Starting a new travel contract can be super overwhelming, especially with only one orientation shift! One twelve hour shift to learn where everything is, to ask as many questions as you can, and to get a sense of what the weeks to come will be like. This is assuming that you will only have one shift to orientate; sometimes it’s more, sometimes it’s even less! With every contract, it will become even easier to jump right in and look like you know what you’re doing. It’s a long exhausting day of having your brain as a literal sponge, but it’s your only day to pick your preceptor’s brain about everything!!! I’ve compiled a list of the top ten questions you should ask during orientation. These are applicable to every facility and will help you not to forget anything important! If you have any other questions you usually ask, feel free to drop them in the comments below so others can read them too!
1) How Do I Call A Code?
This question is number one because it could be the most important one! Make sure you know where the Code Blue button is. I remember during one of my first assignments, I had a patient going into very rapid respiratory distress who eventually ended up going to the ICU and I pulled the call bell out of the wall for assistance (since that’s what we do at my home hospital). Turns out their system was completely different and there was an actual button above the patient’s bed to set the emergency call bell off. At the same place, I remember hearing rapid beeping of the call bell, running to a room to help the nurse and found out that it was just the bathroom bell that the patient rang!! I suggest practicing pressing the buttons and knowing what sounds and lights are what when you get onto the unit. Those few minutes of confusion could be very important minutes for your patient if they are declining! Also make sure you know if there’s a procedure to call switchboard to page the Code Blue overhead so the entire hospital is aware, or if you call the ICU directly, etc.
2) Where is the Crash Cart?
This one goes hand in hand with number one. Sometimes the unit’s crash cart is in a very weird place. At one facility I worked in, it was on the complete opposite end of the unit as the trauma room was. Know what the procedure is for a code…is there a designated person to grab the crash cart on the way to the room? Is there an ICU team that comes and brings it with them? Is it a free for all and hopefully someone thinks to grab it on the way? (Hopefully not!) Another really important thing to do during orientation is to OPEN the crash cart. Look at where the medications are, where the airways are, what supplies are in there, what supplies AREN’T in there, and make sure you know how to use the AED. All facilities have a checklist attached to the crash cart that they check every day or week, depending on their rules. Volunteer to do the checklist one day or night! This is a great way to know where everything is. Another important thing to do is to check the expiry dates on all the meds and supplies…some of these items have been in here for a very long time and might actually be expired.
3) Where Do I Find the Policies and Procedures of the Facility?
This is the thing that so many of my preceptors have forgotten to show me during orientation. Maybe they assume we will just ask when we need to find something? Nowadays, most hospitals have all of their policies online in their database. Make sure you know how to access it and how to search for what you need. Take time during your orientation shift to browse some common procedures. You’d be surprised at how different policies are between different health authorities and hospitals. Things such as blood transfusions, blood draws via central venous lines, how often to change IV tubing, how to insert a nasogastric tube…it’s always different. At my home hospital, we ALWAYS flush and heparinize CVADs that have a clamp on the access port when we disconnect the tubing. At a few other hospitals I’ve worked at, you need an actual doctor’s order to inject heparin into the port, or they only heparinize if the line won’t be accessed for more than 72 hours. Even the amount of normal saline required to flush the line differs between hospitals. There’s nothing wrong with looking up the policies as you need them, but just make sure you know where to look if you ever need to! Something else that’s important to know is what to do in case of a Code Red (fire), Code White (violent patient), Code Yellow (missing patient) etc….Are the colours the same as your home hospital? What should you do if any of these are called? What about isolation precautions? Are there colour coded signs for each type of infection? Is there an infection control nurse who supervises things? Where are extra masks, gloves and gowns stored?
4) How Do I Page a Doctor, Lab, X-Ray, Etc.?
Make sure you know where the list of doctor’s phone numbers is. Even if you yourself do not need to page a doctor, it’s SO helpful to call for a team member who is drowning and doesn’t have a spare two minutes to do so. Is there a hard copy list beside the phone? Do you call switchboard? Is there a nurse’s registry that you call to page for you? There is usually a separate list posted that has the On Call list only if it’s during the night or in the evening. Get an overview of what the doctor’s schedules are where you are working…do they share call? Or does each doctor want to be paged for their respective patient? The same goes for your lab technicians, x-ray technicians, respiratory therapists. Make sure you understand how to page/call each one and how their schedules work as well. I was shocked at my last contract to learn that the lab and x-ray technicians were combined! The same person did both jobs! That is so foreign to me but it’s common in small rural hospitals.
5) Where Are the Supplies Kept?
Us travel nurses always joke about never knowing where things are inside the supply room. Honestly, it’s always going to be a problem for you. Even after some time, you’re always going to stand and stare until you lock eyes on that thing you are searching for. Understand if there is more than one supply room. It’s obviously handy if everything is in one big room, but that is usually not the case. Know where your wound care supplies are, IV tubing/fluids, oxygen masks/tubing, linen, personal care supplies, catheters, you name it! If you have a general idea of what is where, it will be much easier when you are searching for a specific item. Something I like to do is take a few minutes in an empty patient room to examine the bedside and supplies that are and aren’t present. Where is your O2? Where’s you suction? Is there tubing ready to go? Is there a non-rebreather mask taped above the bed? Is it on the back of the door? Is there a whiteboard for you to write on if you have to record vitals really quick? Knowledge is power!
6) Is There Any New or Unfamiliar Equipment That I Need Training On?
