What do I do with a nasty nurse?

[DixieRedHead]

I am at my wits end. I am ADON/ House Supervisor in LTC facility. We have several new grads hired to work PRN. We do give them lots of orientation. They orient on all shifts due to their PRN status.

One nurse on second shift consistently is nasty to her orientees. They have to orient with her because of the need to fill that track if needed.

Anyway, we have talked with her and counseled her, verbally. Then this last week she has a new nurse with her in tears. Now the new nurse has lots of issues. She's scared to death and has very little confidence. But people are different, and some require more feedback than others. I just want this seasoned nurse to provide POSITIVE feed back. I have done all that I know to do, short of writing her up. (I really don't like to do that unless it's a care issue or absenteeism).

Any feedback would be appreciated.

[Esme12, ASN, BSN, RN]

I agree progressive discipline seems to be the only course at this point. Her behavior can not be allowed to continue. Once on warning make apart of her action plan that she complete lateral violence training maybe be restricted to no OT/extra time. Is there a way to avoid this nurse to precept? Can you switch her off to another shift while some else orients on this shift? Her hours are "guaranteed" (so to speak) not the time of day she does them. Tell her if the behavior continues a progressive discipline plan will be enacted.

I have confronted as a manager and a supervisor this type of nurse. They are actually very insecure and are intimidated by new nurses questions because they don't know how to answer them. I have asked them what I can do to help them engage with the new employee's training and sometimes words of encouragement and confidence that they are valued and that is why they are asked to orient new employees....,make them feel valued and needed. Some have bad behavior because they just don't want to be bothered or feel they didn't get an orientation so why should anyone else. I do make it vey clear that this is a performance issue and will be reflectd in their merit evaluation when it is time.

It just needs to be clear the behavior will no longer be tolerated while you are in charge.....that you have high expectations of employees to foster excellence within the facility. Sounds corney I know but....it brings the point home.

[JeneraterRN]

I say do the same thing that you do with a scurvy pirate-make her walk the plank. Sorry, my kids were singing that all day, and the title reminded me of that song again. Good luck.

[Vespertinas]

The poster clearly stated that she is looking to NOT write this nurse up. So I'd like to start from that point: If you are convinced that this seasoned nurse is not worth firing (and I understand) only bc of this one area of poor performance, you should probably look to relieve her of this duty. Not everyone precepts because not everyone has the skill to teach effectively. I know a nurse who I would want to care for my mother but she just doesn't WANT to precept because she doesn't think that's what she'd be good at... though she IS good at nursing. Just because your RN is "seasoned" doesn't mean she's the only knowledgeable nurse on that shift. I'm surprised you think there are NO other nurses you can turn to to do this job instead. If counseling and verbal warnings didn't help, it'd be a long shot for a written warning to make a difference.

[AZMOMO2]

That nurse can't possibly work 7 days a week on that hall or shift that you need to train the PRN staff. There has to be someone else that can precept a new grad for you?

It just should NEVER be tolerated. Until we have a zero tolerance policy the "Nurses eat their young." mantra will never end.

[imintrouble, BSN, RN]

It's a quandary. You have a nurse, who has worked second shift for awhile, when nobody wants to work 2nds. Dependable?

She must be at the very least adequate, since she has to orient the new people.

A dependable second shift nurse in LTC, but she can't orient worth a darn.

As far as I can see it's a trade off. It's like any other nurse, in any other area. You weigh the good and the bad. Strengths vs weaknesses. If this "nasty" nurse is at least adequate in every other area of her job, then maybe somebody else should orient the new nurses on second shift.

Most of us as nurses have areas of our jobs we do better than others. None of us want to do the part of our jobs that we fail/stink at.

At the end of the day, management has to decide if everything the second shift nurse does well, outweighs what she can't do.

I say give her a pass and management orient the new nurses.

[Nurse SMS, MSN, RN]

What would you do if this nurse gets hit by a bus tomorrow? Nobody is indispensible and if they are, there's something wrong with the way things are being managed.

