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New Graduate having Difficulty with Orientation

I just graduated in May and passed boards in July. I found a job with no difficulty in a pediatric unit of a rural hospital. Since I was the only newly hired nurse at this hospital, I had a 4 hour "mini" orientation to cover JCAHO standards and basic hospital measures such as handwashing, etc. Nursing orientation was delayed until more nurses were available to take it with me.
I was started immediately on orientation to my unit. I spent my first week basically observing and helping out where needed. The second I was given my first patient. I had no issues my first three weeks of orientation. My fourth week of orientation, I started the night shift and learning the differences between the two. I immediately was taking patients on this shift without difficulty. I do not have an official preceptor to work with. I work with who ever is working during the shifts I am.
One nurse in particular assigned me three patients my last week of orientation. One of which was a 17 day old infant born at 35 weeks in with near miss SIDS and apnea. He had an apnea monitor ordered which I had never used so I asked for for an explanation on how to use it from one of the nurses. I had no difficulty with setting it up or using it. When taking the infant to the treatment room to start the IV, I pushed the infant in an open crib with the apnea monitor under it instead of disconnecting the infant from it and carrying him. I was asked why I was pushing the small open crib instead of carrying the infant and replied with "When we had nursery clinicals we were told that it was hospital policy not to carry new born infants." I didn't feel it safe to carry both the infant and the apnea monitor nor did I want to disconnect the child from it when he had orders to be on it and I had no idea how long it would take to start an IV. I went on to the treatment room and overheard the nurse saying as she was coming closer to where I was setting up to start the IV, "...this isn't nursery."
I ignored it and went on throughout the night. In the morning before leaving, I came back from another patient to find her frustrated at me and going through my charting. The infant had a negative fluid balance reflected in his chart (though it wasn't negative). I had not had a med-tech charting class as it was apart of nursing orientation and had learned my charting on the unit. I had been charting the same way for 6 weeks and had not been corrected. I even charted the same way I had from the first time someone half-watched me chart I's and O's. There were other issues she discovered. I tried to ask what I had done wrong but her tone had me so upset that even if she was making sense it would have been confusing. I asked another nurse to clarify and was told something different from what she had said do. I went home ready to just quit nursing and go back to school.
I went back and picked up the same patients the next night. Again the I's and O's were negative. I found out there was a different I and O charting tool on the med-tech to use for breast-feeding and was able to correct it for that day.
My issue isn't with being corrected. I want to do things correctly and easily adjust to correction. I know that nurse was only trying to help in a way and was the one on the line, since as an orientee, I don't technically count as "working" on the unit yet, but fussing at me isn't helpful.
I like this unit and the staff have been mostly helpful, but as a new graduate, I don't feel very confident coming off of orientation. Any advice?


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13 Responses to “New Graduate having Difficulty with Orientation”

  1. joanne Says:

    i still think of myself as a new nurse. i graduated 12/08 and moved straight to hospice. i love the job, i had a great orientation (6 weeks) and the nurses are very helpful, but i still run into contradictory ways to do things, whether charting or procedures. and i still run into many, many things i learned in school. obviously in hospice we don’t initiate a lot of procedures so i’ve forgotten many things i learned, whether changing colostomies, maintaining intermittent suction machines or starting kangaroo pumps. but everyone is very helpful. i work NOC shift also so there is only one other nurse with me and each nurse has a different personality, even if helpful. i always try to approach each one with the confession “i learned this in school but have never applied the knowledge, can i run this by you”, or “could you assist me, but let me do it or i’ll never learn”. i’ve always been helped without attitude. if there is a difference in procedures from nurse to nurse, i try to clarify with the ones who i know have the most experience at that unit and if i’m still finding discrepancies, i run it by the director of nursing/supervisor, either in person, if i should run into her (i’m on nights) or through an email. i let her know i’m getting a couple of different ways to do something, i never mention names, but state i would like clarification so i’m sure to be following the unit’s standard of practice (not everyone else’s interpretation). they always seem to understand. i’ve been taken to the side once or twice and “enlightened” about differences of drugs and when to choose specific PRNs over others. the nurse talking to me usually starts out with something like “i don’t mean to be correcting you” or “don’t take this the wrong way”, and by the time the get done i thank them for their input and remind them i do still feel like a new nurse in some ways. there are some things not taught in school, so i wouldn’t know the difference unless someone brings it to my attention. i also ask them to please inform me if i could be doing something different or better and i don’t take it personally but see it as a way to improve. that way they don’t mind giving me hints, knowing i won’t take it the wrong way. maybe i’m just lucky working with the folks i do! good luck

  2. Maryann Says:

    You need to let someone know immediately. The hospital is risking so much on so many levels allowing a nurse to go it alone when so new and not oriented properly. Get to the staff development department AFTER speaking to your immediate supervisor. NEVER leapfrog immediate managers, you will be opening yourself up to another whole can of worms. If talking to your immediate manager doesn’t do the trick, go to the next level until someone LISTENS! The hospital is risking the well being of the patients, your license and their legal and moral obligation as a healthcare provider. I wasn’t a favorite at several jobs because I spoke up, but I always did it professionally and with a written diary to back me up. Make sure you document all situations that are not ethical and dangerous and absolutely use this as your “proof”. I always knew when I left work at night, I did the ethical and responsible thing by speaking up to someone about dangerous situations. Many times the management don’t want to hear it and it is easier to continue in their practiced and acquired ignorance mode. Do not fall into that trap or be bullied into thinking this is “just the way it is”. Too much is at stake. Good Luck.

