Between learning charting systems, locating supplies, and reading up on department policies, one’s orientation can be MORE than frustrating. Here are eight tips to help make your orientation a success, whether you’re a new nurse OR just changing nursing specialties.
1. Arrive Early.
Show that you are dependable and eager to get started!
2. Come prepared.
Stethoscope, hemostats, trauma sheers—whatever is needed for the area you’ll be working in, as well as your orientation book.
3. Bring Food.
I recommend things that are easy to store and don’t require a lot of prep time: such as sandwiches or protein-rich healthy snacks.
4. Take Notes.
While it’s not feasible to write down EVERYTHING the preceptor says, listen for phrases like, “With every patient we check for…” Or, “Make sure after you give this medication that you document…” You’re looking for things that you’re not familiar with and/or that are specific to the area you’re training in.
5. Be Respectful.
Your preceptor may be older or younger than you; they may have more nursing experience, or less than you. But there’s a reason the manager or nurse educator picked them to be your preceptor. Keep this in mind and follow their lead.
6. Ask Questions.
During your orientation if there’s anything you don’t understand, or you’re not absolutely sure about, speak up and get clarification.
7. Stay Honest.
Preceptors ask questions like, “Are you familiar with X?” Or, “Have you ever done Y?” There is no right or wrong answer; we’re just trying to determine to what extent we need to cover something. Be honest, and you’ll receive the training that you need.
8. Anticipate What’s Next.
Several weeks into your orientation you should be catching on to the swing of things AND be able to do simple tasks without being prompted by your preceptor. Do this, and you will gain their respect, and they will trust you with more!
How nurses and other health care disciplines are being educated is starting to have a significant impact on the nursing role. A growing focus on interprofessional education (IPE) is shifting what we know about how the health care team can best work to improve patient lives. It is critical to understand what IPE is, why it is so important, and how nurses must leverage this knowledge to ride the wave that is transforming health care delivery.
What is IPE?
Since the 1970s, there has been growing attention on the quality of health care delivery. One thing has become clear: An increasing number of health care providers are interacting with patients, yet the delivery of this complex care often occurs in silos. One solution that has gained traction is IPE, which is now a requirement in most health care discipline programs. It is defined by the World Health Organization as learning from, about and with two or more disciplines, with a singular focus on the patients’ needs above all else. The idea is that if health care disciplines embrace collaborative learning from the beginning, then they will be prepared for collaborative practice once they graduate.
Why does IPE matter?
If you are reading this and have an RN past your name, you likely are able to think of more than one situation during which you have seen miscommunication and disconnected processes get in the way of patient care. Perhaps you have been at lunch only to learn that the physical therapist has come, ambulated your patient and wrote a report without your input. Or, was there a time when, during a patient admission, you learn they were recently seen by a provider and had tests run, but can’t tell you what the test results were or the name of the medication that was provided? Do you remember a time when a meal tray was delivered to a patient that you knew was having difficulty swallowing or had just started taking insulin? These disconnects are frighteningly common. IPE is one important intervention aimed at closing these gaps. By teaching future health care personnel how to work collaboratively through a team-based approach, we can minimize fragmentation of care delivery and reduce medical errors and adverse outcomes.
Riding the IPE wave
Like other aspects of nursing education, IPE teaches competencies that will lead to proficiency in a clinical skill. The skill, in this case, is working collaboratively to deliver coordinated care with other disciplines. Nurses who haven’t had the benefit of participating in IPE need to understand what these competencies are and how to best support them. This is not only important for the new nurses we will be orienting to the role, but also for those of us who need to embrace this new way of caring for our patients. The following four competencies have become the bedrock of IPE because they form the cornerstones of collaborative practice.
- Communication: Interprofessional communication should be clear, problem-focused, and avoid discipline-specific terms and abbreviations.
- Teams and Teamwork: Embracing relationship-building principles to develop effective team dynamics with other disciplines is the key to delivering safe, efficient, and effective patient care.
