New Graduates who don't welcome feedback

Sassy5d · Oct 14, 2013

Maybe you're focus is off. Are you taking what they are doing too personal?

If their stock is down, it will be them suffering when they need it.

Out of scope? How so?

Documentation off? Isn't that on that nurse and admin who audits charts?

Unless you were given the task of new grad audit, I honestly would tone down a bit. Come here to vent but don't turn your job into 'mothering' and 'tattling'

Of course, I could be misreading your post, then forgive me.

commonsense · Oct 14, 2013

Looking to get some advice on how to work with New grads coming through our Emergency department. For some years, 1st year nurses were not employed directly into emergency, but recent changes mean that within months of graduating from university, young nurses are coming straight to a fast-paced often stressful department. My challenge is this, while I was terrified for my first year in ED and extremely respectful of the senior nurses, these new grads are not. I have had several experiences where the new grads will practice beyond their scope, demonstrate terrible documentation skills, and outright refuse to care for patients. They frequently take breaks to check their phones and emails, and never think to offer assistance to their teammates. I often feel like I am being unreasonable in asking them to get up and restock or help out. At the risk of being accused of work place bullying, I try to put on my educator cap and gently initiate discussion about these issues. However, the new grads do not want to hear it. I and many of my colleagues, have been told in no uncertain terms that they do not require help, and that they know what they are doing. By no means do I believe that all new grads are like this. I also teach at university and see many enthusiastic young nurses who are open to learning. But my clinical experience with young nurses has been overwhelmingly negative and I despair for the future of my department. I would love to hear about strategies that other nurses employ to work successfully with new nurses who seem to 'know it all'!

Teach those who want to learn, let the rest learn the hard way (as long as patient's lives are not at risk any more than usual).

Altra, BSN, RN · Oct 15, 2013

Unless you were given the task of new grad audit, I honestly would tone down a bit. Come here to vent but don't turn your job into 'mothering' and 'tattling'
Of course, I could be misreading your post, then forgive me.

The OP's comment about "putting on my educator cap" leads me to believe she may be a dept educator and/or preceptor ... which does make her directly responsible for new orientees' performance.

Majain2013 · Oct 15, 2013

Maybe you're focus is off. Are you taking what they are doing too personal?
If their stock is down, it will be them suffering when they need it.
Out of scope? How so?
Documentation off? Isn't that on that nurse and admin who audits charts?
Unless you were given the task of new grad audit, I honestly would tone down a bit. Come here to vent but don't turn your job into 'mothering' and 'tattling'
Of course, I could be misreading your post, then forgive me.

Thanks Commonsense. Sassy5d, I don't believe it is mothering or tattling to discuss dodgy patient care with new nurses. Your response almost proves my point that some nurses are unable to take on board constructive feedback without feeling as though it is a personal attack. As a Clinical Nurse Specialist in my Emergency Department, wouldn't it be negligent of me to witness this bad practice and not say something?

My question was essentially, how do I/we develop strategies to work with new nurses, who without the benefit of clinical experience, mistakenly believe they are practicing a safe way?

Sassy5d · Oct 15, 2013

I was confused by your post. Which is why I said forgive me. I was getting mixed messages because 'someone' was telling you they don't need any help.

I would assume that whoever is saying they don't need any help would be the one auditing behavior. I imagine it must be frustrating to see, as I find myself rolling my eyes multiple times a shift at the same behaviors you mention. I see it from seasoned nurses too.

What I find, is the ones who know everything and don't play well with others, do not last or something happens where they realize on their own how their attitude and actions are a result of how things are.

Your post was vague. How are they practicing out of their scope? What is their documentation?

What I'm finding is unfortunately, unless things are enforced by management, like Facebook and cell phones, people are going to remain glued to them.

zmansc, ASN, RN · Oct 15, 2013

I agree that at one point in history new grads generally were not taken directly into ER or ICU for that matter positions. However, now they are. I believe most units that take new grads into them have training/mentoring/orientation programs for them, and as far as I know there is no scientific evidence that this change has been a bad thing (in pt outcomes, etc). Please correct me if you do know of some evidence that shows this as a bad thing.

In my previous career I had 30+ years of experience and I would have these new grads come into the department and want to tell me how things should be done! They thought of themselves as peers to me, and it was very difficult to not realize that they had just passed a major milestone, they had graduated, they had jobs, and for the most part they just wanted to prove to me and to themselves that they were a productive member of the team, that we made a good choice to hire them.

It really is no different here. A few months ago you may have had a professor/student relationship with these people. They were nursing students, and they had to do what you told them to do, how you told them to do it, etc. Now they are new grads, they have passed the NCLEX, they got hired into a very competitive job and they want to show everyone in the department what they can do. I would bet in most cases they are not doing anything wrong (practice out of scope, etc) so much as trying to be as productive as they can be. Trying to show you that they are your peer and that is a good thing.

The approach to teach in a professor/student relationship is vastly different than it is in a peer/peer relationship. I would suggest that you not participate in the new grad mentoring program. We have two professors on our staff and we do not allow them to be in the new grad mentoring program for this very reason. Until they have established a peer/peer relationship with the former students now RN co-workers, it is very difficult on the former student to take direction from these former professors and it is very difficult for the former professors to accept that their former student is a peer who needs to stretch his/her wings and grow from the SN role into the RN role.

BTW, just to set the record straight. I was once a new grad who went directly to my ER. I found then and now that there are some who the new grads take advice from and some that they don't. For the most part these individuals do not change irregardless of who the new grad is. In 99% of the cases, it has to do with how the instructions are given.

myraybans&i · Oct 16, 2013

I'm a new grad that was hired on full time in a busy emergency department immediately after I graduated. First and foremost, although you state you don't feel that all new grads are like this, it certainly does come off that way. I think it's unfair that you're generalizing all new grads based on the behaviours of the new grads in your facility. Many of us are hardworking, passionate and competent nurses that strive to learn and continuously improve our practice. I know of many new grads that are responsible and professional, despite the ongoing obstacles we face as a result of being "new grad nurses". So while it's unfortunate that the new grads in your department are lacking in some of these areas, I assure you this is not the case across all new grads entering practice.

