Orientee Horror Stories?

roma4204, BSN, RN · May 27, 2013

I oriented this horrible but experienced nurse. He could not remember if he had given the patient metoprolol or not. We always pulled meds together, but you would think giving a PO medication to a patient would be okay for an experienced nurse to do on their own. I forget if he lost it or what his excuse was, but he was awful at everything including his communication. Unfortunately he was the brother of one of our nurses who I loved. I just told my supervisor that I thought he was horrible and a few examples of what had happened. Apparently many sounded identical to what he had been fired for in his past job. So whyyyyy did we hire him?!

BuckRN · May 27, 2013

I oriented a new grad a few years ago I can thankfully say she actually turned out to be a pretty good nurse, but boy did she scare me! She couldn't keep her patients straight and she couldn't prioritize properly. One night we had a patient going downhill fast, but she was caught up on who knows what task. The charge nurse and I went in to insert an NG tube on the patient and we ended up having to call an code on the patient and she didn't even hear the code being called overhead on HER patient. I had to go hunt her down after the code team arrived and I had given history and background.

Then, another night when she was almost off of orientation, I was not following her super close because that's how I do things near the end. Better way to gauge how ready they are to be independent is to let them be independent. However, she was super behind, so I went to check blood sugars for her and I found one of our patients unresponsive. His vitals were 100% normal as was his blood sugar and tele rhythm. We had gotten in report that he was really lethargic, but responsive. I called her in the room to ask her if this was a change in condition and she told me "We got in report that he was lethargic." OMG! Lethargic and unresponsive are two totally different things. Got the MD in to assess the patient and even though vitals, EKG , etc were stable, I convinced him to send the pt to ICU and he coded 4 hours later. Dodged that bullet. Needless to say, her orientation was extended for awhile.

dirtyhippiegirl, BSN, RN · May 27, 2013

My unit hired an experienced floor nurse (like 6+ years of floor nurse experience at our hospital) who could *not* get the hang of ICU patients. Just constantly behind. There were rumors that he was making up hourly urine outputs and blood sugars in his charting. I got report once from him and he totally omitted the fact that the patient was on a ventilator, vent settings, etc. Apparently he sucked at floor tasky-things too, 'tho. Didn't know how to put in a foley and managed to contaminate three sets of blood cultures on three different patients.

Also hired a new grad who just...broke down. I got report from her a few times and she was in tears while giving report. (!!) I guess she started off as very cocky, arguing with her preceptor over the "right" way to do certain things (and her preceptor was NOT a nurse that you argue with) and it all just kinda went down hill from there. She was an older second-career nurse, too. They ended up letting her go about half-way through orientation.

We have a couple of new grads who just got off orientation that I worry about. I shouldn't be explaining how many times a shift that we do vitals and assessments on floor/tele/ICU patients when you've been working on our unit for nearly four months now. Maybe it'll get better 'tho.

ThePrincessBride, MSN, RN, NP · May 27, 2013

The problem with many of these new grad nurses is that there are too many poorly-run nursing schools churning out these unprepared nurses who don't know basic skills/knowledge. This is why I am in favor of shutting down these school mills and raising the standards. I know of too many schools that accept any and everyone or have very low qualifications to get in. That is scary, considering how EASY it is for a nurse to accidentally kill a patient.

nurseprnRN, BSN, RN · May 27, 2013

I was a critical care clin spec eons ago and was asked to orient a new bachelors-in-anything-to-MN nurse to our ICU/CCU. My clinical leader wanted to hire her because we needed staff but was very clear that she wasn't hiring a new grad because we didn't have time to put that much work into a new hire-- we needed someone to get going pretty fast.

She was a very bright woman and I really liked her personally, but she had just about no clinical experience and had no idea about common meds, drips, etc. I spent a lot of time with her asking her my usual Socratic leading questions ("This is someone with cardiac failure. Why did the physician include a vasodilator in her plan of care if her BP is low anyway? What do we expect next?") and she looked at me as if I were speaking Urdu. For me, though, the last straw was when I asked her what her patient's chest sounded like, and I watched through the glass wall as she went to listen to it and put the stethoscope in her ears backwards, so that she could not possibly have heard a thing. She returned and told me he sounded pretty clear. "Really," I said and went to listen myself....classic CHF rales almost up to the clavicles. I showed her about the stethoscope, and she blurted, "Oh, that's why sometimes I have a hard time hearing breath sounds and BPs!" Um, yeah.

