Difficult orientee

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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

OP, you should discuss this with the orientee before going to your supervisor. I was taught in nursing school that it is always best to go up the chain of command. If you get no where after discussing this with the orientee, then you should request a meeting with the three of you. This way, the orientee will have a chance to further explain his/her actions. This is something that needs to be discuss face to face and not over an email.

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Specializes in PICU.

I agree this needs to be discussed face to face with both your orientee and your/her manager or educator. I would ask her why she didn't want to go to the code. Was she scared? Did she feel like she was too busy with her patients, so she didn't have time to help? I think it sounds like she needs to understand that she needs to learn what to do if her patient codes. She can't say no then! I think orienting to the ICU is very different than other areas. It is up to the nurses to make sure people coming off orientation are proficient enough to keep the patients safe. No one else is evaluating this. I would suggest putting together a list of things for her to review at home (EKGs, thorough assessments, O2 delivery, specific lab values that she needs to know, etc.) and then "assign" 1 topic per day and have her report to you what she learned about the topic. Maybe offer some good reference books for her to get, so she has a place to look this stuff up. (For EKGs, "Rapid Interpretation of EKGs" is awesome.)

Other ideas, she could get up a little earlier and call in to find out what the diagnoses of her patient are for the day and read up on that before coming in, so she can already know what labs to be watching for, etc. Tell her that for 1 week, you will help more with the routine patient care stuff, so that she has time to look up every thing she doesn't know. Take 5 min. at the end of the shift and have her tell you what she thought she did well with that day, and what areas she needs to improve on.

My perspective is to give her everything she needs to succeed, but don't do the work for her. Give her the tools and let her put in the effort. It isn't your job to teach her all of this stuff, just to provide her with the resources and to help pinpoint what areas she needs help in. If after all of this, she doesn't have the willingness to learn and put in the effort she needs to in order to be a competent ICU nurse, then maybe she doesn't need to work there. The ICU is not a place for people that don't want to continually learn and be challenged. If she doesn't have the desire, then she will never make it. If she is willing to learn and she is just very deficient in her knowledge and skills then maybe she needs a longer orientation, because you can teach that stuff. You just can't teach a desire to learn.

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Thank you everyone for your responses. She is still considered a new grad as she has been working 8 months full time.

You are all correct in being more concerned about the attitude. I did have a sit down with her explaining why she is here, her goals, that I am her support, etc. All I got from her was I know, yeah, I know. I guess its just difficult to understand not wanting to jump into everything. I remember how exciting a foley was, let alone a code and she just has no desire to jump in. I"m just not sure if she has that drive/personality to be an ICU nurse, let alone a nurse in general.

Thank you all for your helpful comments!

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Specializes in Med/surg, Tele, educator, FNP.

With an attitude like that and beung a new grad she isn't cut out for med/surg either. New grads not wanting to learn sounds like she is just there for a paycheck. Fail her because she will be an unsafe nurse. If she doesn't like it now, she will really hate it in a few years!

Sent from my iPhone using allnurses.com

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I would really have an open table discussion about her apparent blase attitude. What made her transfer to ICU with less than a year in her current position? what does her previous preceptor/manager say about her? Where does she want to be in 5 years?

Let her know ICU nurses have to have initiative and drive. That begin an ICU nurse entails more than the minimum effort. Set up a education/orientation/behavior plan with her and your boss.

Or she may just not be cut out for the position.

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Maybe she's just over-whelmed and feels like she's gotten in over her head which may explain her attitude. I'm just throwing that out there. I'm just trying to figure out what may make her act like that. I think all the suggestions already given are very good but maybe she wants an out so maybe you should ask her about these things as well.

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Hmm... Maybe she needs to be a floor nurse longer. Different strokes for different folks. Maybe she's not meant to be an ICU nurse? Maybe she needs more time. Some people hit the ground running some just need more time.

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Specializes in NICU, PICU, PACU.

That kind of response needs a sit down with the educator/CNS and manager. Yeah I know doesn't cut it. If she can't explain herself or acknowledge what you said to her, she is not a good fit for ICU.

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Honestly she is probably overwhelmed. If it was her first code I would have been scared to jump in, actually the first 3 codes, she should be able to observe and then go over with her what happened and if she has any questions and if she would feel comfertable trying to do some of the stuff pertaining to codes. EKG reading takes time as well. If she did not want to be in the ICU I am sure she wouldnt have went through the hiring process and started. I think she deserves longer than 2 weeks to determine if she is a good fit in the ICU. Just my opinion.

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Specializes in Pediatric Critical Care.

I had a hard time with my orientation. What nearly ended my career before it started was that my preceptor didn't share her concerns with me....she went to the educator and told them I was no good, when I didn't even know I was doing anything wrong because she hadn't said anything to me. So good move on sitting down to talk to her first, even if you didn't get much of a response. Please continue to include her in the discussion.....if there is a sit down with you, the educator, and the manager, the oriented should be there too. I really believe in giving her every chance possible, because I needed more than two weeks too and I like to think that I turned out alright :)

That said, yes her attitude is concerning and maybe she's not ready for/a good fit for the ICU. Good luck to her, and to you!

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Maybe she doesn't plan on being there long term? just to get the pre CRNA experience, and trying to skim by?

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Thank you everyone for your responses. She is still considered a new grad as she has been working 8 months full time.

You are all correct in being more concerned about the attitude. I did have a sit down with her explaining why she is here, her goals, that I am her support, etc. All I got from her was I know, yeah, I know. I guess its just difficult to understand not wanting to jump into everything. I remember how exciting a foley was, let alone a code and she just has no desire to jump in. I"m just not sure if she has that drive/personality to be an ICU nurse, let alone a nurse in general.

Thank you all for your helpful comments!

There is your answer right there...she doesn't care.

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