In terms of this on going issue within your department, I think we can revert back to practices that are common in nursing school: evaluations. Document examples of what these nurses are doing well and what areas need to be improved upon so it's not entirely a list of what each individual is doing wrong. Discuss ways in which improvements can be made or how to refine current practices. Once this initial evaluation has been made, follow up with these new grads and track their progress. Reiterate to these nurses that you want to see them succeed and be the best that they can be. I agree that sometimes new grads can have difficulty being open to feedback, but as someone pointed out earlier, the approach can influence how these individuals perceive the feedback to be.

My department educator makes an effort to follow up with me on a biweekly basis to ensure that I am not left to fend for myself, or to discuss any issues or concerns that I have about anything related to the job. Perhaps you're already doing this, but if not, it's a good place to start.

HokieNurse21 · Oct 17, 2013

Looking to get some advice on how to work with New grads coming through our Emergency department. For some years, 1st year nurses were not employed directly into emergency, but recent changes mean that within months of graduating from university, young nurses are coming straight to a fast-paced often stressful department. My challenge is this, while I was terrified for my first year in ED and extremely respectful of the senior nurses, these new grads are not. I have had several experiences where the new grads will practice beyond their scope, demonstrate terrible documentation skills, and outright refuse to care for patients. They frequently take breaks to check their phones and emails, and never think to offer assistance to their teammates. I often feel like I am being unreasonable in asking them to get up and restock or help out. At the risk of being accused of work place bullying, I try to put on my educator cap and gently initiate discussion about these issues. However, the new grads do not want to hear it. I and many of my colleagues, have been told in no uncertain terms that they do not require help, and that they know what they are doing. By no means do I believe that all new grads are like this. I also teach at university and see many enthusiastic young nurses who are open to learning. But my clinical experience with young nurses has been overwhelmingly negative and I despair for the future of my department. I would love to hear about strategies that other nurses employ to work successfully with new nurses who seem to 'know it all'!

First, as a new grad that got to do my preceptorship in an ER, I am sorry that you are having such a negative experience. I fought hard for that ER spot, I knew I wanted it from day 1, and was not going to let any second go to waste. I was always the first one up to change over a room and help out the techs or the RT, especially if my nurse was not doing anything at the moment. If the census was low and we had no patients (yes that happened) I was getting quizzed or looking up things online, or playing with different things in the ER.

I was always craving to learn more. If there a new nurses that are not beyond excited every day they get up and go to work, they shouldn't be there. Try and teach them, and try to encourage they help. No one is too good to not help do the smallest of tasks.

TrevyRN, BSN, RN · Oct 17, 2013

You said "young nurses"... is it more of a generation gap kind of problem? Or is it a new nurse problem? Big difference.

In our department, it tends to be the older moms, grandmas, and experienced nurses that play on their phones :-)

Maybe you should work on hiring people with better attitudes ;-)

Chart audits are awesome because they are objective. When you spell out charting requirements and then show people how they met or failed to meet the requirements, then they can see where they need to improve. That's what our manager does.

Keep leading by example, too!

They'll come around ... or they won't last. Unless you're department is desperate and they were scraping the bottom of the barrel LOL... then, they'll replace them with more ungrateful noobs and... well, I'm sorry. C'est la vie!

:-)

Anna Flaxis, BSN, RN · Oct 17, 2013

When I was a new grad, once off orientation, I wanted to be left alone to get my feet under me and learn and practice and become a better nurse. I chose my mentors based upon who on my unit had a lot of experience, knowledge, competence, and skill, and I followed their example and sought out their feedback when I felt I needed it. I would have chafed under the sense that I was being watched or that someone was breathing down my neck, correcting me every time I farted sideways. I was a new grad in my late 30s.

I understand that new grads need a lot of feedback; but in my experience, if I forgot to chart something or needed to chart it differently, it was my supervisor's job to correct me. If I made a mistake, I owned it. If I did something that was not in keeping with practice guidelines (which I never did as a new grad; you have to know the rules to know when to break them), again it was my supervisor's job to correct me. I had very clear ideas of who had the authority to give me feedback.

I wonder if, as a previous poster mentioned, this reluctance to accept feedback from you stems from generational differences? Maybe these younger folks have a different perception than you.

I would suggest just backing off for a little bit and just get to know the new grads on a more personal/casual level. Establish individual relationships with each of them. Be a friendly, approachable person, and lead by example. Then, later on when you have to give feedback, you've laid the groundwork for them to accept it from you.

llg, PhD, RN · Oct 17, 2013

Whose official job is it to evaluate the performance of these new grads and help them improve as needed? You? Or is there some other educator or manager whose official job that is?

If there is someone else, I would recommend working through that person rather than taking on that role yourself. It is stressful enough to be a new grad in an ED without getting mixed messages from your official educator/mentor/manager ... and some CNS with whom you don't have that type of relationship. Their official educator/mentor/manager may be giving them positive feedback that conflicts with what you are saying -- complicating the situation and making you seem like the "bad guy" in all this.

I strongly suggest you have a "sit down" with the other leadership in the unit and together develop and implement a plan for bringing these new nurses into your team over time. Sticking your nose in it and going at it by yourself may cause more trouble than it fixes. The leadership team needs to stand together on this -- and if you are the one not standing with your colleagues, you will be the loser. But if you express your concerns to them and get their support -- everybody wins.