need advice on precepting special nurse

[rn-jane]

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.

[dianah, ASN]

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.

[jnette, ASN, EMT-I]

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.

Couldn't agree more, Navy.

I, too, would hate to further demoralize and stress this girl... seems like a real motivating, confidence building experience would be soooooo refreshing and needed here. However... med surge is just SO VERY stressful... and I just wonder if this would not end up being her demise (and perhaps that of some unfortunate patient?)... should she stress out at the wrong time... lose focus, etc.

Quite a risk to take. As mentioned.. perhaps another setting for a period of time... something less stressful... where she could still be a nurse, and build her life back slowly and regain the confidence of her peers, managers, as well as her own selfconfidence.

[kc ccurn]

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.

What does she think? Has it been discussed with her? Maybe she is feeling way overstressed about reintigrating to nursing and doesn't know how to verbalize it? I agree that she needs to have a neuropsych eval done before making the decision. That way you've got an objective point of view.