- Roles and Responsibilities: As an interprofessional practitioner, you should have an understanding of your own role as well as how the role of other disciplines can help address the complex needs of patients.
- Values and Ethics: Effective collaboration with other disciplines requires mutual respect and shared values for the skills and knowledge we each bring to the patient care team.
Are you ready to embrace this new way of delivering care? Our newest nurses are and will undoubtedly begin shifting the culture from distinct health care disciplines toward health care teams.
For more than 35 years, Elizabeth (Liz) Drake, RNC-NIC, MN, NNP, CNS, CHOC, Children’s at Mission Hospital in Mission Viejo, California, has worked with infants as a NICU nurse. Her time spent at the bedside of these tiny patients with families and team members have been her most meaningful—and this is one of the reasons that Drake joined Kimberly-Clark’s Huggies Nursing Advisory Council, a multidisciplinary group of experts seeking to support perinatal and neonatal nurses.
Drake took time from her schedule to answer our questions about her passion and the important work the council is doing.
Why did you become a member of Kimberly-Clark’s Huggies Nursing Advisory Council?
I am always interested in being a part of something bigger than myself and being a part of group of experts who are passionate about their specialty. I loved Kimberly-Clark’s vision for the council and was intrigued by the opportunity to share my passion for the NICU with others and to encourage care teams to strive for improved clinical practice. I love partnering with a group that is always seeking how to make things better, and I appreciate Kimberly-Clark’s desire and commitment to help babies thrive by consulting with experts in the field.
What are your tasks as a member?
The Huggies Nursing Advisory Council (HNAC) is a multidisciplinary group of experts that includes nurses, educators, a neonatal therapist, and a NICU parent advocate. Our goal is to identify opportunities to provide resources that recognize nurses’ contributions and help them perform their best—for babies, families, and communities.
Our specific tasks and engagements vary, depending on project and member. Our work ranges from speaking at conferences or webinars, to writing articles on clinical topics such as diaper dermatitis or the power of touch and hugs, to research and development of educational resources, such as Every Change Matters™: A Guide to Developmental Diapering Care, which was compiled based on the HNAC’s literature review of diapering in the context of developmental care.
Tell us about your teaching the NICU team about the power of touch and sound for premature infants.
Many of the infants in the NICU are still in the “development phase” of their lives. Their physical features are all there and complete around 6 months gestation, but the function of those organs isn’t completely developed—namely their brain development, sensory, and limbic systems. If you think about it, it’s those systems that make us human. They are part of how we will learn, feel, experience relationships, hear, and see. There is no other area of nursing/medicine where you are truly having impact in how this human being will become a relational being. I view it both as a tremendous responsibility and an incredible honor.
I have a passion for teaching others what is happening with every interaction with these very tiny—but mighty—individuals. We need to understand and learn what is happening in their bodies when they are in the NICU, including what they are saying with their movement patterns and with their silence. Though they can’t speak audibly, they have a language of their own, and when they can’t communicate we have to step in and protect them.
When drafting Every Change Matters, the HNAC wanted to communicate that preterm infants are physically taxed from the transition into the world and subsequent maternal separation, and the NICU environment contains additional stressors that could impact their development. On top of all of this, studies show that caretaking procedures that are considered standard for a full-term baby—such as diapering or tub bathing—can lead to increased pain and stress for preterm infants. Huggies, with the help of NICU nurses, developed Huggies Little Snugglers Nano Preemie Diapers, specifically for babies in the NICU weighing less than two pounds, with a narrower fit and softer fasteners to promote developmentally appropriate positioning to keep these fragile babies as comfortable as possible. They even have cute graphics to help provide parents with a sense of normalcy in a clinical environment!
The sense of touch is the first sense to develop and the last sense to fail before we die. Touch is also a powerful memory cue. The absence of loving or relational touch can result in significant growth, developmental, and behavioral deficits.
