I just don't know how to do this....

  1. I'm having a problem with a newer RN. She is a VERY nice woman, don't get me wrong. But, whenever anyone gives her report, there is a problem. She doesn't do anything that you tell her about when you leave...and then you come back in and when you ask a question...blank stare.
    We have a pt who has massive leg ulcers on a wound vac...with one wound that we need to do cleansing and dressings on once a shift. So, it was done the night I got him from another floor. when I left yesterday, I gave detailed report about the wound care and said "it's in the chart, and all the stuff's in the room. If you have questions, it's written there.' also, said exactly what we were doing.
    When I came back last night, nurse tells me "oh, I changed the bandage to the heel." Oh, ok, how bout the wound care? "uhh....what wound care?"
    His IV system was open at the cartridge, so when I went to hang antibiotic, I got a yellow antibiotic bath....ugghh.
    Then, doc wrote orders for another pt to have a foley removed, PVR done 4 hrs after, and PVR once a shift. AT 9AM! It was still there when I came in...at 5P.
    She has had 1 less week orientation than me...and still only can handle 2-3 pts...only if they are stable. (I was a CNA for 2 yrs before, but that can only explain so much).
    When I was giving report, the day RN asked me to write a "paper trail" for our boss...over the next few shifts I work with her....not because we're out to get her...but because the concern is for pt safety and orders being followed/carried out.
    I am NOT the kind of person that wants someone to fail...but I almost want to grab her and say "wake up!" If you don't get it, you'll be gone! I am planning to keep a sheet here and there...but only on "major issues" (like the wound care order.....Foley order, etc.) Any advice?
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  2. 22 Comments

  3. by   uscstu4lfe
    Your "paper trail" for the boss sure does make it seem like you're out to get her. I can't help but notice you mentioned that she's a newer nurse. Try taking her to the bedside and physically show her what needs to be done. I'm new too, and I still need a lot of people with things I'm not familiar with, such as vacs, PCAs, special wound changes, and so on. SHOW HER. sometimes new RNs like myself want to prove ourselves so we wont ask the questions we should. Politely fill her in on it, take her to the beside and do a return demonstration if that is how she learns. sometimes it takes multiple times doing the same thing before you get the hang of it without needing help. and stop trying to get her trouble with the boss (whether you think youre doing that or not). how on earth is firing her going to make her better at another job she finds when no one has taken the time to do show/do things with her at your job?

    An RN gave me detailed instructioned on how to change a PCA vile during report. step by step. I got to the beside (alone) and I had no idea what to do. text to reality isn't the same thing at all
    Last edit by uscstu4lfe on Oct 15, '08
  4. by   Eirene
    I agree with taking her to the bedside and showing her what needs to be done.

    I wouldn't write anything up about her to the NM, but that's just me. I know you guys are just a few months out-- perhaps she needs some more orientation time?
  5. by   uscstu4lfe
    like learning to drive a car, this kind of stuff stakes practice, practice, practice.
  6. by   llg
    I agree that she may just need more "teaching" during report rather than just being told what to do.

    However, definitely document properly when things are not done. Should there be any questions later (e.g. due to a patient being harmed) and YOU did not document it properly, it will be YOU that is in trouble. This orientee is a nurse and she needs to be held accountable for the things she fails to do -- just don't be mean about it.

