need advice on precepting special nurse

  1. We recently hired a new nurse at one of the facilities i work at. This is the third unit she's been oriented on, due to problems in orientation or with the preceptor. First of all this nurse was in a major truamatic accident about 4 years ago, and was a major head trauma patient, spent almost 2 years in the hospital rehabilitating. There had been situations when inappropriate comments had been made to patients, preceptors ect. She has been a nurse for 14 years and recently only has been working at a nursing home for the last year. My unit is a med-surge telemetry unit that tends to be very demanding at times, i'm not sure if this is the proper environment for her to come back to, but i guess this is her last chance or they will let her go. I think she has healed physically, but emotionally she is a mess, broke down several times about her accident. I know people have been talking about her
    labeling her as psycho nurse which is also deterring her ability to fit in here. I've precepted many new nurses, my boss wants my opinion wether to keep or fire her. I know this girl needs a break, but we are dealing with other pt's lives. Many people on the unit have acted strangely and rudely to her, i basically have told them to get off her back and any real problems to be directed to my boss and me and not to feed the rumors. I really want to help this nurse, i feel we are in the caring business, we also should be helping our own right? I think this girl does need therapy though, she on mega antidepressants and has not really been in any realtype therapy dealing with this traumatic event. I told her i will try to support her the best i could, felt like she needs a friend, feel bad for her. She was injured in a horsebackriding accident, and being an avid owner and rider myself i can empathize with her and her situation.
    I'm sorry so long, but could use advice. Any help is greatley appreciated.
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  2. 14 Comments

  3. by   nekhismom
    That is terrible for the new nurse. I hope you can find a way to help her out. Maybe she could use a nurse refresher course? I don't know exactly what the problems are, but perhaps that would benefit her. I think you are right, we do need to care for our own as well as the pts. I don't have any good advice, but I am sending you both well wishes.
  4. by   ceecel.dee
    I am worried about whether she SHOULD be there, more than if she can make it through orientation. If she is breaking down and can't establish a working relationship with someone who is good enough with people in general to do preceptor work, I worry about her remaining patient focused. Perhaps she wants to be ready to move on, but isn't ready yet. Be careful.

    Would she be interested in something less...(how to say this without inflaming someone ) life and death? Patient education, a rehab department, home care? I am in no way diminishing their value as positions or their importance in patient's lives. Some positions require a bit less adreneline-surging day to day, so often less stressful. Can she handle the stress on your floor?

    Good luck to you and to this healing nurse!
  5. by   BadBird
    Although I admire you for trying to mentor this nurse I am worried that she will not be unable to handle the stress of a telemetry/medical surg. unit. Those type of units can be very demanding and you need strong skills to handle it. Coddling only goes so far, she will need to fly on her own to be a productive member of the health care team and if she has as many problems as you refer to I doubt she will make it. It isn't fair to the patients who she would care for or other staff members to have her, although it seems harsh you have to look out for what is best for the unit overall. I feel sorry for her, overcoming that type of injury and trying to get her life back but she must be realistic too, you can't expect people to bend over backward and accommodate you forever, sometimes you must make life altering decisions and change your scope of nursing. I wish you and her luck.
  6. by   purplemania
    If she is not able to perform as any other nurse is expected to do on your unit, she needs to be elsewhere. This may be a blessing for her as she will be constantly stressed with not fitting in, peer pressure, wondering if she will make a serious mistake, etc. Judge her according to the job description standards, not her history.
  7. by   jnette
    Quote from purplemania
    If she is not able to perform as any other nurse is expected to do on your unit, she needs to be elsewhere. This may be a blessing for her as she will be constantly stressed with not fitting in, peer pressure, wondering if she will make a serious mistake, etc. Judge her according to the job description standards, not her history.

    I agree.

    This is sad, to be sure, but she needs to address her own issues before she can be expected to be able to be a healing touch to others.
  8. by   rn-jane
    Quote from jnette
    I agree.

    This is sad, to be sure, but she needs to address her own issues before she can be expected to be able to be a healing touch to others.
    I don't think this nurse is beyond working in the field of nursing, or even in a hospital, but my unit is particulary stressful. unfortunately my boss has layed this upon my shoulders to be the deciding vote on her performance. I think maybe she would psossibley do well on a transitional care unit or rehab unit but this stepdown unit is very stressful, and even the best of nurses sometimes can't hack it here. I know her dream is to be back at working med-surg again, i think she's grasping to be the person she was. I told my manager, we can watch her while in orientation but on her own in a code, how would she handle it? I think this decision will be tough to make, i hate being put in the middle, it will ultimately have to be my manager to make the decision though.
  9. by   sjoe
    jane writes: "I don't think this nurse is beyond working in the field of nursing, or even in a hospital, but my unit is particulary stressful. ... I think maybe she would psossibley do well on a transitional care unit or rehab unit but this stepdown unit is very stressful, and even the best of nurses sometimes can't hack it here. ...I think this decision will be tough to make"

    On the contrary, you have already made your decision about what to advise the manager. Now you just have to do so.
  10. by   nurseunderwater
    On the contrary, you have already made your decision about what to advise the manager. Now you just have to do so.[/QUOTE]


    ditto
  11. by   bluesky
    Are her breadown moments from performance related stress or from the way she is being treated by other staff people?

    Clearly there is a lack of professionalism on your unit and she doesn't have the strength to advocate for herself. She needs to find someplace where she'll be supported and the workload is appropriate to her skill level.
  12. by   traumaRUs
    I would think that maybe a neuro-psych eval from Occ Health is in order. This will assess her cognitive ability and perhaps point your facility in the direction they need to go. Maybe nursing in a hospital is too strenuous for her. After major head trauma - there are many stressors, not all physical. Take care...although this nurse needs some understanding, it can't come at the expense of patient care.
  13. by   missmercy
    While I wish I had a magic wand and could totally fix things for this poor gal, sound like she would be a potential hazard to patient care standards. Some one posted earlier that the patient has to come first... I agree. Your manager shouldn't make you feel as though you are signing the death warrent for this gal's career! You have to be honest with your evaluation of her skills as a nurse and her ability to handle the particular stresses of your unit -- then management needs to use that evaluation to determine where ( if anywhere) in the facility she could be used appropriately. I ahd a dear friend who was in a major MVA w/ severe head injury -- her personality was never the same -- and regardless of how she fought to regain the "old her" we had to adjust and get acquainted with the "new her" we counted ourselves fortunate to have her back at all -- but we could never really go back-- something like that changes you in all sorts of ways-- sometimes facing those changes is relaly hard and hurts like blazes -- the sooner she finds a way to be at peace with who she is NOW, the sooner she can develop that person. I think that she is probably in need of the psyc eval through oc health that someone suggested! She needs some help adjusting to the way things are now -- coddeling her, or "overhelping" could keep her from getting the help she needs. You are in my thoughts and prayeers -- tough spot to be in!
  14. by   dianah
    sounds like ptsd. She may indeed find her niche in nursing, be it elsewhere. Agree w/time to get used to the "new her," although if she is still working on internal issues, the "new" her is in fact the "evolving" her.
    What does SHE say about how she perceives her training time, the breakdowns and her "gut" feeling of working on the unit? Kudos to her for her efforts; it may just be too soon/not the right place.

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