  3. michelle ceo Says:

    this is lateral violence between nurses, and being a bully. this must be eliminted from the nurse’s world. it is creepy, not healing. i am a new nurse one year fulltime i too have gone through all this ugly. i called the boeard or B.O.N and asked if there were an advocacy group to protect us from these beasts. (my term). she suggested i start one, right learnin a new job in my fifties, i’ll jump on it. but as new grads we can advocate for each other. protect each other.

  4. S.O. Says:

    I’m sure you are frustrated, but keep in mind that each day you are learning something new. Don’t let a sour apple spoil the whole bunch- if she is that miserable its a heart thing-not a you thing. Talk to the nurse manager if you feel the care your providing is inadaquate (remember,pt advocate) due to inadequate orientation, but don’t quit you’ve worked too hard. You are a nurse, and good nurses are needed. Let us always remember how it feels to be uncertain or new. so we can bless a new grad someday ourselves. Blessings

  5. Jenn Says:

    Oh honey, I have been there! I had a HORRIBLE orientation experience and after my 16 weeks ended they started giving me the crap assignments and overwhelming me on purpose – I was surrounded by mean girls… I followed the chain of command to do something about it and demanded more orientation time with a different preceptor because the one I had was critical and a bully. I got additional time and was trained at two of our sister hospitals by nurses who really wanted to have an impact on my learning. It made be a better person and I was able to stick it out and not go home in tears. It has now been a year. I still find I need a go-to from time to time but I have learned SOO much. I would suggest you go to your director and have them place you with someone that you think you can work well with and work their schedule until you feel a little more “safe.”

  6. C.V. Compton Shaw Says:

    Too many nursing employers and their minions attempt to abuse and exploit nurses. The same maximizes their political, economic, and social power by intimidating nurses in particular and in general into subservience.
    Given the aforementioned, a calculating strategic approach to the nursing employment environment is appropriate rather than one which, unrealistically, expects “good will” from either employer or fellow employee.
    Your situation, therefore, calls for a cool pragmatic evaluation of your current employment and the long term affect of the same on your nursing career.
    Perhaps, therefore, another job that allows you to build up your nursing skills in a more measured manner while allowing you individual and professional respect would be appropriate.

  7. Mackenzie Says:

    I am also a new grad coming off of orientation shortly! It is terrifying but during orientation just take all corrections/comments in stride (even if the person has an attitude) because as nurses we need to be patient people and the people offering advice only want to ensure that the patients are taken care of. Just let attitudes and such slide off your back because you just need to ensure that you patients get the best care possible 😀 Good luck!!!

  8. Leslie Says:

    When I was a new grad I had an 8 week orientation and it was with the same nurse everyday. She had been on the unit 23 years and was an excellent nurse but there were days when I went home in tears because she was so type A, however having the same nurse everyday was beneficial because it helped with consistency and I did’nt have to deal with multiple ways of doing one thing and wasting time trying to figure out which way was right. It’s very overwhelming in the beginning as a new nurse. There is just so much information to learn, not to mention learning how to become organized and efficient with my time and how I approached taking care of a pod of 5 patients by myself. The one thing I have observed in my 15 years as a nurse is that generally nurses are not always as helpful to one another as you would expect them to be. We eat our own and I have never understood that. I worked as a travel nurse all over the nation and not only on med surg floors but ICU’s and ER’s and I have always experienced that if I was going to be a good nurse I had ask questions and bother as many people as necessary when it comes to the well being of my patient and the delivery of good care. You have to develop a thick skin as a nurse and you will as time goes by. The physicians alone can test your patience but sometimes your coworkers can be just as difficult. Just remember you will not always be a new grad and one day you will remember what it was like to be a scared new nurse and you can treat the new nurses on your unit differently. The one thing that may help you is that there are nurses who teach you how to deliver quality care and there are nurses who teach you what bad care looks like. If you are not getting the answers you need go to your charge nurse, if your charge nurse can’t help you go to your unit manager and so on until you get the answer or resources you need to be comfortable. You are an advocate for your patient as well as their care giver. Always do what is in the best interest of the patient and if a co worker gets pissed because your doing things the way you were taught, who gives a damn. There’s no such thing as being too safe and if I were in your position I would have rolled the baby in the crib attached to the apnea monitor just like you did because really, whats the big deal. Your not putting the patient at risk so is there really anything to complain about. Keep doing what your doing and don’t let your fellow older nurse push you around. Ask what you need to ask and do what you need to do to give top quality care as well as protect your license. With the nursing shortage sometimes staffs are stretched too thin and nurses become frustrated with the patient loads and take it out on each other. Stand up for yourself and they will back off. Your doing a good job. Give yourself some credit because nursing is a hard profession, rewarding but hard.

