Opinions welcomed

[-Renal RN-]

Hi. I am a Center Director at a dialysis clinic. Our typical RN training is 8 weeks. I have a nurse who is at 10 weeks currently and is not even close to being competent on the floor. Assuming adequate training was provided, even if she is motivated, would you extend the training or not? This is a very experienced nurse, not in dialysis, but many years on the floor. Just want to hear your ideas.

[gymnut]

Hmmm there seems to be many variables to this. For one you say you assume adequate training was provided. Was it? Maybe she learns differently that what is being taught to her. There are many types of learning styles and she could be with a person who isn't meeting that goal. See if you can switch who she is training with and see if there is any improvement from there.

Also what exactly do you mean by not even being close to competent? Is it with everything in general or is it just with a handful of things like organizational skills, time management or operating the machinery? Is she learning from her mistakes or making them over and over again?

I know someone with experience in this field will offer you better help but, that's just my two cents.

[BettyBoop01]

How many preceptors has she had? If just one, I would try a new oen that does things differently. If she has had many, ask her which one was most her style of learning and try with that one. How is the patient load while precepting? Can you give them a few days with a smaller load? If you give up on her your going to have to start from scratch. Id say if what your doing now is not working, try to change it up & try something new. Give her a chance.

[BluegrassRN]

How long are you willing to invest?

Personally, I'd get rid of her now, before you invest a year or two in her, only to have to build a case for firing her later. Sorry, but experience has taught me that if they aren't ready by the end of orientation (and I mean, where we expect a nurse with their previous experience or lack of experience to be), then they will never be ready, and it's best to give that spot to someone who WILL be able to perform their job well.

[HiHoCherry-O]

You mention that "typical RN training is 8 weeks." To me this means that on average most nurses are relatively competent by 8 weeks, some sooner, some later.

The next comment is that she is not even close to being competent. In what sense? Practicing safely? Equipment? Patient load? Skills i.e. fistula cannulation etc? Knowledge? Depending on which one of these categories she is incompetent in would lead me to my next action. Some of these categories are more easily rectified than others. How has her progress been measured to show where she currently is in learning/competence? Is it a matter of opinion?

In the long run, is she a good investment? Does she have potential? What does she bring to the table for your unit?

[Simply Complicated]

Have you spoke with her and her preceptor(s)? Is there some specific issue that could be hindering her learning that you are not aware of. Or is it possible that she is so set in her ways she is having difficulty learning a new area?

[classicdame, MSN, EdD]

"rules" for when to let go

1. Misses important items consistently

2. Cannot use past expeirences and apply them to a current problem

3. Cannot recognize own limits of knowledge

4. Does not ask appropriate questions

5. Cannot display self-starter qualities

6. Does not seek more challenging experiences

Our weekly evals include these statements for the preceptor to consider and evaluate. If, by the end of the evaluation period the orientee has not had all of them "checked off" they are let go. The preceptor must give an example of the behavior that meets or does not meet the expectation. If this is done weekly the orientee knows what to expect at the final evaluation.

[canesdukegirl, BSN, RN]

8 weeks seems like adequate time to "get it". Especially for an experienced RN. I agree with a previous poster when they posed the question of how long you were willing to invest in this nurse.

It has been my experience that if I trained someone for this long and they were still nowhere close to going out on their own, I would consider a few things:

1. What was the background of this nurse? Did she work on the floor for years and years? What sort of exposure did she have to working fairly autonomously? Does she have critical care experience?

2. Look back at the references. See if you can find any discrepancies and if you do, research that further.

3. Was this nurse out of work for a long time and perhaps in need of a basics refresher course?

4. Have a one on one with the nurse. She may have no idea of your expectations, or furthermore, may not realize that she is behind in performance.

5. How eager is this nurse to learn? Is she too nervous to enable adequate learning? There may be some roadblocks to her learning simply as a result of anxiety.

6. Is everything else in line? Does she show up on time, doesn't miss work or inservices? How does she respond to being critiqued?

If the nurse seems to really want to learn, there is something else going on. She may be facing a crisis at home, or she may have some sort of condition that she is trying to overcome (like chronic fatigue, or something of that sort), and is too embarrassed to divulge it. The only way to know for sure is to have a heart to heart. Let her know your expectations for performance. Then extend training for another 2 weeks. If you don't see improvement, let her go.

Sometimes it just takes a while to learn something new. I know a superb nurse whose training was extended for another month because she wasn't catching on fast enough. I am so glad we kept her on, because she really shines now.