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!
This sounds like a very scary situation, especially on an oncology floor. What if she hangs the wrong chemo on someone, doesn't premedicate them correctly, or sets the wrong rate?? It's already scary to think of someone like that working on a general med-surg floor, but even more so on a floor where you are handling such dangerous substances like chemo. I agree with everyone else, document everything and go to the higher ups. She doesn't sound safe at all.
Yowsah! I would document everything. I do a daily anecdotal on all orients with what we did, what needed work, what I witnessed, good skills, things that need further review, etc. This nurse seems a bit lacking in skill if bedside commodes and priority are posing a problem. Lying, now we all cringe knowing that could be dangerous. I agree with the others, set up a conference. In her defense do you think she's intimidated by you? (yea it's a stretch but something to look at) Do you think having someone else evaluate her for a day or two might help? It would be a good idea to have someone else document these things also. I recently had to orient a nurse who I had some doubts about, not to your extreme. I had to look at myself and ask did I expect her to do it how I would or was she really not cut out for the job. In the end, she's good in her own way and an asset to the department. Mind you.... if you read a post I put a bit earlier about "write ups" you'll see a bad nurse can go years without being noticed if no one speaks up. Good luck!
Thanks to everyone for all of the wonderful advice! This is actually the first time I have ever posted on here. I know that I need to take this up with the manager and our staff educator, I think I just needed to hear that I was doing the right thing. Thanks again!
Specializes in L&D, OR, ICU, Management, QA-UR, HHC.
I haven't oriented anyone lately, (been away from bedside nursing) but it seems from reading various threads that orientation is more basic education than it used to be. In my day (oops, there I go) orientation was a time of learning the hospital standards, the "culture" of the unit and advanced techniques specific to the specialty, not basic nursing education. If someone doesn't know how to give a bath, or the essentials of a bedside commode, I would wonder about their basic education and their mental status. Please don't tell me that new grads are coming out of school lacking Nursing 101. Getting older and maybe needing hospital care in my old age is scary enough as it is.
Skills can be taught, of course, but lying??? Someone who lies will most likely always lie, and if they don't, will never really be trusted. How on earth would you work with someone like that? Trust is HUGE in nursing.
The lying is what worries me most. Ironically, your preceptee is probably off somewhere whining about nurses eating their young and you being mean to her because she's pretty or some other stupid reason.
I am a new GN orienting with a nurse who is as tough as a drill sergeant. She watches every move I make like a hawk and doesn't let me move a muscle unless it is correct. As hard as this is on me, and believe me, I want to cry most nights, I am grateful to have her as a preceptor. She is not going to let me harm a patient. By the time I am through with her I will be a much better nurse. And I am remedial in some skills. I have a hard time hearing heart sounds and taking BPs, I know this will garner me some attacks because these are basic skills, but in my defense we just didn't do these things enough in clinical. We also had a horrendous teacher who not only taught Nursing I, but was then our Nursing III teacher also. Excuses aside, I probably didn't work as hard as I should have in school to get the extra help I needed and now that I am out on the floor it is glaringly obvious. I take all of the blame for not being further ahead. So I need work.
Apparently my preceptor was not impressed with my skills the first few days and talked to the supervisor who helped her to conclude that they were going to work with me and I am grateful that they are taking this attitude because I need this job and I really want to be a nurse. I am willing to take all of the abuse in order to be a better nurse. I worked my ass off in nursing school and did whatever it took to get through it and I will do whatever it takes to get through being a new nurse. I am also grateful for the open communication that my preceptor has with me, at least she lets me know exactly where I stand. And she is an awesome nurse. Patients and their families can rest easy knowing she is in charge. I want to be like her and I will do whatever I can to make sure I have all of the skills I need to make it.
I know as a new grad you feel like fresh meat in a shark tank most days and it takes a lot of strength to say "I don't know." I am not defending this grad nurse who lied, I am just sharing my perspective. My opinion is that communication is key, but matter of fact and not with any emotion behind it as hard as that may be. People in general are prone to letting their emotions and personal issues cloud the work place and a new rookie who is messing up is fair game for a kick from everyone with an ax to grind. Someone without any self awareness then turns around and gives the same treatment to the next newbie which is why nurses are accused of 'eating their young.' I am grateful that my preceptor was open and honest but without being mean just for the sake of boosting her own ego. She doesn't need that because she is a bad ass nurse who saves lives and some day I will be like her if I can make it through this and learn what I need to know.
ChocoholicRN
213 Posts
This sounds like a very scary situation, especially on an oncology floor. What if she hangs the wrong chemo on someone, doesn't premedicate them correctly, or sets the wrong rate?? It's already scary to think of someone like that working on a general med-surg floor, but even more so on a floor where you are handling such dangerous substances like chemo. I agree with everyone else, document everything and go to the higher ups. She doesn't sound safe at all.