There is a gap between the womb experience and the NICU experience. The auditory system also must learn to separate meaningful versus non-relevant sound. In the intrauterine environment, noise is regulated by mom’s circadian rhythms; there are no competing noises and mom’s voice isn’t masked. In the womb, sound is non-directional and protected by the mother’s body while her voice travels inside and begins the recognition to maternal infant attachment. Purposeful sounds are needed to “prime” the brain. If we think about the small babies in our NICUs they are deprived of not only the biologic sounds from the intrauterine environment but also the low frequency tones of their mother’s voice and redundant heartbeat. When this happens during the critical period for this sense’s development, it can have a profound effect on auditory brain maturation and speech and language acquisition. Persistent background noise above 50 decibels reduces an infant’s ability to discriminate differences in pitch, intensity, tone, and pattern.
As health care teams, we need to protect REM sleep, reduce background noise levels beginning in the third trimester, provide periods of appropriate sound and of quiet, and ensure that the newborn infant hears plenty of conversational, interactive human speech from an attachment figure. Bringing parents into the NICU also provides the opportunity to bring their familiar voices closer to the baby and encourage sensory development.
Why is it important for NICU nurses to know?
The brain and limbic system is involved with many of the expressions that make us human; namely, emotions, behaviors, and feelings. That humanness also includes individuality. Infant brain development is a dynamic process dependent upon internal and external stimulation and a supportive environment. Every Change Matters describes the perfect environment as safe (providing physiologic stability and supporting optimal neuromotor development), hygienic (including ensuring hands are clean and dry before and after a diaper change), and manages stimuli (moderating bright lights and loud noises). Disruption or deprivation in the infant’s social and physical environment can create permanent deficits in the developing neurosensory and limbic system.
Educating ourselves is key. Knowledge of the experiences that play a critical role emphasizes the responsibility we have in the care we provide. The challenge is in assessing what interventions are necessary and appropriate, and if can they be performed in more protective ways. We have such a responsibility every day with every touch. With every experience as we leave a profound imprint on who they will be.
When I first became a labor and delivery (L&D) nurse, I didn’t quite know what I was getting myself into. I didn’t have children and I didn’t know anyone who did. I hadn’t even held a baby before! I had quite a long road of learning ahead of me. I loved every minute of my job, but internally, I was terrified and overwhelmed by the vast amount of information that was being thrown at me every day. After almost a year of being a L&D nurse I am beginning to feel confident and knowledgeable with my patients. Looking back, I wish someone had told me what my job would truly entail so that I would have been more prepared. So for anyone out there who is interested in becoming a L&D nurse, or even is just curious about what our job is like, here is a list of things I wish I had known first.
1. Most people (surprisingly) don’t know a lot about giving birth.
You might think that most parents would spend nine months preparing for the imminent delivery of their child, but a surprising number of families do not. So as a nurse, it is your job to explain the nitty gritty of what will happen during labor and delivery. Even the most prepared moms have never felt the intense pain of contractions or pushed a human out of their body before, so they will need some assistance. Over time you will gain a plethora of knowledge about the labor and delivery process, and your patients will soak this information up like a sponge.
2. You are going to see a lot of vagina. I mean a lot.
You will quickly become accustomed to the sight of a vagina, and you will learn that each vagina and cervix are different. The first time you go to check a cervix, it will be awkward, and you may not even be able to find it! It’s not easy (or pleasant for the patient) to do a cervical check, but as you gain experience, you will learn tricks for finding a posterior cervix and how to tell which way a baby is facing. Vaginal exams are your roadmap to the laboring process, and you will learn how to use them to help you deliver a baby successfully.
3. Everyone has a different pain tolerance.
Giving birth is arguably one of the most painful things a person can endure. Some women handle this pain with grace, and others, well, do not. As a nurse, you will see women who quietly breathe through each contraction, and you will also see women who scream and thrash through every one. At first it is alarming and very difficult to see your patients in so much pain, but over time, the yelling will simply become the normal background noise of your shift. One of the most important parts of your job is assuring patients that there is absolutely no shame in getting an epidural. It is not “cheating,” and sometimes it’s actually very helpful for the dilation process (and the nurse and support person’s sanity!).