  9. Rhonda Says:

    This still happens to me, I’ve been an RN since ’05 and have bounced a lot between jobs looking for a place that doesn’t have lateral violence.

    I have never really had a mentor, but looking back to my first days of orientation it sure helped when I had friendly people working with me who I could feel out and ask questions to without feeling inadequate.

    Now, I carry around a smallish book with me and write down my questions as they come up. When I get a moment where I can ask someone, I will pull them aside and ask things like “hey, I noticed that you guys use X procedure, and I am wondering if I’m doing it right… can you show me how/tell me?”

    Sometimes I do watch closely, because on occasion people will show me their way of doing things and I’ll find out later that it in fact wasn’t the correct/procedural way of the unit… and then I get dinged.

    Being a new grad is tough.

  10. bryn Says:

    this isn’t too big of a deal. New grads get thrown in the deep end all the time. The priority here is to make sure someone does finish your orientation properly though. It sounds like generally you’ve got a good bunch of people to begin with.
    What you need to do is put it in writing the issues you’ve had, and write a polite letter highlighting some of the practical problems that you’ve had that are due to not having a complete orientation eg The charting issue.
    Also, by writing this down, you have informed the management of the problem and helped protect yourself.

  11. CJ Miller Says:

    You have sort of described my orientation 17 yrs ago. I had worked at this hospital during a nurse extern program and when I was stationed there as a new nurse (and LT), the director of critical care remembered me and placed me in the step-down cardiac unit. The first year was the most brutal time in my entire career. In the military it is required for you to be a leader so you had 6 weeks orientation and you were on your own. Little did I know that my preceptor was “helping me out” the whole time by picking up my slack so that when I went orientation I had no idea how much she did not show me. It was traumatic and scary, but somehow I got through it. Mostly due to the fact that I had the most awesome head nurse ever. In the end I was finally able to find the art of being a nurse, but they were hard lessons to learn.

    I turned that negative orientation into a positive by making an orientation packet to give to new nurses to the unit. They were still using it several years later.

    My one concern that you need to bring up to whomever is in charge of your orientation is that you did not get a charting class for your documentation system. You need to know what you are responsible to chart for your license so you do need to bring that up with the charting issues you have already had. Remember it is your license that is at stake here.

    The most important thing to remember is that you will make mistakes so you do need to get used to that up to a point. The most important thing is that you learn from them. Develop a thick skin so that you listen to the correct, not the tone of voice. It is the other nurse’s problem if she is getting irritated. Maybe she has gotten burned before, or maybe she is assuming that you already were taught this material by your primary preceptor.

    In regards to the crib, look up your hospital’s P&P for transporting babies. It is vital for any procedure to not go by what is “told” to you by another nurse. When I am teaching my students or helping new grads, I always pull up the P&P since I’ve been burned a few times by going by what I’ve been told by another. It is a good habit to adopt.

    It is normal at the beginning when you realize just how difficult this job is to feel overwhelmed. Just maintain the feeling of always giving your best effort and never lose site of our primary directive: to take care of the patients assigned to you. For that shift, they are your primary responsibility.

    My recommendation is always at the end of the first year, when you really feel burned out. Read, “The House of God” by Dr. Samuel Shem. Any sooner than that and you will not get the humor in it. Mainly I am telling you to find the humor in your job. It makes it so much easier :O) Not disrespectful humor, but the real humor like when you have a proper, little older lady who is devastated by losing control of her bowels due to a GI bleed brought on by the anticoags given to her after a large MI. The secret is getting her to see the humor of the situation, not the horror. That is the secret to nursing…

  12. Zula Says:

    I have been nursing for 30 plus years and am a very good nurse, but having worked 10 plus different hospitals…there is more than one way to do a job…you will always find those nurses that aren’t helpful and those who are. Ignore the attitude of those who arent helpful and hang with those who are. Take notes when someone tells you something if you can so you don’t have to bug anyone twice for the same issue. Most of the time I have been thrown in without orientation….they were supposed to, but then it got too busy…..which is ok if you have done that type of nursing before…you can do it your way. I have always hated orientation….it always gets better when you are on your own after an orientation.

  13. mary Says:

    I understand how frustrating it can be to not get the proper orientation, especially being a new grad. We have an excellent program at our hospital where the new grads are in an internship program for one year. During that year the attend classes two days a week and work with the same preceptor nurse two days a week. So far these new grads are excellent nurses when the program is finished, they have confidence in their own skills and yet know that it is okay, no matter how long you have been a nurse, to “bounce” a question to a co-worker. We all believe at our hospital that being able to do this we prevent possible errors and thus our patient’s safety remains a priority. If you are doing tasks that you have not been properly trained in per the facility policy, and an adverse event happens, it is your mistake. That can also affect your license in some situations. So make sure you are comfortable performing your job, you worked too hard to get that license.

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