Walking into a minefield...

[deanaRN]

I graduated 7! years ago, only worked a few weeks, long story. Recently completed simple RN refresher course. New med surg job to start next week after months of looking. No one wants an old new grad. Had to pull some strings to get this job. Was told by blunt unit manager that the position was open b/c the other nurses ran previous nurse off. I am glad she was honest about it but wow. I will get 12 weeks of orientation. Told they want ratios to be 5:1, but often they are 8:1, not divided by acuity but by hallway, and that it is a crazy busy unit with tons of admits/discharges. I know I have a steep learning curve, in what may be a hostile environment. Am scouring all of the threads reading, reading, reading. Scouring books, magazines, anything I can find.

I was on a similar unit for 3 shifts during the refresher. I did not see one nurse looking up meds, despite the fact that some pts had a 6 page MAR. Could they ALL possibly know all these drugs well enough to not look up anything? I am reading tons of pharm sites/books trying to learn/relearn all these meds. It has been 7 years after all! I am willing to apply myself and do the work, just worried that the zillion meds combined with the multiple iv's meds combined with my lack of knowledge will lead to error. Told to expect everything, but they get a lot of renal pts, COPD, diabetics, a few peds. I am worried, I want to put in the work to be a great but am scared I will end up looking like a Anyone else out a long time then tackling med-surg?

[Tweety, BSN, RN]

Most units and docs tend to use similar meds. If you were to follow me on one med pass it just might happen to be a day when I didn't look anything up, that I knew the meds I was passing, because I've looked them up many times before.

Med-Surg for new grads can be very very tough. So please go in with a healthy dose of self-esteem knowing you can do this and will do well. Know there are going to be some tough times when you feel like total complete failure. Allow yourself to be a new grad.

I'm very concerned that the manager basically disrespected herself by saying she allowed her staff to run off the person you are replacing. That's not good new at all.

Good luck!

Check out the "First Year In Nursing" forum often and post there of your comings and goings.

[meownsmile, BSN, RN]

I agree the NM shouldnt have LET another nurse "run someone off". That is just laziness on the NM part. We have a couple who tend to not be well liked as preceptors. Dont let them run you into doing something you dont feel ready to do, dont let the preceptor rush you while giving meds. You look up what you feel you need to and you will soon find you will be remembering some of the more common ones. That mental list will grow at lightening speed im sure. If worse comes to worse, the person precepting you isnt the only nurse on the unit. See if you can change preceptors if she doesnt do what you need her to do. They should be accomodating YOU in your orientation process to some extent, because everyone learns differently.

[deanaRN]

Thank you both. That makes sense about the meds.

The thing I wonder about is how do they have the time or energy to worry about what someone else is doing or run them off? If the unit is crazy busy with high ratios isn't everyone busy with patients?

I am pretty good at standing my own ground, but would rather I didn't have to get into what sounds like childish quarrels. I was told if the preceptor and I were not a good fit I could change. The one I am assigned to is supposed to be really good.

[Marie_LPN, RN, LPN, RN]

I'd be more than disturbed at the UM's statement.

[meownsmile, BSN, RN]

Deana, it is difficult to precept someone on a very busy day. However,, your preceptor should be working with you. Letting you take report on new surgicals,, do the admissions, assessments first,, let you get comfortable with those, with a few IV meds mixed in there for good measure(and she should be at your side the whole time to start).

As you become comfortable with those basic skills,,post op stuff, admission stuff, and seeing those through all the way then she should expand that by having you doing IV meds, maybe mixing treatments in with your assessments.

Dont worry about calling doctors and the phone stuff right away, that will come after you are comfortable with the routine of the floor. Let your preceptor do the phone work the first few weeks with you listening in (encourage her to do it and let you listen in). If she is insistant that you do ALL that stuff,, then negotiate to take a couple patients first adding a couple more each day until you are managing the whole team.

Mind you this is just a for instance, and everyone does things differently but i found this kind of set up works great with the new grads that i have precepted. They get confidence with me behind them(i usually go with them for the first few days for assessments until im comfortable they are doing good assessments). I have usually done a quickie assessment and ask them questions as they chart their assessments. They find they build confidence as they go and usually want to take on more. Good luck, i think youll do fine.

[deanaRN]

Thank you so muchmeownsmile! What valuable information! I completed the 5 day classroom stuff on Friday. I am feeling better about it. It looks to me like the orientation is set up to be thorough. MUCH different than what was offered when I graduated 7 years ago. I learned that it is set up like this:

Day 1 each week on various units of the hospital. The goal is that by end of orientation I know where and what each unit does. Ex. 1 day on admissions, 1 in urology etc.

Day 2 and 3 on the floor with the preceptor. (Saturdays and Sundays) HUGE packet of information that she should witness and sign off on each skill when I demonstrate without error.

Multiple days scheduled for me to come in on my off days and attend an inservice or skills class like Diabetes, Phleb class etc. Each has a test I must pass.

At 6 weeks in I take some sort of critical thinking test. If I pass I will continue with orientation for another 6 weeks. If I do NOT pass I get counseled and must pass the test at the 12 week mark or will be terminated. At 12 weeks if I have passed that test I am off orientation.

Is this typical of what most large hospitals do now?

[meownsmile, BSN, RN]

I cant really say what large hospitals do. Some have a nurse educator that takes the lead with new orientees, my hospital doesnt. I am glad you are feeling better about the orientation process though.