4. A lot of your job is reassuring your patient that yes, they can and will deliver this baby.
Giving birth is scary. There is no denying that. After 20 hours of labor, even the strongest woman can begin to lose hope and want to give up. This is when the nurse steps in and becomes the woman’s biggest cheerleader. You will give every ounce of your energy to help a patient deliver their baby. You will help them breathe and make it through each contraction, and cheer them on through every millimeter of movement during pushing. One way or another, the baby will be delivered, and it is your job to remind the patient of this!
5. Babies are unpredictable.
On a L&D unit, the babies run the show. Ultimately a baby’s position, cord location, placental reserve, and many other factors will decide when and how a delivery occurs. Nurses have to be ready for absolutely anything to happen….even catching a baby! Within a matter of seconds, you can go from having a routine labor to running back to the OR for an emergency cesarean section. It is always exciting and suspenseful waiting to see what will happen!
6. You will become accustomed to certain sounds.
Your ears become your biggest asset on a L&D unit. When a laboring patient walks on the unit, the nurses can predict (with surprising accuracy) how far dilated a patient is based on her moans and groans. We know when we need to walk versus run toward a patient! Your ears will also become accustomed to the sounds of a normal fetal heartbeat and ominous drops in the heartbeat.
7. Your patients and families will absolutely love you.
Everyone remembers their L&D nurse. You are their source for information, advice, support, and encouragement. They truly could not deliver their baby without you. You have the ability to make their birth experience truly amazing and memorable. Little details and thoughtful gestures like grabbing warm blankets for a cold patient or placing a wet washcloth behind a nauseous mother’s neck can really make your care memorable.
8. Watch your support people like a hawk. They need care, too!
As a nurse, it is your job to utilize your support people and help them get involved in the care of their loved one. They can assist with counter pressure, pillow placement, hand holding, and encouragement. A lot of times, they are so focused on these tasks that they forget to take care of themselves. Ask the family how they are doing, pull up a chair for them to sit down, and make sure they are eating and drinking. During procedures and the delivery process, watch for blank stares and pale skin… Remember that they are not accustomed to seeing blood and may end up passing out!
9. When it’s sad…it’s really sad.
Delivering babies isn’t all rainbows and sunshine. Some days we frantically search for a fetal heartbeat, only to have the horrible, gut wrenching realization that a baby is not alive anymore. You will carry each fetal demise with you for the rest of your career. And no, it does not get any easier. But you will get better at coping over time.
10. It is endlessly rewarding!!
Every time you go to work, you get to witness the amazing miracle of new life coming into the world. It doesn’t matter how tired you are or what your day was like, there is truly nothing as rewarding as seeing the joy on a parent’s faces as they meet their child for the first time. It never gets old seeing a child enter the world.
While nurses need to know how to care for patients who have hepatitis, they must know about hepatitis transmission and take action to protect themselves from hepatitis at work as well. There are several types, including hepatitis A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV). Nurses have a higher exposure to hepatitis—particularly HBV—due to their line of work.
Recent research shows that some (but not all) nurses have knowledge about the mode of transmission as well as an effective prevention strategy. With World Hepatitis Day approaching (July 28), it’s a good time for all nurses to take action to educate and protect themselves. Since hepatitis can cause serious harm to the liver and is the most important etiology of liver cancer, the importance of timely prevention among nurses cannot be overemphasized.
Here are a few of the most important things to know about hepatitis when working as a nurse:
Mode of Transmission
- HAV is usually caused by consuming contaminated food or water, fecal-oral pathway, and oral-anal sexual contact.
- HBV is caused by contact with contaminated blood or other body fluids. The factors found to be significantly related with blood-borne hepatitis are needle-stick injury, attempted recapping of needles, or use of hollow-bore needles.
