What makes you nervous about or irritated with a new grad or orientee? - page 13

I've noticed alot of threads lately from new nurses who seemed quite stressed out, which I can totally understand, I've been there for sure. So I thought I'd start a thread from the other POV. This... Read More

  1. by   CMCRN
    I am a preceptor for L&D. I love questions.Most of the new hires/new grads are serious and committed to learning as much as possible during their time with me. What makes me irritated is nursing students who sit at the desk and flip through magazines or chat with other students rather than try to LEARN anything. Even if your patient is asleep you can review and learn from P&P's. Or follow me around and see what I am doing. I had a great student working with me in OB Triage the other day, a male by the way, and when we were done with the patients for the moment I said I needed to do the QCs and he could help me with that. He loved it. And the instructor came by after post conference and said thanks too as it had provided the post conference topic, some of the other things that we are responsible for other than direct patient care. I agree with everyone else, the know it alls are the scariest and the ones without common sense
  2. by   burnay76
    Hi, I'm a relatively new nurse myself and I have certainly been a pain in the rear I am sure. I am a strong proponent of evidenced based practice and this leads me to a lot of "why" questions. I know experienced nurses become really frustrated with this. It is unfortunate, like some have said, that the input of newer nurses is often dismissed or discouraged. I do not know it all...... not even close. I am quite well read on recent innovation and most current standard practice (doesn't mean I can always do it though). I try to encourage discourse on methods so that I and those helping me can critically think about what we are doing. Unfortunately this is too often seen as challenging. I cannot be content, however, to just do it because I am told (especially if it doesn't seem to make sense) Other fields are better at recognizing that fresh blood brings a wealth of useful knowledge and "old" blood bring a wealth of experience and wisdom. Knowledge, wisdom, and experience are pretty much useless (and even dangerous in nursing) when they stand alone. They all depend on each other to form a coherent and effective practice.

    That said - there are also those newbies out there who just need to be slapped silly (maybe even me sometimes) :trout:
  3. by   2longasn
    I agree that any Nurse new or not that belives they know it all is dangerous. But what's bugging me today is the experienced Nurse who is orientating and orientating and never seems to find that rhythm. How long can you play the orientation card before you get busted for subpar skills and or overtime abuse?
  4. by   sayitgirl
    Quote from 2longasn
    I agree that any Nurse new or not that belives they know it all is dangerous. But what's bugging me today is the experienced Nurse who is orientating and orientating and never seems to find that rhythm. How long can you play the orientation card before you get busted for subpar skills and or overtime abuse?
    I have been in the nursing field for thirteen years now, and one thing that I have seen that each nurse is an individual. What is easily learned by one may take longer for another and so on. I have also seen a lot of intolerance by nurses with each other, it must be the nature of the nursing culture, to be uncaring and unkind to your coworker, yet caring to the patient. Go figure...
  5. by   Susan9608
    I haven't been a preceptor for any actual new grads yet, but sometimes, my supervisor asks me to "orient" experienced nurses who are either just new to my hospital or totally new to the PICU AND new to my hospital.

    The thing that makes me uncomfortable and/or irritated is being asked to evaluate someone's performance when that person has more actual nursing experience than me! I think I'm a pretty good nurse, but I don't think that with my 5 years of experience I'm in any position to evaluate someone with 20 years of experience in the same field. I don't think that's fair to me or to the person I'm supposedly "orienting."

    I don't think I want to precept any new grads, at least not for a long while. I feel like I'm just now getting to a point where I'm comfortable enough with my skills and practice that I'm not having to run to others all the time with questions. I think it will be awhile before I'm confident enough to help someone learn to be a nurse.

    What's kind of ironic, though, is that I *love* having nursing students. I remember hating clinicals so much because I thought they were boring and way too stressful, with all that emphasis on the paperwork. I love finding things for students to do (catheters, IVs, drsg. changes, trach changes, etc.) and then I like helping them find their information for their paperwork. I think it's important to give students good experiences in clinical so that they don't go through school with the idea that they might hate nursing because they hated clinicals.
  6. by   crissrn27
    Quote from KellNY
    Yep, know-it-all new nurses bug me. When I try to show them something (ie: "They're going to extubate Mr. Smith-why don't you go assist?" or "Mrs. Jenkins is going to have a c/s and btl, why not scrub in and assist or observe?") I get back "No, I saw one last week." or "We did that in clinicals."

