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Feedback desired orienting new nurse

Hi everyone! I am orienting a new nurse who graduated with a BSN over 9 months ago and by choice had not pursued a nursing career until now. We are in an ICU. Orientees get a total of 16 weeks orientation. This includes 2 weeks of corporate and 2 weeks of unit based classes. My orientee has now finished their 1st week at the bedside. So, 8 patients and 4 12 hour shifts. We have taken the lowest acuity I could possibly find, no oxygen, one medication, no lines, no tubes. Seriously easy. She will not give report to other nurses at the end of the shift. She will not talk with the doctors on rounds. She will not call the doctors with questions or clarifications. She states she is afraid she will mess up or look stupid. I have assured her that I will be right there at every interaction and that I will make sure that everything is properly communicated and that no one will be mean to her. She is in safe environment where learning occurs everyday. We are very well supported. Still she refuses. Her communication with staff, patients, and families regarding non clinical topics is wonderful. My question is: do you think my expectations to begin to communicate with her colleagues with regard to patient related issues is too soon? Are my expectations too high? Sorry about the long post, I just wanted to give background info. Thanks for reading!

Nonyvole, BSN, RN

Specializes in Emergency.

She's had a week to start to learn her way around. Next shift, I'd say sit down with her and work out a, well, care plan for the rest of her orientation. Day 1: do all the communication related to one patient. Day 2: two low-acuity patients or one patient who is a touch higher acuity. Etc.

She can also practice giving report to you before talking to the doctors, oncoming nurses, whoever. Print out a SOAP outline and have her give you reports.

That doesn't work? Be blunt. She's afraid of looking stupid, okay, fine. But what will the doctor of the critically ill patient think if she didn't call about a confusing order and ended up doing the wrong thing?

Pangea Reunited, ASN, RN

Has 6 years experience.

These sound like things she should be doing from day one ....assuming that she's been coached a bit and you're nearby to rescue her if things don't go well.

She needs to put on her big girl panties and at least try....

Perhaps you can ask her to write down what she needs to say. Then, take a look at it and give her tips and suggestions. Once she has a script for the basics, role play with her to give her a little practice and help her anticipate the questions she might get.

She's not going to get over her fear by not doing it. In fact, her anxiety level is probably going to increase.

Maybe she's just the type of person who needs a plan so she can start thinking about what she will say. Try telling her at the very beginning of the shift that she will give report on patient X at the end of the shift. Tell her the things she should include in the report. Then when she gives report she knows exactly what to say and will go down her list and not look silly or feel dumb.

anh06005, MSN, APRN, NP

Has 6 years experience. Specializes in Cardiac, Home Health, Primary Care.

I think a few days of getting he flow of the unit is fine but as PP's said she needs to jump on in now. The best way to learn is make mistakes. Orientation is the time to make these mistakes and learn!

I like the idea of her taking a few minutes and making notes on what to say in report, say on a call with a doctor, etc. then you look over it and ask some questions that maybe she didn't address to get her used to it.

I graduated 5 years ago and still make notes before I call anybody regarding a patient.

A brain sheet might make her more confident as well if she doesn't have one. It will quickly give her info she needs.

I agree with the others. Prepare her early and give her one patient to be responsible for (with you there as guidance). Have her write out an sbar so that she's ready for reports and a script so that she's prepped for the doctors. You could also come in a little early and get a basic report on her pt separately if the previous shift doesn't mind (dx, providers, most pertinent info). After she gets report, she can give it to you so you can fill in your blanks. That would give her some practice. I wouldn't do that every shift, because it takes some extra time, but one or two to build her confidence.

OCNRN63, RN

Specializes in Oncology; medical specialty website.

She's had a week to start to learn her way around. Next shift, I'd say sit down with her and work out a, well, care plan for the rest of her orientation. Day 1: do all the communication related to one patient. Day 2: two low-acuity patients or one patient who is a touch higher acuity. Etc.

She can also practice giving report to you before talking to the doctors, oncoming nurses, whoever. Print out a SOAP outline and have her give you reports.

