Help! I have to precept a new grad who already knows it all....but not really.

Nurses General Nursing

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  1. How do you precept a new grad who knows it all?

    • 157
      Teach them all you can and hope it sinks in. Set the bar high, do not allow for mistakes or excuses. Make them accountanble.
    • 14
      Give them the basics and let them figure it out on their own. They already know everything, so this is just a review, right?
    • 44
      Give them the best orientation and knowledge you can, then scare them straight. Give examples of the nursing horror stories.
    • 0
      Coddle them. Tell them they are great. We are all winners, right?
    • 114
      Do you let them sink? And while they are sinking, step in to save them and the patient. Make them learn from their mistakes because they would not listen?

112 members have participated

I need your help! How do you teach a new nurse humility and respect along with the fact that they do not know it all? I love sharing knowledge. Being a nurse is a profession that I take seriously and have enjoyed...I particularly like to share what I have learned along the way. I have never been one of the types of the nurses "who eat their young". I have been an Emergency Department Nurse for 13 years. I have been a preceptor for a while, and I am having a bit of a difficult time with a new grad RN. And to be quite honest, I am beginning to get hungry and this new RN is close to being dinner, if you catch my drift.

This RN was previously employed in our department as a tech, and while the RN has learned a lot about the department, they did so in a non-nursing role. The RN has a tremendous amount of potential, but lacks the critical thinking, knowledge and skills that comes from on-the job training and doing in the RN role. While this RN lacks the critical thinking, knowledge, skills and prioritizing (just to name a few), what this RN does not lack is a tremendous sense of self and an overwhelming cockiness that is not well-received on the unit. This RN has already reported several senior nurses for what the RN deemed were "breeches in protocol" when, in fact, the senior nurses were 100% correct for the way they cared for their patients, this RN was just not aware of different techniques used by nurses for many years.

This new RN has already made very unprofessional comments and has degraded the techs and some new nurses in the department in numerous ways.

This nurse may possess some good theoretical knowledge learned in school and may have some good clinical skills, but I fear that the attitude of "I don't need to see this or that because I've already been there or done that as a tech" is going to be to the detriment of the patient.

Does anyone have any advice on how to help a new RN tone down the attitude and learn how to be a good nurse without alienating staff. I feel it is my duty to teach the RN how the Emergency department works, but it is an even bigger duty to the profession of nursing to make sure we help to develop well trained and well rounded nurses who know their limits and are team players. I was taught by one of the greatest nurses I have ever worked with, a nurse with over 40 years of experience and is still working, that the moment a nurse feels like they know it all, that is the time they should retire. I think that is solid advice.

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Wow, tough spot. I wonder if we'll soon be seeing a post from a new RN who is being precepted by someone who just doesn't understand how valuable she is? :no:

I guess my advice would be to schedule a sit-down, no distractions permitted, private "come to Jesus" meeting. Meaning that this is when you'd spell out her finer qualities...and her NOT so fine qualities. Let her know that you've had enough time to assess her abilities, and that includes not only novice skill assessment but also interpersonal relations, her ability to work well with her peers and those she may supervise (techs). And let her know that it is in the latter categories she is lacking, and will really need to pull it together if she is to satisfactorily complete her orientation/preceptorship and remain employed with the facility.

Right now, she believes she is the End-all, Be-all, and that's unfortunate. But until someone has a serious, no holds barred chat with her, she will absolutely continue in that vein.

Let her know that if she DOES continue in that vein, that not only is her job in jeopardy, but the willingness of her co-workers to come to her aid will be negatively impacted; nothing makes aides disappear as quickly as "THAT one is demanding something again".

Perhaps it is more that she has an opposite problem than what you think: she's actually NOT confident, but is putting out a lot of bravado and pretending to be more sure of herself than she really is. Suggest it. If she seems to give on that, that maybe she is overcompensating for her uncertainties (and going about it in the wrong manner) then you can take the opportunity to help with that. If she just stares at you like you're nuts (because she really IS that wonderful)....all you can do is lay down the law, tell her the expectations you have of her and her colleagues have of her, and that at this moment she's failing to meet them.

And document the heck out of it!

Good luck :)

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Thank you so much for such a great reply. It is actually a "he" and I will have that sit down.

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Specializes in PACU.

I second a sit-down. There are a lot of red flags just in your post alone, and he could very well be in danger over losing his job very soon. I am really concerned with his need to report other staff. It is not making him any friends and I am not sure if he realizes his position on the totem pole... and a nurse manager may find that a suitable solution is simply to terminate him, especially if his behavior is affecting a majority of the staff.

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Wow..I agree have a one on one candid talk . Let him know what you expect, what will be tolerated and what you will not tolerate. Am a new RN and I would be so delighted to have an experienced nurse teach, advise, show me how things work. Still job hunting but good grief does he know the word HUMBLE? Keep doing good though. Im the end ots always better to good than bad even if those you are helping are jerks.

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Wow..I agree have a one on one candid talk . Let him know what you expect, what will be tolerated and what you will not tolerate. Am a new RN and I would be so delighted to have an experienced nurse teach, advise, show me how things work. Still job hunting but good grief does he know the word HUMBLE? Keep doing good though. Inthe end it is always better to good than bad even if those you are helping are jerks.

