Frustrated preceptor

[OncRN612]

I have been orienting a new grad RN for the past 4 weeks on an oncology floor. In the past, I have really enjoyed precepting new nurses and students. My present orientee, however, has left me uncharacteristically frustrated. I need some advice on how to handle the remainder of the orientation (so that a: she is going to be a competent nurse and b: I don't lose my mind). Here are a few of the problems I've been experiencing. First, I'm seeing a general lack of common sense (she claimed not to know how to bathe a patient the other day). Second, she is lying to me about things. She went to give pain meds for another nurse and for some reason reset the one of the patient's drips to a completely different rate. Fortunately, the primary nurse caught the error within a few minutes, and there was no negative outcome. When confronted about it, she swore that the nurse told her to change the rate of the drip, when all she told her to do was give some morphine. Today, I asked her about the status of some of her afternoon meds. She told me she had given them all, and that she just needed to mark them as given in the computer. A little while later, I questioned again about them, and she told me that she had in fact not given them. At another point in time today, I was assisting another nurse whose patient had sudden onset of severe respiratory distress. The other nurse and I were working on the patient, and she came in the room and started asking us about how to use a bedside commode, while clearly seeing that we were quite occupied with trying to prevent a code. Not even three full weeks into her orientation, she told two other nurses that she didn't need to be on orientation anymore, that she knew what she was doing (even though she was not close to be able to carry a full pt load, which is 5:1 on our floor). I have always considered myself to be a very patient person, but I recognize that my fuse has become short with my orientee. I am alarmed by both her actions, and her over-confidence. I am not quite sure what to do about these issues, or how to confront them, as I've never run into these problems before. Any words of wisdom would be greatly appreciated. Thanks so much!

[nlhnurse1982]

Wow I have precepted some questionable GN's but this one sounds dangerous. I would talk to your manager and the nurse educator about her mainly her lack of ethical behavior. She really needs to be knocked down a peg. I would also keep a log of each incident so you have them right in front of you when she is confronted. SHe sounds like a person that is covering up her lack of confidence by lying and acting like she knows what she is doing because she does not want to be wrong. Good luck with this and keep us updated on what happens!

[symmetry]

I have enjoyed precepting new grads also and usually they're great. In my experience the first clue that things may not work out is the that fact that you feel frustrated. Seriously, lying about what she did or didn't do---how can you trust her now? I agree you should notify your manager and educator and keep a record of each incident. They'll probably need it.

[elkpark]

Have you taken this up your chain of command? It sounds like the situation is getting to be serious enough that it would be appropriate to bring more people into the situation to help you figure out how to proceed. I also agree with keeping a log of incidents/behaviors of concerns, with specific dates/times/descriptions.

[CaLLaCoDe, BSN, RN]

Set up a conference with the department head and go over weighty issues. Perhaps you and your boss can set up some goals (safety goals!) and if she can complete the goals without stumbling (occasional stumbling ok) she gets the job. And definitely NO LYING, especially when it involves the safety of the patient. Good luck and yes, you are definitely not losing your mind! She aught to have a concrete understanding of what is expected of her pronto. A reality check.

Sometimes it takes a superior to knock sense into an underling IMHO.

[CFitzRN, ADN]

Holy crap - something just doesn't sound right there. She sounds like the kind of nurse who would kill someone, and I don't say that lightly. I'd be frustrated as well... and more than a little worried!

[romantic]

She went to give pain meds for another nurse and for some reason reset the one of the patient's drips to a completely different rate. Fortunately, the primary nurse caught the error within a few minutes, and there was no negative outcome. When confronted about it, she swore that the nurse told her to change the rate of the drip, when all she told her to do was give some morphine.

I doesn't make any sense to me why one would change the drip if she wasn't told to do that. Accidentally or on purpose, who would play with a drip? Too dangerous, especially when she is only 4 weeks in training and it is her fate at stake. I don't think that she is THAT stupid.

[neuro9]

Are you sure she even attended nursing school?? Does she seem like she is under the influence of something? Very unusual situation! Jan

[chudy]

I wouldn't want somebody with that type of attitude caring for anyone, You need to take her to the side and talk to her and if that doesn't work then go to your supervisor...plain and simple.

[llg, PhD, RN]

I agree with many others -- talk to whoever coordinates the orientatoin and find out how they want you to handle the situation and document this orientee's problems. She either needs to change fast or leave.

We can't save all the patients we care for. We can't save all the new employees we try to orient. Sometimes as teachers, we need to give "bad grades" -- and while you will feel bad about it, think how worse you would feel if you let these things slide and then she really hurts somebody. It's your reponsibility to "call her" on these things.

[sasha1224]

Whoa....scary! A couple things come to mind. One is to document skills she claims she doesn't have(as you mentioned bed baths, bedside commodes), and document the errors she has made(changing drip rates, lying about giving meds and who knows what else!). Two, talk with the educator and manager about the issues(hopefully they are supportive). Three, sounds like she needs to "go back to the beginning", meaning follow her every move. And fourth, give her a good "dressing down".

This last one comes from my own experience. I was a new nurse in ICU. I was so afraid of being seen as ignorant that I would say I knew about a disease or med when I didn't know enough. My regular preceptor never said anything. But one day, I had an alternate preceptor and she saw through me quick. She pulled me aside privately and laid into me. Not meanly, but bluntly. Told me that if I didn't know, I need to ask questions, ask for help, research, etc. And told me that if I continued the way I was going I would fail. At the time I was mortified and angry, but in hindsight, best thing that ever happened to me. I still remember and utilize this after almost 20 years

.

As for the first three, I encountered these issues with a nurse I was precepting. Others had given up on this person and this orientee was passed to me because I had the reputation of being patient. And mostly, I like precepting. So I took on the challenge. It was evident right away that this person wasn't getting it. I tried and tried and when this person's orientation period was about to end, I talked to the educator and manager. I relayed my concerns. Somehow(whether they or others told this person) the orientee got wind of my concerns and(rather pissy about it, I did understand, maybe another preceptor could get this person up to speed) changed preceptors and got cleared. Independently, this person made many errors and after just a few months was fired. I thought maybe this orientee could have been a great nurse(had great drive and enthusiasm) just needed more education and mentoring. Sadly, didn't happen. If I had support from the manager and educator, maybe it could have been realized. That is why I questioned if you had support from these departments.

Hope it all works out. Looking above, I seem to be long winded!!

[MomBSN]

Whoa....scary! A couple things come to mind. One is to document skills she claims she doesn't have(as you mentioned bed baths, bedside commodes), and document the errors she has made(changing drip rates, lying about giving meds and who knows what else!). Two, talk with the educator and manager about the issues(hopefully they are supportive). Three, sounds like she needs to "go back to the beginning", meaning follow her every move. And fourth, give her a good "dressing down".

After precepting several times...i think this is the most solid advice. document your concerns and back it up with the incidents, address it with the coordinator/supervisor, develop a plan (hopefully this includes assessing the NG learning needs) and f/u with the NG. Think the above poster really hit the issues on the head :)