Feedback desired orienting new nurse

[Rnwithwings68]

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!

[Rnwithwings68]

Thank you so much!

[Rnwithwings68]

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

[vanilla bean]

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]

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]

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.

[loveSBK]

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]

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.