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Who You’ll Hear

Kati Kleber, MSN RN – nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, speaker

Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center

What to Expect During Your New Graduate Nursing Orientation. This episode discusses the structure of typical nursing orientation, what to expect, tips for working with a preceptor, and more. #FreshRN #nurse #nurses #nursingorientation #newnurse #newgradnurse

What You’ll Learn

  • The structure of a typical nursing orientation
  • What to expect throughout your nursing orientation
  • Tips for working with a preceptor
  • What to do when you and your preceptor don’t get along
  • How to acclimate yourself to the culture of a nursing unit

Show Notes

General information

  • New graduate nursing orientation can be structured differently and vary in lengths
  • Many med-surg units are around 12-weeks, while specialty areas may require longer orientations (18+ weeks)
  • Be prepared to keep track of a lot of paperwork; keep track of it at home – it is your professional responsibility
  • Don’t throw any papers away, even if your manager has a copy (we’ve all been burned by this, managers are often responsible for hundreds of employees with dozens of required forms to keep track of)
  • Get a calendar together with all orientation dates and deadlines to make sure you don’t miss anything (almost like your first few days of a new semester in nursing school)

Your Preceptor

  • Their primary focus is for you to become a safe bedside nurse
  • This is a formal role
  • They will correct you when you’re doing something wrong
  • They will sign you off on various competencies and participate in formal evaluations
  • Get to know their teaching style, make sure they know your learning style as this can prevent miscommunications and misunderstandings
  • Typically will ask you many questions to assess your level of comprehension so they have a better idea of what your needs are; it’s really important they can fill the knowledge gaps to prepare you to safely care for patient independently
  • Establish a relationship with open communication; tell them when you don’t know something or something doesn’t make sense
  • Don’t try to impress them with everything you know, be honest about educational needs
  • Learning how to be a nurse on your new unit it’s a performance to impress your preceptor, it’s a learning process to grow into the nurse you want to become and naturally there will be growing pains and missteps

Your Mentor

  • Focuses on getting you socially acclimated to your role and encouragement rather than bearing the responsibility of getting you up to speed clinically
  • Less formal role; typically does not participate in formal performance review process
  • Helps navigate relationships with other members of the healthcare team, other nurses, your preceptor, and manager
  • Helps put pieces together away from the bedside and process scenarios after the fact
  • Reinforces teaching and support from preceptor
  • Very helpful in navigating your relationship with your preceptor, as there are bound to be moments of friction

More on preceptors and mentors

  • Preceptor and mentor should be different people
  • Build rapport with other coworkers throughout orientation
  • Orientation should be challenging: each shift counts
  • Shouldn’t have any easy shifts on orientation
  • Advocate for yourself if you need to care for a specific kind of patient
  • If your preceptor is jumping in too much, ask for some space to figure it out

Typical phases of nursing orientation

Phase 1: Beginning

  • Get a lay of the land
  • How to get meds
  • Where is the supply room
  • How to use phone system
  • How to page a physician or advanced practice provider
  • Observe your preceptor – how do they delegate? How much information do they provide? How do they talk to their patients… the manager… specific providers… etc.
  • Take as much in as possible; be an active observer rather than a disengaged body in the nurse’s station
  • Make an effort to meet your entire team and introduce yourself
  • Tour of the facility and areas you may go frequently (CT, MRI, cafeteria, lab)
  • Your preceptor will be taking report on all of the patients and their primary nurse as you observe, take it in, and help with miscellaneous tasks
  • You will be task-focused; you will not anticipate big-picture issues yet
  • You will be slow with documentation

Phase 2: Middle

  • Start taking patients on your own, going to preceptor for guidance
  • Preceptor should be backing off as you begin to take charge of your patients
  • Most likely, your preceptor may have 1-2 patients of their own
  • You’ll begin to be more big-picture oriented and able to anticipate obstacles easier
  • If you weren’t sure at the beginning, now is the time to make sure you know how to use your email, how to submit and receive your schedule, how to complete online education modules, how to check your pay stub, benefits, and so forth
  • Start to look for documentation shortcuts on computer systems to increase efficiency

Phase 3: End

  • You should be giving and receiving report with your preceptor listening in, only interjecting if absolutely necessary
  • Your preceptor should be hanging out at the nurse’s station most of the time, checking your documentation and task completion behind you
  • Go to your preceptor only when you need to get a second opinion
  • Try to be as independent as possible
  • It is you taking care of patients independently, not two people dealing with your patient assignment
  • Continue to build rapport with your nursing teammates so that you feel ready and supported when orientation is over

More resources

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