That doesn't work? Be blunt. She's afraid of looking stupid, okay, fine. But what will the doctor of the critically ill patient think if she didn't call about a confusing order and ended up doing the wrong thing?

I agree with this. I would just add writing out SBAR and have order sheet ready if she needs to call for an order. Make sure she's printed out pertinent labs if needed or have them up on the computer screen.

Let her know we all have had a "stupid" moment here and there, but she'll look a far sight more "stupid" if she continues to avoid talking to docs.

Thanks for the feedback guys! The affirmation that my expectations are valid and all the suggestions really helps. It's gorgeous outside where I live. I think I'm going to go for a walk and process all this information and come up with a plan! Sometimes even the teacher needs encouragementí ½í¸‰

cardiacfreak, ADN

Specializes in Hospice.

I hope you are relaying this info to your manager and educator.

dudette10, MSN, RN

Has 9 years experience. Specializes in Med/Surg, Academics.

I don't think your expectations are too soon. She will, however, require a sit-down outside of patient care duties. I hope you can arrange that. Not necessarily a tough-love sit-down, but yet a tough-love sit down, if you know what I mean. Lots of encouragement and reiteration that you are at her side, but yet a firm expectation that she has to do it to become competent at it.

by the way, you sound like a dream preceptor. Good job, and good luck.

Hello there cardiac freak! No, as yet I have not brought it to anyone's attention. That is my plan though. I will see what she does tomorrow. If she demonstrates no interest in moving forward I will be meeting with the appropriate personnel ASAP. It is only fair and right to all involved to be aware of the situation. I realize that I will do her no favors if I sit idly by while she sets herself up for failure and her patients for harm. I really hope that after we discuss it it all works out! Stay tuned I guess.

I replied below before I saw the option to reply directly to the person who posted, lol!

When I began my new grad job on my specialty unit, I was allowed to watch a shift change report and rounding 1 time before I was expected to begin doing it myself. Even though I was unsure of myself and sort of fumbled my way through both when I initially began performing them, the feedback I got from the nurses I was reporting off to and the docs and NNPs during rounds was an invaluable part of learning my role on the unit. My preceptors were always there with me (in the beginning) to answer any questions I was either unable or unprepared to. In my opinion, it is just like any other new skill one masters as a new grad and the more they are performed, the more proficient one becomes at performing them.

TriciaJ, RN

Has 39 years experience. Specializes in Psych, Corrections, Med-Surg, Ambulatory.

The time to do anything is EARLY on before anyone expects much from you and you have an attentive preceptor. No harm waiting until you've seen something at least once but at some point it becomes procrastination and only exacerbates anxiety. Does the orientee at least have a game plan for when she starts doing these things? If she does, great; maybe you can work with that. If she's just being avoidant, she's going to need a little nudge...

blondenurse12, MSN, NP

Has 13 years experience. Specializes in Family Practice.

I think sometimes nursing school does a disadvantage to students. You are pushed for perfection and no one ever discusses making mistakes or how to deal with it when you do, because we all do.

Maybe question the orientee a bit more as to whether there is a certain source of this anxiety? Did she get chewed to pieces by a doc or fellow RN in school? Does she have anxiety talking on the phone? I used to have terrible anxiety about talking on the phone, it was the strangest thing but I've overcome it because I had to.

I think the SBAR sheets would definitely be helpful. Maybe also give her heads up on difficult physicians and have her write a note before calling. Some will always want you to recite the labs or all the swan readings or whatever. If it's written down, then she doesn't need to frantically scramble for it.

When I first started orienting in ICU, I was afraid of talking to the docs or anyone else, and I was especially afraid of giving report. My preceptor always told me that I needed to practice my report so we started doing that, before change of shift I would give him report on both pts and he would point out things and that made it better. Also, now I am way more comfortable talking to doctors and other people, I am not afraid to ask something if I need to know. But its important to start early to build confidence, my preceptor always pushed me to do it even if I didn't want to.

Caffeine_IV

Has 7 years experience. Specializes in LTC, med/surg, hospice.

I think it helps to set goals during the orientation (long and short term). That has worked for me as both the trainee and preceptor. The nurse sets her own written goals and the preceptor writes down goals, things to work on, etc.

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