    WTH? Take each opportunity you can to learn. No one expects you to know everything. Nurses are never done learning. I can say with honesty that I've never seen two identical deliveries. Even now, I still learn something with almost every patient, be it better positioning for comfort...better technique for procedures...different emotional reactions...more words or phrases in Spanish...side effects to meds, etc.
    I agree with this for the most part. But we don't need to "dump" undesirable stuff on the newbie, either. A few years ago, when I started in the newborn nursery, I went to every delivery, took every ICU baby, went to every circ, and it got old very quickly. After about a year of being assigned to every........single........delivery, every night, I decided we could go back to rotating (as per policy). Did I know everything at this point? No. But it wasn't fair to continue to dump stuff on me, because I was new. Some of the other nurses didn't like going, and decided that it would be "good for me" to go to all of them. Well, it was, for the first few months, then it just wasn't fair. It didn't stop, either, until we got a new newbie, then she was assigned all the crappy stuff. I always made sure to offer to go to deliveries for her, help with ICU babies, etc, because I remembered how it was. OK, rant over. By the way, I love having students and new nurses.
  7. by   twistedpupchaser
    I have just finished another 6 week placement as a student, 3rd year!, not long to go. I was put onto the ortho ward and had a great time. (who would have thought that ortho was full of little old ladies with #NOF's, I was thinking football players and MVA's)

    My preceptor was the absolute best, very "old school" and things had to be done her way, not the wrong way. She was a complete b*tch at times and I would have it no other way. By standing back and leaving me with my own workload I managed to prioritise my workload and learn time management. She would disapear and "float" the ward, assisting the other nurses but always knew when to come back to assist or sign off the medications. I feel that her no-nonsense and "sink or swim" attitude (ok, I started off thinking that was her attitude) pushed me and my skills further than I thought possible in such a short time.

    A friend of mine had a different preceptor and learnt very little in comparison because the preceptor had a different way about her. I have to say that at the time I gritted my teeth when I was asked for the 17,000th time "What, you arn't finished that yet?" I wouldn't trade the experience.

    I guess what I am saying is that preceptoring is not a popularity contest, it is a learning experience and everyone has different styles and teaching habits, try to learn what you can from any preceptor, be they good or bad. Open minds tend to absorb more info than closed or narrow-minded ones.
  8. by   clee1
    I've read a good deal of the thread, and one thing jumps out at me: NOBODY likes a "know-it-all" (least of all me!), and ANYONE can learn something from nearly ANYBODY. After all, even the worst among us can perform valuable service as a bad example.

    However, keep in mind that all newbies are not the same, and some of the "know-it-all's" might have more knowledge/experience than you initially give them credit for. It should go without saying that NOBODY appreciates unsolicited advice

    I am a 4-month nurse; a newbie by definition. However, I was an EMT-P and an independent-duty medic at one time in the past, and came to the nursing profession without the baggage many new nurses have: fear of dealing w/ pts, never having inserted a foley or put down an NG tube, etc. I am the only ACLS/PALS certified LPN in the facility. I religiously look up meds I am unfamiliar with and DO NOT HESITATE to ask questions. I ask dozens of questions per shift; mostly of the "why do we so this "that" way", or "how do we handle "this" particular problem?" kind of questions. I always get a complete and comprehensive answer from my excellent charge nurse(es). I had some time-management issues in the first few weeks for which I sought, and received, a lot of help from the other nurses - and I am deeply greatful.

    I was on new-grad orientation a total of 17 shifts (huh????) before being assured by my unit director and preceptor that I could handle it "on my own". I am now routinely asked by nurses with far more experience than me to start their "tough stick" INTs, or "Listen to Patient A's lungs and tell me what you think." My point is that many of the folks you might consider to be "know-it-all's" may actually know quite a bit (but not nearly "all").