- HCV is the most common cause of chronic viral hepatitis in the United States and is caused by contact with contaminated blood or other body fluids.
- HDV is also caused by contact with contaminated blood or other body fluids.
- HEV is caused by consuming contaminated food or water and fecal-oral pathway like HAV.
When caring for a patient with hepatitis, preventing transmission to yourself and other patients is of the utmost importance. Here are four key prevention strategies you can to take:
1. Practice universal precautions at all times.
This approach to infection control recommends that you to treat all blood and bodily fluids as if they were infected and avoid direct contact. Always wear gloves if you need to draw blood or perform wound care. If the blood or body fluid spills onto the floor or another surface, it is important to have it cleaned immediately as the virus can survive in dried blood for up to 4 days. Make sure to dispose all items properly before coming into contact with other patients.
2. Practice good personal hygiene.
Practice good personal hygiene through hand washing, as good sanitation can help prevent a hepatitis infection. Always wash hands and use hand sanitizing gel before and after providing care to each patient.
3. Get vaccinated.
Both HAV and HBV can be prevented through a combination vaccine.
4. Follow your hospital’s protocol when caring for patients.
Make sure to refresh or update yourself about the hospital policies and guidelines when you care for infected patients or have potential contact with their blood or bodily fluids.
Unfortunately, nearly everyone knows someone who has had cancer. As a result, there are many oncology nurses working to help patients get through their experiences—whether with surgery and the aftercare, chemo, radiation, immunotherapy, and the like.
We interviewed Savannah Dunivant, RN, BSN, a nurse working in oncology at the University of Maryland Upper Chesapeake Medical Center, located in Bel Air, Maryland. She gave insight into what it’s like to work with these amazing patients.
Describe a typical work day for an oncology nurse. What do you enjoy most about it?
A typical work day can be quiet or hectic, but it is always rewarding. Certain tasks must always be completed: Physical assessments, administering medications, bathing, toileting, and rounding with doctors. You may have a patient who is newly diagnosed with cancer or you may have a patient that gets to go home.
I enjoy each day I get to spend with my patients, seeing them smile or reach for my hand. I have always said that with such a terrible disease as cancer, I hope that one good and positive thing that could come from their stay is me and the care I provide.
What are the various types of jobs that nurses can get in oncology?
There are various opportunities for nurses in the oncology field, such as staff/floor/inpatient unit nurse, Infusion Therapy, and Radiation. The primary role is teaching patients and families what to expect and to monitor patients for pain, fatigue, appetite, any side effects of treatments, etc. Nurse Navigators have oncology-specific knowledge and can give individualized assistance to patients, families, and caregivers to help navigate the health care system barriers.
What kinds of changes have occurred more recently in the oncology field? Why is it a good specialty for nurses to pursue?
There are many changes within oncology. Medications are always changing as are the treatments and protocols. There is always room to advance your skills and abilities.
What have you learned from working as a nurse in oncology?
That life is a very precious thing and never take time for granted.
What are the biggest challenges of working as an oncology nurse?
The biggest challenge is the emotional involvement you can create with your patient, although it is a positive thing. I once spent many of my shifts with a patient who then passed away, which was difficult for me. Nursing practice and your patients always take up a little piece of your heart, and it hurts to let them go—especially when we have been with them from first diagnosis to first chemo and beyond, up until when the treatment has just become too much. Your team members are your family, and your regular oncology patients become like family. But when it comes time to see them go, you know that they are no longer in pain, and you learn to love your memories of them.
What are the greatest rewards of being an oncology nurse?
The greatest reward is hearing your patient’s gratitude and knowing how much they care for you as a nurse.
What would you say to a nurse considering working in oncology? What kind of training do they need?
Go for it! It takes a special person to be an oncology nurse! It’s important to be trained in difficult situations and conversations as well as chemo certification and training in order to educate the patients and families. Oncology certification is important in order to educate patients and families and knowing the side effects or reactions to treatments. It is also important to be trained in “comfort care/palliative care.”