I hated to tell my CL about that, and she was really ripped about it, but there it was. I thought she'd be a good nurse after some med/surg practice, but she left and I never did hear what happened to her.

amoLucia · May 28, 2013

Having oriented many staff nurses, I too, have my horror stories. So I find this thread sadly reminiscent of those. The ones I find most disturbing are those concerning EXPERIENCED nurse orientees.

I've also taught nursing school RN students and there are the horror stories there too. (Maybe we need a thread for that.)

Students and new nurses should really hear out our full side of the of the issue before they begin their lamentations about the 'mean preceptor' and/or 'horrible instructor'.

megank5183 · May 28, 2013

Exactly! I hear all the time about these horrible preceptors that sound like Hannibal Lecter meets Charles Manson. But I have never witnessed any preceptor be really mean to a new hire. Some are definitely tougher than others, but a lot of the new grads or orientees are just obnoxious! And the ones who are tough are usually that way because they are trying to point out that if you do this without me here to catch you, you can really injure a patient. I was nervous as hell during my orientation, but I was respectful and deferred to my preceptor. I can't stand new nurses who walk in and feel like they are just as knowledgeable as senior nurses. They just aren't. The nurses who ask questions, are friendly and respectful will get all of my assistance (even if they don't know something that they probably should). A lot of it is about attitude.

Having oriented many staff nurses, I too, have my horror stories. So I find this thread sadly reminiscent of those. The ones I find most disturbing are those concerning EXPERIENCED nurse orientees.
I've also taught nursing school RN students and there are the horror stories there too. (Maybe we need a thread for that.)
Students and new nurses should really hear out our full side of the of the issue before they begin their lamentations about the 'mean preceptor' and/or 'horrible instructor'.

anotherone, BSN, RN · May 28, 2013

To all the ICU staff who posted or will post, don't send us the rejects to med surg. Most of them can't even handle that either! I hate precepting. Ones who keep doing the same thing wrong after they have been told 20 times. Ones who only want to take 1-2 patients for weeks. Ones who cry if they get admissions. Yes, we can get up to six patients and on some terrible nights that may mean even 4 admissions and 2 transfers, more pts if you include the ones you transferred to ICU. Ones who have a chip on their shoulder and think because I am younger I can't possibly know more than they do.

amoLucia · May 28, 2013

To all the ICU staff who posted or will post, don't send us the rejects to med surg. Most of them can't even handle that either! I hate precepting.

And they will probably have the same problems in LTC where time mgt & task overload & staffing issues are so tough.

anotherone, BSN, RN · May 28, 2013

. I will help anyone and answer questions. Even if it is stuff people SHOULD know, even if it is a more "experienced" nurse asking. Rarely saw anyone not help or laugh too much about it, if the person asking was pretty nice. However, if you come across as a know it all, have the gall to complain when someone tries to teach you something or tell you what you are doing is incorrectly, some people will laugh or gloat when you fail. On my floor at least, the orientees are usually the problem and the complainers. Some people just don't take even constructive criticism well. At least in my experience the people on the high school, college, nursing job track are more used to it and seem to do better than others.

evolvingrn, BSN, RN · May 28, 2013

i had one really really bad preceptee experience......i was just there to fill in. I was told they were safe with oral meds but not iv and they did best with a little space so i stepped out. because the oral meds were going to be crushed through a ng tube it threw them for a loop . they crushed all the meds before scanning meds so they totally bypassed the safety system, (including blood pressure meds) without checking blood pressure ect........ then they dropped some pills on the floor couldn't remember which ones (but they did send a not to pharmacy) so i was able to find out which one/ but documented they gave it all. it just went down hill from there. Next pt they realized the other shift hadn't checked a blood sugar so they just canceled the insulin order and stated "pt already ate' wasn't going to check a blood sugar ect...... then the persons meds were supposed to be crushed ..........so they crushed them(were going to crush them all and scan them later, bypassing the scan system like the previous pt but i stopped them ) their other pt was calling so i stepped out to answer the light while they were crushing them and when i came back they were mixing all of the crushed pills in water ...........for the pt to drink.....eek. Sadly the day just got worse from there. I talked with their preceptor and this wasn't even and exceptionally bad day........but the norm......yikes. obviously , this new hire wasn't a good fit and was let go. very very nice person, just not right for acute care .