Unsafe Nurse Residency

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I am a new graduate nurse and accepted a nurse residency position in L&D. I am very grateful, but I am working at a small hospital with an underdeveloped nurse residency program. There is very little training, I do not have a consistent preceptor, and I am working between days and nights due to the lack of nurses available to train. The nurses that I do train with aren't designated preceptors, I'm just put wherever they can put me at.

The nursing unit as a whole is very unorganized. The hospital has very few policies to guide our nursing practice in L&D. Because of this, all of the nurses do things differently and it is hard to keep up when training with several different people. There is a lack of accountability and continuity. Nurses are leaving in huge numbers and we are very short staffed. We also have a short residency of 14 weeks compared to 20 weeks of other bigger hospitals in my area. We have received two training classes on fetal monitoring and there are no other classes for new residents that are pertinent to L&D. Other experienced nurses on my unit are helpful and very supportive but are frustrated themselves. They have warned me that starting as a new nurse in this unit will not be good due to the disorganization and lack of policies and stated that it's not helpful to start out as a nurse being taught to cut corners. They described the unit as one that you come to after having experienced. I have see a lot of unsafe practices and patients put as risk and I am nervous. I also feel that I am not getting a lot of experience during actual deliveries as many of my shifts I have precepted in triage because they didn't have anywhere to put me or we get an admission that does not deliver during our shift.

I understand that it is very unfavorable to leave during a residency. I am half way through and I did not sign a contract. I am not sure what to do as I do not feel prepared to provide safe care given the training I am getting. My nurse manager is aware of the issues but she is new and I don't think she is able to address them right now. What should I do ?

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What you should do depends on what options you have. As a new graduate, you're not going to be competitive for the best jobs with the most ideal circumstances.

A lot of us had no "residency" and were simply thrown into the deep end to sink or swim.

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Specializes in New nurse, nursing assistant 5 years.

If it is going to risk your license don't do it. It's not safe you or your patients if you aren't trained properly. I would start working on an exit strategy. It might include you working in a specialty that you don't like.

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3 hours ago, AbstracRN said:

If it is going to risk your license don't do it. It's not safe you or your patients if you aren't trained properly. I would start working on an exit strategy. It might include you working in a specialty that you don't like.

I wouldn't worry so much about loosing your license. Check your state BON, and read how licenses are lost.

But, you have some legit concerns.

14 hours ago, Nikkib0911 said:
  • I am working at a small hospital with an underdeveloped nurse residency program.
  • There is very little training,
  • I do not have a consistent preceptor,
  • The nursing unit as a whole is very unorganized.
  • The hospital has very few policies
  • There is a lack of accountability and continuity.
  • Nurses are leaving in huge numbers
  • we are very short staffed.
  • We also have a short residency of 14 weeks compared to 20 weeks of other bigger hospitals
  • They have warned me that starting as a new nurse in this unit will not be good due to the disorganization and lack of policies
  • I have see a lot of unsafe practices and patients put as risk
  • I do not feel prepared to provide safe care
  • My nurse manager is aware of the issues but she is new and I don't think she is able to address them

Those are legit concerns. Clearly, this is not a good unit. Is getting trained and working on a good unit an option?

What Do you see as your options?

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Specializes in ER.

When I got trained for L&D in a small unit I had six years experience in pediatrics, and they said six month of preceptorship would be given. They gave me a L&D textbook, and I gradually went through the chapters in my own time, while applying concepts to real patients on the unit. After a month I was doing NSTs and outpatients myself and reporting my findings to my preceptor. After two months, easy deliveries with the preceptor in the room, three and four months, gradually increasing complications and independence, but verbally going over my plan with a partner. Then for the first year, there was ALWAYS a second person at each delivery with more experience who would help (thank goodness.) After about a year, I was able to be the primary nurse, with the second person having less experience. So the learning went on for a GOOD year.

During my preceptorship, I learned that ACOG has really great guidelines and standards already set out for labor. Even if the hospital is bassakwards, if you know and follow those standards, you will be fine.

That said, you need to find at least one person that is smart and reliable that you can pepper with questions. See if they can be available to text or call if you need someone you trust. Without that, I'd step away from the whole job.

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On 12/7/2019 at 1:19 PM, Sour Lemon said:

What you should do depends on what options you have. As a new graduate, you're not going to be competitive for the best jobs with the most ideal circumstances.

A lot of us had no "residency" and were simply thrown into the deep end to sink or swim.

Just because some nurses didn’t have residencies doesn’t make it ok for anyone else not to have it. Nursing school has changed tremendously from previous decades when we got a lot more hands on experience vs. almost nothing today. I personally would not want to be a new grad today. Just my 2 cents.

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I'm super scared too, my residency is only 12 weeks in which I feel is not enough time to learn everything especially as a new grad.

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Specializes in OB.

Look around for another job. If you can find one, leave. This one sounds awful. If you can't, stick it out till 1 year and more doors will probably open up.

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That is one "underdeveloped residency," for sure; it can barely be called an orientation let alone a residency of any kind. It sounds quite a bit like just getting thrown into the fire. They co-opted the word residency because it sounds good.

I agree look for another job. It's no joke to be managing the nursing care of someone's labor/delivery having barely even attended any delivery before. Ridiculous.

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7 minutes ago, LibraSunCNM said:

Look around for another job. If you can find one, leave. This one sounds awful. If you can't, stick it out till 1 year and more doors will probably open up.

I haven't started yet it starts in February but it's a 2 year contract...smh

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3 hours ago, jobellestarr said:

Just because some nurses didn’t have residencies doesn’t make it ok for anyone else not to have it. Nursing school has changed tremendously from previous decades when we got a lot more hands on experience vs. almost nothing today. I personally would not want to be a new grad today. Just my 2 cents.

I graduated in 2010 and came very close to sinking ...not ideal, but an unfortunately reality. Whether it's "ok" or not, again, depends on what other options you have. There are still many, many, hospitals that don't have formal or organized orientations.

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Make sure you have a job before if you decide to leave...i made that mistake

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