Difficult orientee

OCRN3 · Apr 20, 2013

Is this a new grad? I'm not sure how she survived med/surg/ tele?

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NicuGal, MSN, RN · Apr 20, 2013

I second the is she a new grad or someone with experience? Do you have a log that has to be filled out? We do a log of skills, but we also write a daily eval on the person. We then do a weekly meeting with the CNS or UM alone and them with the orientee.

I would first flat out ask the person if they want to work there and say that they seem uninterested or leery. I have also found with many accelerated BSN grads that they do lack basic skills as they are put thru the program so quickly. Then I would meet with the manager, face to face, not by email. Don't worry about being a *****, just state your issues as you did here.

chrisrn24 · Apr 20, 2013

Definitely keep a list and voice your concerns to your manager.

jadelpn, LPN, EMT-B · Apr 20, 2013

I would put it to your orientee simply: "My goal is to make you into the best ICU nurse you can be. Hopefully, we share that same goal. It is going to take some work on your part. You have really put some good effort into blah, blah, blah....However, I have noticed that you are having difficulty with 2 patients. What can I do to help your organize and prioritize? And it would be in your best interest to review EKG basic interpretation and and lab values. I will be happy to answer any questions for you. ICU is not easy, and I don't want you to begin this job independently feeling overwhelmed and under trained. Additionally, you need to be present at as many codes as you can, as this will be of great assistance to you when you are on your own" Send the manager a copy of the points you have made to the orientee, so that the manager has a heads up on what it is that you are focusing on with the orientee, and what she still needs to work on. In a couple of weeks, re-assess, and if the orientee still has not improved, follow up with an email to the manager referencing your earlier email, and what you have done to assist her in the process of learning what she needs to and that she continues to fall short of the goals.

As a complete aside, I wonder what the heck she was up to on Med Surg/Tele if 2 of the major things to monitor (labs and strip interpretation) are so foreign to her?

A reminder that you are both on the same team, that your corrections of her work is "annoying" at times, and that you don't want her to be uncomfortable or nervous. And my personal favorite-- a light "I have been doing this since disco days.....humor me"

Esme12, ASN, BSN, RN · Apr 20, 2013

It makes a difference if this is a new grad...how long have they been working at the bedside. How long have they been in acute care.

rumwynnieRN · Apr 20, 2013

Hrm. Some of that sounds like clumsy new grad stuff (I'm still a new grad -- been working on a geriatric psych floor for 2 weeks), but some of it, er, well, I think you should pull her to the side to give her a head's up. I only say that because of an experience one of my classmates had while she was orienting on another floor at another facility, but then again, my friend is one of those people who will change their way of doing things when you give them constructive criticism. I don't know what your orientee's attitude is like, but some of your complaints are valid. Seriously, "do I have to?" A code? My mother works ICU as a tech, and one of the new grads (she's not a new grad anymore), asked her why their other coworkers were a little cold to her. She explained in a roundabout way, "Well, you remember the admission a few nights ago? They feel like you don't want to do anything, like your attitude is, 'Well that's not my patient so I don't care.'"

In the event she's not a new grad, I think the question the rest of us have on our minds is, "Uh, then, why are you there? Would you like to transfer to IMU or a regular floor?" I don't like the floor I work on (I swore up and down in nursing school I would never do psych. Whoops.), that doesn't stop me from working with my coworkers, and learning how to talk to people. I still stumble when I give report, and how many times do you find a floor where the doctors and your coworkers are awesome?