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Specializes in Med/Surg, Ortho, ASC.

Don't forget to include specifics to counter the inevitable denials.

"When you reported Nurse B for x infraction, but in reality, Nurse B was correct in her practice."

"When you did not take advice given and chose to do xyz, that was inappropriate because...."

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Specializes in Nursing Professional Development.

I'd have the sit-down. But I would follow it up with assuring that he gets experience in lots of situations that surpass his current abilities so that he "sinks" a little. Some people keep assuming they are perfect until they see their imperfections for themselves.

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Specializes in NICU, PICU, PACU.

I just went thru something similar. Mine was a care partner on postpartum and came to NICU as a new grad. She was know it all, made off side remarks to older nurses and new nurses.

I took her aside and told her, you may have some knowledge, which is fab, but you don't know what you need to know, you don't know the nursing policy and procedure and do you want to continue her and work? I went into giving others respect and that yes, there are going to be people who will eat you alive or let you flounder to teach you a lesson. Hard convo to have but it helped.

Two months later her cockiness caused an incident and she tried to backpedal her way out. Didn't work and she was written up. Has kind of humbled her.

It isntough, but sometimes you have to be that crusty bat that tells them how it is.

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Specializes in Family Nurse Practitioner.
Does anyone have any advice on how to help a new RN tone down the attitude and learn how to be a good nurse without alienating staff.

This RN was previously employed in our department as a tech, and while the RN has learned a lot about the department, they did so in a non-nursing role.

I'm not sure if this new grad is "one of those" but some techs think there is not much difference between a tech and a nurse and they think they can actually be an RN..."it's not so hard...they get paid more to do the same thing..." Common thought among some techs I've worked with. They fail to recognized the level of responsibility we have and the stress we are under. I'm sure you realize this already.

The RN has a tremendous amount of potential, but lacks the critical thinking, knowledge and skills that comes from on-the job training and doing in the RN role.While this RN lacks the critical thinking, knowledge, skills and prioritizing (just to name a few), what this RN does not lack is a tremendous sense of self and an overwhelming cockiness that is not well-received on the unit. This RN has already reported several senior nurses for what the RN deemed were "breeches in protocol" when, in fact, the senior nurses were 100% correct for the way they cared for their patients, this RN was just not aware of different techniques used by nurses for many years. This new RN has already made very unprofessional comments and has degraded the techs and some new nurses in the department in numerous ways.This nurse may possess some good theoretical knowledge learned in school and may have some good clinical skills, but I fear that the attitude of "I don't need to see this or that because I've already been there or done that as a tech" is going to be to the detriment of the patient.

I think that with this particular new nurse you have to be very very direct about what your expectations are. He may be so caught up in himself that unless communication is direct, it will go right over his head. You need to have a little sit down with him (as others have suggested) in private or maybe go outside. It should be in the form of a heart head heart sandwich. Has your workplace made you watch those silly customer service videos?

My conversation with such an orientee would start like this:

**Person's Name**, can I talk to you? I need you to hear me out and then comment

**Person's name**, you have a lot of potential. I see a great nurse in you. But you really really need to calm down on the attitude. It's not appealing. It's not appealing to me, it's not appealing to your colleagues, and it's not appealing to **Manager's name**. You've been a tech, you know how this ED flows, that's great and that's to your advantage. However, you aren't a tech anymore. You're an RN and you need to start thinking like one and acting like one. I'm here to help you. I've been an ER nurse for 13 years and I've learned some things along the way. I'm here to help you become independent and get off orientation practicing safely. I want you to be a good nurse, but I don't want you to alienate your colleagues on the way. Reporting the nursing practice of experienced nurses is not a good start. You are a new grad. You need to solidify your own practice before you can critique the practice of others, including the other new grads and the other nurses here. And even when you actually know what you're doing you have to be very very careful so you don't turn people against you. You have to watch your mouth. If you piss off the techs, they won't be there when you need them. Again, I am saying this because I care and I think you're going to make a great nurse. You just need to tidy up the ends a little. I want to work with you and I want to help you succeed.

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Thank you so much. This guy already has Human Resources on speed dial for what he feels are "bullying behaviors" and "injustices" to himself. The scripting you have provided is great. I am thinking of bringing in a third party, that way I am covered. He would rather get people fired, than get in trouble and it is not a comfortable place for me to be in at this point.

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Specializes in Ambulatory Care-Family Medicine.
Thank you so much. This guy already has Human Resources on speed dial for what he feels are "bullying behaviors" and "injustices" to himself. The scripting you have provided is great. I am thinking of bringing in a third party, that way I am covered. He would rather get people fired, than get in trouble and it is not a comfortable place for me to be in at this point.

I precept at the clinic I work at. If I were you I would have a manager sit in on the conversation and maybe even add to it as well. My charge nurse has had to sit in on these convos in the past and in our preceptor training class the HR rep that was there even suggested a manager be present though it not mandatory. Sounds like it'd be in your best interest to as if the manager would join though.

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