May 19, 2010, 1:31 pm

Dysorientation in the ER

Found this pic in the Library of Congress collection.

Perhaps this was a “Nurses Week” gift: a ping pong table in the break room!

This looks like a combination of ping pong and marital arts (Tae Kwon Pong?).

Either way, who plays ping-pong in their cap?

Nurse Ratched has discovered the same LOC collection.

Not that I have to use them before she does….

But it’s more fun if I do!


Change of Shift is up at The Muse, RN! Many thanks to our “muse” for hosting a great edition!

The host for May 27th will be Nurse Teeny at The Makings of a Nurse.

Submissions can be sent via Blog Carnival or to “nurseteeny at gmail dot com”.


Congratulations on your new job!

For the next six weeks (or so), you will be center stage, in the spotlight.

The play is called “Employment”, the audition is called “Orientation”.

You may embark on a long, successful engagement, or you could go dark on opening night.

Your audience decides.

Your audience = your colleagues.


Let’s face it: orientation is all about evaluation. Your actions directly affect whether or not you are successful in keeping your new role.  I’ve seen many an orientation turn into a “dys-orientation”.

How can you tell a successful orientation vs. a “dys-orientation”?

  • Orientation: You’re the first to get up and the last to sit down.
  • Dysorientation: You think the night shift is for relaxation and spend the down time texting, reading five-year-old editions of Better Homes and Gardens and snoozing. At the desk.
  • Orientation: You  realize the only way you will get the routine of the department is to be responsible for patients. A slow shift means you have to take the patients that do come in to get that experience.
  • Dysorientation: You pout when it is suggested that you take those patients, even if they are coming in only once an hour with simple chief complaints.
  • Orientation: You document your nursing care clearly and legibly.
  • Dysorientation: You think scribbling “IV” in the narrative is enough.
  • Orientation: You get to know your new co-workers.
  • Dysorientation: You spend time trading giggles with the guys/gals in the corner while you have four charts in the rack with orders.
  • Orientation: When your work is done, you ask your co-workers if they need any help.
  • Dysorientation: When your work is done, you sit.


I see an entirely different attitude toward orientation in younger hires. The focus is less on “how much can I learn during this time?” and more on “how little do I have to do before I can sit?”.

“What can you do for me?”  vs. “What do I need to learn here?

It’s the difference between seeing employment as a registered nurse as a “job” or embracing it as a “career”.

Have I turned into the dreaded “old fogey”?  T. Rex, RN?


Orientation is supposed to be the time when you put your best foot forward; a time for making a good first impression.

There will be time for socializing or “downtime” activities once you get the rhythm of the department. Time for splitting a slow workload with your co-workers. Time for knowing when you can relax and when you need to be on alert.

Orientation is not that time.

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  • RehabRN

    May 19, 2010 at 2:30 pm

    Thank you Kim! New nurses, please really believe this, even if some of the lazy toads you may work with say it isn’t true.

    People like to work with people who give a damn…about their patients, as well as their coworkers.

    The good folks outweigh the lazy arses at my place, thankfully, but even they get sick.

    Just remember, you’re at work to work. If you have downtime, here’s a trick I learned from the older nurses: read charts and if you don’t understand something, go look it up.

    Some charts can keep you busy for hours…

  • Jesse

    May 19, 2010 at 3:23 pm

    Where did you find that pic…awesome

  • ednurseasauras

    May 19, 2010 at 6:23 pm

    I am an old nurse too. One facet of nursing that was pummeled into my tiny brain by the old nurses of my yesteryear: “Don’t let me catch you sitting unless EVERYONE can sit”. ’nuff said.

  • Andi, On Call RN
    Andi, On Call RN

    May 20, 2010 at 1:06 am

    I’m a new nurse and I agree with you. I work in the ICU and did very well on my orientation, but I also have a very strong work ethic. Just blogged a post about people in my unit who don’t have good work ethic; it drives me nuts. Whether you are young or old, inexperienced or experienced, there is no excuse for being lazy and not doing your job. Great post!

  • Black Cloud ER Tech
    Black Cloud ER Tech

    May 21, 2010 at 6:30 am

    As the ER Tech… I am the first to stand up and last to sit down. If you are the new kid on the block, whether a tech or RN, you better be up before me and down after me. If you think that every thing is done, think again, there is ALWAYS something to do (don’t make me have you check the expiration dates on all the 2×2 gauze and cotton swabs on the unit).

    As for the magazine reading, internet surfing, giggling with co workers, that is for your 30 minute, union guaranteed, lunch break.

    After your 90 day probation, then you MIGHT be able to think about reading the magazines after EVERYTHING is done!

    I guess its just the work ethic that was instilled in me from an early age…

  • Stephanie Thorvalson
    Stephanie Thorvalson

    May 23, 2010 at 5:49 am

    I just finished my second week of orientation in the ER. Great post! I’ll pass it on to the other RNs and techs I’m training with.

  • Lionlover

    May 23, 2010 at 6:41 pm

    Ahem. “Marital arts?” I’m sure you meant martial arts. I’m pretty sure a combo of “marital” arts and ping pong is COMPLETELY different (especially with a cap on). LOL!

  • greenie

    May 25, 2010 at 9:53 am

    Then there are the Trex RN’s who decide you will get every admission “for the experience” then make snide remarks when you ask them to assist you. Just because they have been there (ICU) longer doesn’t mean they can’t learn something from the newbie.

    greenie (not so green anymore :) 0

  • Steve

    May 27, 2010 at 9:06 pm

    I’m a new nurse and I agree with you. I work in the ICU and did very well on my orientation, but I also have a very strong work ethic. Just blogged a post about people in my unit who don’t have good work ethic; it drives me nuts. Whether you are young or old, inexperienced or experienced, there is no excuse for being lazy and not doing your job. Great post!

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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