Jory, MSN, APRN, CNM · Apr 20, 2013

Hi everyone. I am a critical care nurse. I love my job and everything that comes with it from my fellow staff members to the puzzles of patients. I was given an orientee who will be transferring to the ICU after 8 months on the floor floating between med surg and tele. DUring her two weeks with me, I noticed some red flags. She has a lack of interest in new things ( a code was called and when I told her to jump in she responded with "do i have to?") She has a very blase' about the ICU. Because it was her first two weeks in ICU, the two of us had fairly simple patients, liver failure and respiratory distress/ pneumonia. This was perfect for her to time manage two patients with a lot of charting. She was drowning, even with constant reminders and prodding (and I do realize time management does take time) But most concerning was her lack of basic learning skills. Inability to read basic ekg, what labs pertain to what, what some medications are for, placing a pt on NC at 15L, skin checks, etc. I am concerned enough to give me supervisor a little heads up but i'm unsure how to write an email regarding this type of situation without coming off like a bully. Can anyone give any advise how to word these concerns in a professional manner?
thanks in advance for your help!
Jen

I'l be honest...be more concerned about her attitude than her skills. Nursing schools vary DRASTICALLY.

I wasn't taught to read EKG's...I knew the dangers of oxygen, but I couldn't tell you what was an appropriate level and I knew there were different methods of delivery, but didn't fully understand this until I actually started working in the hospital. Not 100% sure of what you mean by skin checks, but if you mean just turning a patient, checking for pressure spots and IV sites? That is POUNDED into our heads...she should know at minimum..that it should be done.

Lab values, are a "once over" and we didn't have extensive training on them, other than fluid and electrolytes. This again, was something that I learned more once I got to working in the hospital.

Yes, I went to a really crappy nursing school, but I was very, very proactive in my learning once I worked in the hospital and I second-guessed everything. If I wasn't 100% of what to do...I ASKED a more senior nurse until I felt like I could make decisions independently.

Time management, was never talked about...it was sink or swim once I worked in the hospital and was the most difficult skill to master. However, I gained this skill by constantly asking other nurses that seemed to have extra time on their hands, "What do you do first? How can I make this process more efficient?"

I would address her attitude and focus on things that you have told her repeatedly that she still cannot master.

I had a preceptor that was an "old school" nurse (30 years experience)...she had this huge preconceived notion about what I should have known when I got out of school. Let's just say her and I didn't work well together and I asked my manager for a change. She put me with another nurse who had been out of school for 5 years. She was more in tune with what was taught and her and I got along very, very well and I flourished, but like I said, I was VERY proactive.

Just keep that in mind when you write your report. Ignoring a code-blue? Seriously...she has no business in healthcare.

Jory, MSN, APRN, CNM · Apr 20, 2013

...one more thing...I would give her ONE more opportunity to correct herself. I would sit her down and say, "Ok, we need to talk." I would be as gentle as I can. She may not understand that your report could end her job as a new hire. Let her explain herself and tell her, "It will be at least a year before you can be considered minimally proficient, two before you know what you are doing"...tell her it is your responsibility to make sure she is SAFE to practice alone and right now you don't feel that she is. Maybe she is afraid to ask questions, etc.

That way, if you have to write a negative report, you won't feel a shred of guilt because you gave her a head's up and she didn't heed the warning.

itsnowornever, BSN, RN · Apr 20, 2013

If she's a new grad, have you asked her if she's scared? That could play a lot into it. I saw my coworkers as fearless, dictionaries of knowledge. When talking to one and admitting my fears and my shame regarding my fear, she said "you better be afraid. A nurse without fear is a scary nurse. I've done this for 20+ years, and I'm afraid every day. Fear makes you cautious. Questions make you safe" and that helped with my shame, she was aware that I needed to talk things out when I had questions and her and I work together remarkably well!

Posting from my phone, ease forgive my fat thumbs! :)

pixiestudent2 · Apr 20, 2013

She is probably scared/nervous, thats how I act when I am. Not saying it's ok...

turnforthenurse, MSN, NP · Apr 20, 2013

Honestly, the fact that she asked, "do I have to?" when asked to respond to a code situation is a HUGE red flag to me. I, too, would be more concerned with her interest (or lack of) than her skills, especially if she is a new grad or someone without any acute care experience.

I don't know. This just reminds me of a nurse I have worked with who was experienced, but when a rapid response was called on her patient (and then a code), she was NOWHERE to be found. It was the charge nurse who had to provide all of the information to the doc on that patient. And to me, that was a huge red flag, too.