I don't want to eat the young!!! Advice, please!!!

  1. HI, all, I'm rather new to posting here, I think this is my 2nd or maybe 3rd post. A little background on me, the surgery bug bit me while I was still in nursing school, I did a preceptorship in surgery, then went to med-surg for the required year, then back to surgery for 2 years, and have now landed at a small (2-room, but only running 1 room at a time) surgery center, where I've been for 2 years and hope to be for many more. In preparation for hopefully running 2 rooms at once, we hired a new grad nurse, who did her nursing school preceptorship with one of the FA's who works with us a lot. She's very interested in learning, and she has the best of intentions...problem is, the docs, other PA's, our ST (who has an attitude from HELL), are ready to eat her alive. She's only been with us for almost 3 months, and she's a bit of a slow learner, but we all know how long it can take to get comfortable in the OR (I was told in the beginning 1 year to be comfortable, 2 to be competent). Problem is, the things they are complaining about are big problems, and I'm afraid when I talk to her about them, I'm not sure she's getting it...for example...she was doing the prep today for a CTR. She finishes the prep, and she's standing there, holding the prepped arm with 2 hands, one on the wrist, one at the elbow, waiting for drapes. The PA asks her to move the chux, so she reaches down & does that, then reaches over and moves the rolling stool out of the PA's way, then reaches back & grabs the arm again...I re-did the prep, but the surgeon was by then in the room...he took it well, all things considered, but in the VERY NEXT case, she was getting ready to prep, put her gloves on, and proceeded to adjust her mask. I don't know what to do to get her to get it. When I talk to her after, she recognizes the contamination (although she still doesn't remember touching the stool), and it seems to only happen when she's stressed over the hectic pace we're keeping. I don't want to get her in trouble, I'm just looking for ways to help...any suggestions? We have an administrator, but I really don't want to bring this to her, I don't want the new nurse to feel like she's getting in trouble. I know there will be some who say this has to do with not doing that (eww) year of med-surg first, but that's not helpful now because 1-we've already hired her, and I'll be danged if she's going to get fired, and 2-how much do you REALLY learn about sterile technique working med-surg...

    Thanks
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  2. 10 Comments

  3. by   smk1
    i am not a nurse yet but just wanted to say how nice it is see that you have that teamwork attitude and seem to be really willing to mentor and train someone into a valuale staff member. I hope i get to work with nurses and other colleagues like you when I am a new grad!
  4. by   cocothemonkey
    After 3 months, she really should have sterile technique down to second nature. An occasional slip up, maybe, but for it to be an ongoing thing, something is wrong. Some people just can't get sterile technique. That's about as basic as it gets in the OR and it's sadly why some aren't cut out to work there. You shouldn't have to watch her like a hawk 3 months in.
  5. by   truern
    Not sure how much experience you get working Med-Surg, but in over two semesters of Med-Surg I've only done one sterile procedure

    Some people really *don't* get it, abbi. There's a student in my group that still doesn't know how to put on sterile gloves :smackingf
  6. by   ortess1971
    Quote from abbi77
    HI, all, I'm rather new to posting here, I think this is my 2nd or maybe 3rd post. A little background on me, the surgery bug bit me while I was still in nursing school, I did a preceptorship in surgery, then went to med-surg for the required year, then back to surgery for 2 years, and have now landed at a small (2-room, but only running 1 room at a time) surgery center, where I've been for 2 years and hope to be for many more. In preparation for hopefully running 2 rooms at once, we hired a new grad nurse, who did her nursing school preceptorship with one of the FA's who works with us a lot. She's very interested in learning, and she has the best of intentions...problem is, the docs, other PA's, our ST (who has an attitude from HELL), are ready to eat her alive. She's only been with us for almost 3 months, and she's a bit of a slow learner, but we all know how long it can take to get comfortable in the OR (I was told in the beginning 1 year to be comfortable, 2 to be competent). Problem is, the things they are complaining about are big problems, and I'm afraid when I talk to her about them, I'm not sure she's getting it...for example...she was doing the prep today for a CTR. She finishes the prep, and she's standing there, holding the prepped arm with 2 hands, one on the wrist, one at the elbow, waiting for drapes. The PA asks her to move the chux, so she reaches down & does that, then reaches over and moves the rolling stool out of the PA's way, then reaches back & grabs the arm again...I re-did the prep, but the surgeon was by then in the room...he took it well, all things considered, but in the VERY NEXT case, she was getting ready to prep, put her gloves on, and proceeded to adjust her mask. I don't know what to do to get her to get it. When I talk to her after, she recognizes the contamination (although she still doesn't remember touching the stool), and it seems to only happen when she's stressed over the hectic pace we're keeping. I don't want to get her in trouble, I'm just looking for ways to help...any suggestions? We have an administrator, but I really don't want to bring this to her, I don't want the new nurse to feel like she's getting in trouble. I know there will be some who say this has to do with not doing that (eww) year of med-surg first, but that's not helpful now because 1-we've already hired her, and I'll be danged if she's going to get fired, and 2-how much do you REALLY learn about sterile technique working med-surg...