    As Frank Lloyd Wright said, "It's hard to be humble when you're great."
  9. by   jbp0529
    Had a new nurse to our ICU recently off orientation (although maybe shouldn't have been ??) have a problem recently.

    Her problem wasn't the know-it-all attitude but more a failure to grasp simple skills.

    She didnt stop the Levophed pump before changing bags, ran air into the line, pump stopped pumping, couldn't figure out how to get the air out. A series of unfortunate events resulted....

    After 4 months of ICU orientation, we were baffled that she couldnt fix it. Did we fail as preceptors, or is the problem soley hers?? I guess one could argue both sides.
  10. by   UM Review RN
    Quote from jbp0529
    Had a new nurse to our ICU recently off orientation (although maybe shouldn't have been ??) have a problem recently.

    Her problem wasn't the know-it-all attitude but more a failure to grasp simple skills.

    She didnt stop the Levophed pump before changing bags, ran air into the line, pump stopped pumping, couldn't figure out how to get the air out. A series of unfortunate events resulted....

    After 4 months of ICU orientation, we were baffled that she couldnt fix it. Did we fail as preceptors, or is the problem soley hers?? I guess one could argue both sides.

    I've had to show newbies how to do that.

    (Newbies, take note: If you get that much air into a line, take the line off the patient first, then prime the tubing. Then put the line on the pump and last, reconnect to the patient.)

    Any questions, PM me, I'll be happy to help.

    I once saw a nurse who was years my senior in experience and expertise foiled by a tube of wound gel. She couldn't get the thing open to save her life. I told her how to open it by simply snapping the top off, and I learned that day that we all have things to learn that seem really simple to others.

    But until she actually ASKED, I had no idea that she didn't know what she was doing.
  11. by   time4meRN
    Yes , nurses who don't ask questions! I awlays try (I think I do anyway) to make the environment comfortable for admitting mistakes and asking questions. I usually try to ask the new grad questions too. They have learned new things that I'm interested in as well. You know how it is, sometimes even after 30 years of ER and critical care, I have a major brain fart. I'll ask the new grad what may seem to be really silly questions. But, not so much because I can't find it out with just a little thought but, beacause they can see it's OK to ask.

    Other things that make me jittery is , having little experince with basic skills . Difficult to teach critical thinking if they can't get past starting and IV or other such things.

    And yes, the new grad that argues, (don't mind professional debate, because maybe I can learn somthing) but to stand and argue with me when I see the bigger picture (like a pt going bad , no time to waste) Then , I get ticked ! I told one of my new nurses when she was in the way, things are going fast here. Get in , sit down , buckel in and shut up. ( I know that's rude but what I was actually thinking at that point was much more harsh). But, it worked, she was able to ask appropriate questions when she was spectating rather than getting in the way.
  12. by   DaMale Nurse
    Have you ever thought that a new grad is so overwhelmed with the whole experience that questions have not started to form. Perhaps engaging them in a discussion of how to do stuff and what is the bigger picture will facilitate an open discussion on what is expected in terms of care or diagnosis or medications can get there brains working on a tract that will be more helpful. Frankly during my senior practicum I was so scared that I didn't know what to ask. I just wanted to go and throw up. I finally started asking the questions toward the end but it took me a whole 2 weeks to relax enough to start asking. The fact that my mentor just wanted me to ask questions and not teach was totally disruptive and by the end she was ok with me but at the begging I was having a horrible time.
  13. by   txRN07
    After reading all of these useful posts, I am glad now that I asked so many questions when I was orienting. I always felt stupid for asking, and then coming back and asking about something else until finally one day I asked how I was doing, and they were actually relieved that I always asked before winging anything. Now that I am off orientation, I feel more confident due to all of the helpful nurses who helped during orientation. I still come across things that I still have not done, and now I am perfectly comfortable with asking again! Just the other day I have to draw blood cultures, and I still had not had the chance to do it until then, yeah I felt dumb, but I asked anyway, and the most important thing is that I did it right. The focus is on my patients, not my ego!

close