    Teaching, precepting, etc. are difficult jobs, particularly when the student/new employee is struggling. You need to be working with your unit educator and/or supervisor on this to be sure this person is getting the education she needs. Once that has been assured, then she needs to do her part and improve her performance. You need to do your part and try to help her out by explaining and showing as appropriate -- but also by enforcing professional standards, even if it might lead to some unpleasantness.
  7. by   Flightline
    If the nurse is still in orientation and is getting frazzled with the patient care, I can understand that--if in fact she is a worker and isn't just lazy. It's all in the attitude. If she's lazy write her up left and right. If she's just new and overwhelmed, don't write anything. There's nothing worse in the world of nursing than knowing your coworkers are out to get you.
    Last edit by Flightline on Oct 15, '08
  8. by   ZooMommyRN
    The paper trail would be a CYA to me, how on earth did she make it off orientation barely able to handle 2-3 patients? Are other nurses on her shift un supportive to where she feels she can't go to them for help? She could be drowning which is unfortunate BUT it can't just be left to smooth itself out at the expense of the patients, good luck with this one, it's a tough one that could get sticky
  9. by   Straydandelion
    Your "paper trail" for the boss sure does make it seem like you're out to get her.
    I don't agree with this and feel it is more a patient advocate position... wound care is very important..is this not in the med sheet also? I am ALSO wondering how she made it off orientation, was someone worried about a "paper trail" during her orientation also? This could continue until a patient is seriously hurt. I may be mistaken, but a paper trail for the NM gives her an idea what is going on with this nurse and MAY help in getting her the help she apparently needs...which is better then incident reports later on. The NM can see if she asks for help and doesn't receive it during the shift, or doesn't ask for help at all and go from there.
  10. by   Ginger45
    Dayshift is a nightmare. What was going on with her patients during the day? I am new to a unit and I carry a full load but I have had patients go bad and spent my whole day on them. I was instructed on certain things but when I had to do them I did ask for assistance just to make sure I did it right.
  11. by   nikjalik03
    I agreee. There is a long transition from student nurse to the "real world" of nursing. This young lady just seems to be totally lost and will need more precepting to give her the confidence in providing the best nursing care.
  12. by   pagandeva2000
    I would definitely try to walk her to the patient's room privately and explain what has to be done, why and the consequences of inaction. You do have to report what was not done, because as llg stated, it can fall on you. She went to school, passed the course, took NCLEX and the same Florence Nightingale oath that you did, received the same policies and procedures and is just as liable. It doesn't mean that she has to be left in the cold, however, but maybe a kind word of "Wake up, or they'll GET YOU" might be what she needs. In addition, explaining what shoes she would be leaving other nurses in will let her know that this WILL be reported, because you all have no choice. This way, I feel, her feelings were taken into consideration, she was warned and it gets you off the hook in case you have to protect yourself.
  13. by   locolorenzo22
    thank you all for the replies....she is NOT off orientation yet, but the preceptor issue is not there. I don't want to make it seem like we're trying to leave her in the cold....BUT when you tell her, show her in charts, assist her, etc.....it does NO good. She does not do certain items, and then when you attempt to assist her or educate her....you're a jerk.
    Paga....I would say something to her, but she does not know how to tactfully approach a situation. If I did,(and she has done this in the past) she'd be right in the manager's office saying "lorenzo said that I'm not doing x, y, z...and everyone feels like I don't know what I'm doing, and ......tangent in all sorts of directions" And I don't want to get into that.

    I'm not trying to write a paper trail for getting her in trouble.....My concern is pt safety. i.e. the wound care issue, the Foley, etc......These are things that can lengthen a stay, cause other issues, etc.....and if I did them, I'd want someone to turn me in to. I value my role as a advocate....but not at the detriment of the patients.
    You all have given me some stuff to think about....thanks.
  14. by   lovingtheunloved
    Quote from uscstu4lfe
    Your "paper trail" for the boss sure does make it seem like you're out to get her. I can't help but notice you mentioned that she's a newer nurse. Try taking her to the bedside and physically show her what needs to be done. I'm new too, and I still need a lot of people with things I'm not familiar with, such as vacs, PCAs, special wound changes, and so on. SHOW HER. sometimes new RNs like myself want to prove ourselves so we wont ask the questions we should. Politely fill her in on it, take her to the beside and do a return demonstration if that is how she learns. sometimes it takes multiple times doing the same thing before you get the hang of it without needing help. and stop trying to get her trouble with the boss (whether you think youre doing that or not). how on earth is firing her going to make her better at another job she finds when no one has taken the time to do show/do things with her at your job?

    An RN gave me detailed instructioned on how to change a PCA vile during report. step by step. I got to the beside (alone) and I had no idea what to do. text to reality isn't the same thing at all
    That being said, as a newer nurse myself, if I don't understand something, I have a responsibility to my pt to take the initiative to ask for help. It is not acceptable to endanger a patient by simply ignoring something because you don't know how to do it.

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