think of some things your residents have that she may not have seen in clinicals or might be nervous about. Two examples - 1. I did 1 foley cath in clinical with my instructor helping me. I have never done a straight cath. On one of my training days, there was a resident who gets straight cathed 3/day. I mentioned I never did one & would like to. When it came time to do it, the nurse brought me in with her but did the cath herself. She explained that some nurses have a CNA hold a flash light but I just do it - she's real easy. I thought to myself, I would have liked to experience that myself. 2. On the other hall, a resident had a suprapubic cath that needed changed. I have never seen one outside of my med/surg book and told the nurse that. She had me doing treatments and never got me when it was time to change the cath - even after I asked her too. Take the time to show the MAR and TAR - make sure they know what they're looking at. I had one clinical in a LTC facility (out of 6 total), and we passed meds only one day - the noon time pass so there was only 7 out of the 20 residents that got them plus we were paired up. I had more experience in hospitals using Pyxis & bar code scaners. Punching meds through cards is real awkward for me.

Now, when the new nurse goes from following/shaddowing to doing, observe their technique & how they work with residents but don't keep interupting them. Wait until they are done with that resident or even med pass to make suggestions. On my extra day, the nurse would interrupt constantly when I was in the middle of something, sometimes I was just double checking the MAR to be sure I had the right med pulled & she would say whats wrong, what are you doing. Plus she kept saying, hurry up, speed it up, which only distracted me. The exception is if you see something that could cause harm, then yes, speak up. When you see things done right, speak up too. I never heard a good thing I did during training. I often felt like I was worthless and never should be a nurse. I kept reminding myself that I got great reviews in clinicals and all my teachers liked me so there must be something there.

I heard more than once that "you'll come up with your own system". That is to vague. Now, it would be more helpfull to have "your" system explained to me with some options and maybe even a "don't ever do this" thrown in. Now, I know we are supposed to know right & wrong, know the nurse practice act by heart, etc. but during training it is so overwhelming and there is a lot to absorb so a reminder now and then would be nice.

Starting on the floor with a limited number of residents - say 6-10 would be a great experience (after being oriented). Then gradually build up to a full load all while having a trainer available for questions or to help with those things that come up that you never prepare to train for because they don't happen that often or you need to see it in action in order to understand it (deaths, falls & all the paperwork, combative behaviors).

Training should be more than 3 days period. Hospitals do more. An office where a friend of mine used to work heard her replacement had 6 months of training. When my mom was getting chemo, they were training a new CMA as chemo receptionist. She was with her trainer at least 2 months and she worked full time. It makes completely no sense to me why LTC generaly has only 3 days. You are usually in charge of more residents and CNAs. They are coming sicker from hospitals and from home with more complex problems too. Plus we have 2 hours for a med pass no matter how many residents you are assigned. In clinicals, the nurse on the hall we were assigned had 20 residents & where I work now we have, depending on the hall, 20, 38 or 32 residents. Makes no sense.

Training could be catered to individual experience and there is nothing wrong with a new hire finishing early if they have previous experience. In my opinion it is better to have the training days budgeted and not need them than to need them and not do them because of $$ and risk someone leaving due to being overwhelmed and stressed. Then you have to start over - its a waste of money. Also, the saying - If you keep doing what you always did, you'll keep getting what you always got - works here. If a facility has high turnover, they should examine the training program. But enough of my soapbox.

I hope this helps - anyone