    Thanks
    Hi, I'm an ST who is also in my second year of nursing school. I'm wondering, does your OR have a nurse educator or a formal perioperative nurse program? Some places just subscribe to the theory of throwing new people in the deep end. Working med surg does not adequately prepare people regarding sterile technique and for that matter, most nursing programs breeze over OR nursing, if they teach it at all. I have run into more instructors who get this horrified look on their faces when I tell them I'm going into the OR when I finish school.:angryfire I think that some people learn slower than others and she just needs time. The fact that she didn't do med-surg shouldn't affect this. In clinical, I've seen more floor nurses that have no clue about sterile technique and I've had instructors who are terrible about it too. Thanks again for not subscribing to the "eat your young" theory!
    Last edit by ortess1971 on Oct 7, '05
  7. by   carcha
    yeah, sticky one this. I guess my only suggestion is to start all over again with her and see how she does. My guess is that as a very junior nurse she feels the pressure from all around her to perform to their standards and she is screwing up because she must feel isolated from this group. I also think the S.T. needs a talking to because its easy to pick on a new person when you have worked in the same environment for a million years and know everything. My only suggestion is to take this nurse aside and really go over everything with her from scratch. Then have her explain the rationale for her actions to you. I feel you should also let the teams know that she is learning. I always believe they will follow the example of the nurse in charge and if they see that your not happy with her work, they wont be either. If everything else fails be honest with her and let her know the OR may not be the place for her. A willingness to learn does not mean success.
  8. by   grimmy
    [font=book antiqua]i agree that this is a sticky situation, and she may have too much on her plate right now. is she running the room by herself right now, or does she have someone (you?) still with her? expectations are high, and having a sterile conscience takes time, and some never have it. i think that talking with her, and trying to observe her covertly might allow you to make a more complete evaluation of her technique. ultimately, you'll have to decide whether or not she's worth the training if the training must continue for an inordinate amount of time.
  9. by   lisa41rn
    I'm very new to nursing and must say this girl sounds like she's just plain nervous!! People love to say they are "supportive" but are quick to make the newbies feel stupid. She may not be a slow learner. Maybe it's just the attitude she is receiving from others. I hope this doesn't offend you, but think back when you started. You haven't been a nurse for that many years. It is normal to feel inadequate in the beginning, then when you get the negative attitudes from others it really leaves you wondering if you've chosen the right career. I've heard a couple PA's talking about how ""stupid" so-and-so was the other day. They sounded so foolish. This field has really amazed me. We should show respect for one another regardless how hectic things get. Many are in the healthcare field and act as if they can't stand people. It's sad. You all should do your best to really think about how things sound when you speak/correct this girl. I bet if you correct her in a more caring way and perhaps mention what she did right, she might start being less nervous and will make fewer mistakes. Good luck.
  10. by   abbi77
    Quote from lisa41rn
    I'm very new to nursing and must say this girl sounds like she's just plain nervous!! People love to say they are "supportive" but are quick to make the newbies feel stupid. She may not be a slow learner. Maybe it's just the attitude she is receiving from others. I hope this doesn't offend you, but think back when you started. You haven't been a nurse for that many years. It is normal to feel inadequate in the beginning, then when you get the negative attitudes from others it really leaves you wondering if you've chosen the right career. I've heard a couple PA's talking about how ""stupid" so-and-so was the other day. They sounded so foolish. This field has really amazed me. We should show respect for one another regardless how hectic things get. Many are in the healthcare field and act as if they can't stand people. It's sad. You all should do your best to really think about how things sound when you speak/correct this girl. I bet if you correct her in a more caring way and perhaps mention what she did right, she might start being less nervous and will make fewer mistakes. Good luck.
    The point of my post is that I AM trying to correct her in a caring way and reinforce what she's doing right, I was simply looking for advice on any other tricks for doing that. I have never been disrespectful or said how "stupid" anyone was.
  11. by   JaneRNBSN
    How about sending her to a perioperative nursing course? I attended one for 6 weeks when I was a newly hired grad. There's so very much to learn and trying to learn it in a stressful, hurried setting is not the optimal learning environment.
  12. by   Ferret
    Quote from abbi77
    : I don't want to eat the young, any suggestions?
    I'd suggest that sweet chilli sauce might make her more palatable.

    Some people just don't get the whole ritual of sterility, others need calm and patient coaching, others need to consider an anaesthetics/recovery career...

    I don't think that doing a med/surg placement before the OR would make that much difference, as the best, if not only place to learn sterile technique is in the OR. Either get this nurse to do a periop course or accept that you are going to have to be really patient with her. She needs to learn her job, and teaching her that is not eating your young. It's forcing her to do unnnecessary things to comform to the tradition of nursing in yout facility that is eating your young.

    But in the end, don't forget the chilli sauce.

    Ferret

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