Difficult Orientee

[ejnjj143]

Hey all! Need some help and maybe just some venting on my part. I'm a new preceptor and I do have experience training other RNs experienced and new grads. This is the first time I've have a new grad for a length of time. I have had my new grad for about 6 weeks now and I'm about to rip my hair out. She's a recareerer and old enough to be my mom. Ok enough background info. She got the short end of the stick with her preceptorship at a fellow hospital and it has put her far behind. She was supposed to know our computer program for charting and I've had to take A LOT of time showing her that. (Yes I've told the educator and she won't be sent to the class again. ) I have to show her how to do the same things in the computer everyday and have gotten her a notebook to write instructions down. She freaks out about everything and I'm typically very laid back and feel that I panic when necessary. She panics when we have a patient that has a central line and we need to draw blood for example. She just wants to watch and not do it. At first I show her skills and she's very reluctant to even try to do it the next time. I make her (I'm there instructing) and she's incredibly upset the whole time. I've tried many different approaches like being all in her chili and micromanaging her day so she can get things done. After a few days, I back off and she crumbles and is in tears. Yes, she is in or almost in tears everyday. We got notified of an ED admit at 5 pm and she just shuts down and won't talk to me when I tell her not to get frustrated. She's on the verge of crying and won't respond to me. Whoa! Is it me as the preceptor or what?!?!

[SubSippi]

She sounds like she might be overwhelmed. I don't precept, but I've had to help train new grads last minute when if someone calls in sick from time to time. There have been a couple of times when a new grad was having trouble, and we started grouping tasks, instead of doing everything all at once.

For example, one week, she will focus on patient care tasks only. All lab draws, medications, hygiene...and you keep it charted.

The next week, she will do every bit of the charting and making phone calls to docs, etc. You do the patient care and giving medications, and have her chart everything, and put in all the orders. It'll give her a chance to focus without worrying as much about everything else, and hopefully will be able to retain the information more easily.

If there's an admission, have her take care of JUST getting the admission done a few times, and not to worry about the other patient.

Being able to focus on one thing without distractions lets people get used to the flow. Once they're used to taking care of an individual component of the job, it's easier for them to put them all together, and get back on track if something throws them off.

We've found that this works better sometimes then having people do a little bit of everything, while letting them gradually become more independent...especially for those who get frazzled easily.

[Jules A, MSN]

Kind of ageist.

Meh. Just my experience and opinion, anecdotal at best.

[MOSTLYHAPPYRN]

Well how did she get through nursing school? They make it so stressful so you know if you can handle this kind of stuff. It's difficult at any age but I think older people ( ya know, not in their 20's lol) may tend to be more cautious and less ambitious. Maybe a different preceptor would be good so you can have a break and she can get some additional feedback. Where I work we switch around the newbies eventually so they can learn from all types.

[AcuteHD]

I was a nearly 40 new grad, so JULES just made my list (lowercase lol). And there's a whole lotta tough love on this thread, I thought you ladies would be like, "here, have some chocolate" But, yes, the crying needs to stop.

[THELIVINGWORST, ASN, RN]

I think the age thing has more to do with style of learning and work. I find older nurses tend to more caring, careful, and tend to doubt their knowledge. The younger ones are more afraid to ask questions but they are quicker to pick up on charting and tasks.

It's naive to think that there aren't any differences in nurses depending on age.

Just remember there are strengths and weaknesses in everyone so make sure when you evaluate her, you remind her of what she does right too.

[quiltynurse56, LPN, LVN]

Do you ask if she has performed the task before? Have her describe how to do it before entering the room. If she hasn't teach it to her, have her teach it back and then go into the room. As has been said, ICU doesn't sound like the place for her.

[jadelpn, LPN, EMT-B]

What did she do before nursing (as you mentioned this is a re-career for her).

If she was an accountant, or some other black/white/no grey kind of a person, then how you communicate needs to be direct and to the point. The nurse educator could work with her on critical thinking skills.

If she was a counselor or teacher or some other first career that relied on instinct and feelings, then you could try and tailor your communication towards more "feeling".

Finally, a "As a person, I would and do care about what happens to anyone outside of these 4 walls. As a nurse and your preceptor, I need you to attempt to leave everything at the door when you come in. Nursing is overwhelming, it seems like at times one will never 'get it' however, you will." "I am not sure how you studied when you were in school. Would step by step on index cards help? A print out of computer steps? I need to know what would help you so I can help you."

Set up an appointment for yourself, her and the manager. Set timelined goals for her to follow. Come up with a plan for you to perhaps let her fly solo with one patient. See if when she is not being directly observed, she can make it work. Or if nothing else this will be the time to say "this is not for me".

And do a bit of stroking--"You are an amazingly compassionate nurse. I am so impressed with your depth. However, that doesn't get accurate charting done. Which is equally important. So let's refocus, shall we?" Or if she is a black and white kind of girl "These are the 3 tasks that need to be completed by 10 am on tomorrow's agenda. Tonight, I would go home and create a paper brain for yourself (maybe one from your school clinicals) so that we can be ready to complete what needs to be done for your assignment."

Sometimes people with bachelors degrees in other disciplines can take a "accelerated" RN program. Which can be a dis-service as they really don't have a whole lot of experience from the get go. I have worked with brilliant minds that can quote scientific theories til the cows come home....but don't know a foley from a fiddlestick. They think in an alternate way. Which I find fascinating, however, frustrating when attempting to teach clinical competencies.