Advice on underperformers

[Julia sears]

I have a relatively new nurse at my clinic who is struggling to pick things up. She has been here since mid-June. She is very detail oriented, which is good, and has a good memory for new information but she is SLOW. It takes her a while to incorporate new things into her workflow, she often focuses on the wrong thing, and also just moves slowly. There is absolutely no lighting a fire under her to speed things up and she is needing consistent reminders to do pretty simple things, like speaking up to repeat back orders or concur in a time out. What she does she does well, but she has been in orientation longer than normal and I don't see her ever picking up the speed. We are a clinic, but we also do procedures and she is drastically holding up the procedure day. She is only doing half of her job so far- haven't even started to add the other half into her training because she is so slow with what she is currently doing. I have the capacity to let her go, but there needs to be a clear-cut reason that she is failing at her new job, not meeting the standards, but speed of practice isn't a justifiable reason. I'd love any advice on how to deal with this or get this nurse up to speed.

[Rose_Queen, BSN, MSN, RN]

My facility uses orientation development plans when there are concerns about the orientee. Documentation includes specific examples of issues (I.e., returning (specific number of minutes) late from meal break on (date), (date 2), (date 3). Stayed late to finish charting (amount of time) on (date). References to policies to review and goals with deadlines are set (I.e., will return from break on time during all shifts until (date, usually end of orientation), and includes that the timeliness is expected to continue after completing orientation.

We also utilize the Tiered Skills Acquisition Model (TSAM), with the expectation that the first tier is mastered before skills on the second tier are started. So, in the first tier, the orientee is expected to complete vital signs, but is not yet passing medications (second tier).

The lack of progression through tiers combined with not meeting the deadline for goals is where we move into the termination process.