[Vespertinas]

LOL, it's funny to see the changing of the tides the moment a different opinion is offered. Or perhaps we've exhausted all the posters who would urge to fire the offender.

Honestly, we talk about how insecure our jobs are because we can get fired over practically anything and yet every poster one after the other was adamant about discipline or outright termination.

I don't like the way the preceptor's behavior sounds either but boy we can really turn on each other.

[rn/writer, RN]

LOL, it's funny to see the changing of the tides the moment a different opinion is offered. Or perhaps we've exhausted all the posters who would urge to fire the offender.

Honestly, we talk about how insecure our jobs are because we can get fired over practically anything and yet every poster one after the other was adamant about discipline or outright termination.

I don't like the way the preceptor's behavior sounds either but boy we can really turn on each other.

So, you are suggesting that someone who has repeatedly ignored the directives she has been given about precepting new nurses properly should just be left alone and those in charge should just say, "Oh, well. She doesn't like precepting."?

Firing this person would not be the same as a nurse with good intentions falling down the rabbit hole after a misunderstanding or some other small offense. This nurse is demonstrating a pattern of behavior that is both improper and insubordinate. And it would suggest that she thinks she has management over a barrel simply because she is a capable nurse and she is willing to work second shift.

Allowing this kind of attitude to continue is a dangerous precedent to set. Not only does one employee get away with refusing to do a part of her job, but others see this and start wondering where other loopholes might be.

Requiring an employee to perform the duties expected of her and disciplining her when she shows a clear unwillingness (or inability) to do so is not "turning on" her. It's part of managing the workplace so that it functions efficiently and protects all of the employees, not just the ones that think they have the company by the short hairs.

Progressive discipline is the best bet for convincing someone that the powers that be mean business. They need to make it clear to this nurse that she could very well lose her job, not because they don't like her or they are being mean, but because she has to be both willing and able to do the whole job.

People sometimes dig in and look stubborn when they don't want to do something because they don't really know how to do it decently. You can't always tell from appearances whether they can't cooperate or they won't, but that's an important determination to make.

Maybe this nurse has never felt comfortable precepting because she has never actually been taught to do it properly. That, combined with the mistaken notion that she doesn't really have to honor this "request" could have helped her dig in on the matter.

Progressive discipline can help correct this faulty thinking and make it clear to her that her job may indeed be in jeopardy. Once she sees the seriousness of the situation, she might be open to additional education about precepting.

Has anyone every asked her outright what it is she hates so much about that part of the job? That might be a good place to start.

[DixieRedHead, ASN, RN]

I have no choice with whether or not she precepts. And I don't have a choice of whether to write her up or not. I must. Thank you all for your imput.

[Vespertinas]

Where I've worked, precepting has not been a part of the job description unless you were getting paid a differential or you were promoted to a higher position where the role specifically outlined. If precepting is not actually a part of her job description, I don't think it would be fair to fire her on that alone. If she is getting paid more to be in a role that requires this of her, there is an alternative which is to demote her to a role and a pay scale that would reflect the minimized expectations. On the other hand, I wholly agree that if this role is in her job description and you can't accommodate her as anything less, then by all means let her go!

I have had a difficult preceptor myself and I thought it was very unfair. Did I dislike it? Yes. Did I think the RN should have lost her job over it? No. Do I think that she shouldn't be allowed to precept and should not get paid for an advanced role because she generally provides no leadership and her seniority means little to me? Yes.

Again, I was offering a response within the parameters of what DixieRedHead asked which was: how to deal WITHOUT a written warning. We may all have an idea of how things SHOULD go but you can't make everyone bend to your will so I willingly discussed alternatives.

[netglow, ASN, RN]

Well Dixie knows this will come up again and again. And, it's always worse the next time.

[imintrouble, BSN, RN]

If the second shift nurse is written up, and continually expected to orient new nurses, the OP will be looking for more than one new nurse to hire.