This is so important!! Start with your vitals machine! Can you auto-program intervals for a post-op patient or to monitor a blood transfusion? Does it save the vitals to go back to later? If you are a specialty nurse, look at your ventilator, have you used it before? Check out your ECG machine, glucometer…same one? Even IV pumps are important to know. Within Canada, I’ve used three different pumps and they all operate completely different. Do you run urinalysis on the floor? Make sure you know how! This goes for any and all equipment you may be using. If there is something that you are unaware of, make sure someone takes the time to train you on it. If not, what happens if you are the only person who can operate that equipment in that instance and what if there’s no one around to help you use it? A lot of facilities require you to complete a checklist with the lab supervisor or preceptor so that there is a record of your training. What charting system does the facility use??! Is it paper charting or is it a computer program? How often should you be charting? How do you enter doctor’s orders…digitally or by fax? Even knowing how the phone system works is helpful…if you ever have to transfer a call or put a call on hold, make sure you can do so!
7) What Are the Codes for the Med Room, Break Room, Etc.? What is My Computer Login?
Is there a key pad for the doors? Make sure you know the code! I suggest writing it on a sticky note or something and tucking it into your badge holder so it’s always on you. I usually do this for any important codes, phone numbers, passwords, etc. That way it’s easily accessible in a pinch! Maybe the doors open with a swipe card? Make sure you have that and keep it safe. You 99% of the time will have to hand it in when your contract is completed. In addition to this, ensure you have a computer login and password if needed. Is there an email account you need access to? The most important thing is if there is a Pyxis or Omnicell (or similar) system to remove medications…make sure you have access and do the required training as needed. Hopefully the manager and pharmacy is on the ball! I rarely had Pyxis access my first few shifts and it’s always annoying having to ask other nurses to remove your medications for you!
8) What is the Scope of Practice for Myself and Others?
You should always know what your own scope of practice is. If you aren’t aware, you can access it on your respective college of nurses website. For Registered Nurses, it’s most often the same but in rural hospitals it can differ. Some nurses with extra training can do more and have a wider scope! The biggest thing for me is to know what the OTHER nurse’s scope of practice is. In Ontario, RPNs (Registered Practical Nurses) have a large scope and can do a lot of things that RNs can. When I worked in Alberta and British Columbia, I was shocked at how limited the LPNs (Licensed Practical Nurses) scope was. Depending on the facility, LPNs can’t hang IV medications. That is so important to know and communicate about with your team at the beginning of the shift so that you know when you have medications to give to a patient that is not your responsibility. I usually would scan the MAR and make an IV label for each medication to give and stick it to the side of my computer screen, or the side of my med cart. If I have time, I’ll pre-mix whatever I can as long as it can be re-constituted during my shift. Basically, just get a run down during orientation of what each profession does. If you have health care aids, know if they bathe/set up washes for everyone, is there a schedule? Does the unit clerk transcribe orders? At one facility I worked in, the unit clerk just answered phones and restocked supplies…I didn’t know that I was expected to transcribe all of my doctor’s orders! Things like this will help you be more organized.
9) Are There Any Special Rules or Policies for Medication Administration?
Know where your parental manual is!!! Is it hardcopy in the med room, or can you access it online? Is there an IV compatibility chart or website that you can access? It’s so important to know how to administer each medication you are giving, what to dilute it in, what tubing is needed, how fast to administer it. Even common medications that you give all the time could be diluted in a different solution or administered slower than you are used to. Always double check! Each facility has their own pharmacy guidelines and policies that you are expected to follow. Are you expected to have a witness for removing narcotics from the narc cupboard? At my home hospital, we only have to have hydromorphone witnessed, but other places you always need a witness for any narcotic or controlled substance removed. Do you have to have a witness to waste medication (obviously, but know this anyway!)? How often do you have to count the narcotics at shift change? This is a super crucial topic to be aware of…you never want to be accused of stealing narcotics. And if something is missing or miscounted, the staff are going to look at the new travel nurse that they have no prior knowledge of! Don’t let that happen! Something else to know is where the stocked medications are. If you need to give something at night time, is there a night cupboard where the medications are stored? How do you sign them out? Are you expected to mix all IV medications, or does the pharmacy pre-mix any of them? In a perfect world, right? 😉
10) What Do I Need to Know as a Staff Member at This Facility?
This is a broad question, but it pretty much sums up the rest of the questions I came up with. Where do you find your schedule? How do you change a shift if needed? What is the process for calling in sick if this should happen? How do you clock in and out and how are you expected to complete your timesheet for your agency? How do breaks work? Do you have a specific person to report off to, or do you just choose anyone? If you have a car, where is the staff parking lot? Do you have to pay for parking? If you work night shift, is there a nightly checklist to complete for restocking supplies and linen carts? If you have to transfer a patient to a different floor or to a completely different hospital, what is the process for this? is the nurse responsible for giving report to the receiving facility, or does the doctor handle it? There is SO much to know, as you can see. You should know these things though! A great thing to do is to bring up a lot of these things while you’re on coffee break with all of your new co-workers. It’s a great way to get a feel for the place and also meet new people at the same time!
Though almost all of these questions were ones I came up with myself, I did put a questionnaire on my Instagram story recently to see what other travel nurses had to say about questions to ask during orientation. Most people said to ask where the crash cart was. I found it funny that the majority of people said to ask….where is the staff bathroom? I suppose that’s very important to know too!!! It’s nice to have a special spot to gather your thoughts and take some deep breaths during a busy shift!!!
I hope you found this post helpful!! As I mentioned at the beginning, if there is a question that you would ask on top of the above, please write it in the comments below so others can read it too! Happy orientation!!! 🙂
xoxo, Hales
The Tales Of Hales 