What makes you nervous about or irritated with a new grad or orientee?

[GardenDove]

I've noticed alot of threads lately from new nurses who seemed quite stressed out, which I can totally understand, I've been there for sure. So I thought I'd start a thread from the other POV. This shouldn't be an opportunity to be sarcastic or uncharitable, but maybe it can help a new grad to see the other side of the story.

I get nervous by a new nurse who doesn't ask questions. I also will have misgivings about a new nurse who asks a question and then argues with my answer. Also, a new nurse who knows it all makes me nervous.

I get irritated by a cocky new nurse. A little bit of deference and humilty is a good thing. But someone who grovels makes me unsettled. I also get annoyed if a new nurse is too bossy with the pts.

[RNsRWe, ASN, RN]

Thanks for writing that.

I'm starting 2nd semester of my first year and while I was fine in the nursing home, I am terrified about starting our med/surg clinicals. I've actually been up all night worrying instead of sleeping and its 3 weeks away!

JW, your post made me smile: I had nightmares through four straight semesters about clinicals. Sometimes the night before, sometimes, just for psychic fun I suppose, they'd hit on the weekend. Always, in all of them, I was desperately trying to find my patients, to get meds passed in time, to revive patients who were under my care but whom I had managed to neglect ("he's MY patient?!?"). I'd wake in a cold sweat, heart beating.

And once I graduated, was working on NCLEX studies, I had no such nightmares at all....figured, "whew, done with THAT!" Imagine my surprise to find that once I began working as a 'real nurse' that I'd get some of those same dreams/nightmares back again!

Only this time, I wasn't the student who was lost, but rather, the RN responsible and still unable to find that danged beeping pump, unable to get an IV start (and there would be, of course, a crowd of people waiting for me to do this).

LOL, at this point, I don't have many dreams like this, they're rare, but I still remember.....

All I can tell you, JW, is that you probably will lose a fair amount of sleep while you get through clinicals, and once you begin work later. Doesn't mean you won't do well, just that you're conscientious

[lashes]

I precept alot, and there isn't really a whole lot that upsets or irritates me about new grads. I had an awful preceptor and an awful orientation in ICU so I try to be as patient as I possibly can with my orientees. Questions-- YESS! Ask as many as you want.. If ur not asking questions, I will start to wonder why. The " I'm an ICU nurse , Im better than you" attitude seems to be common amongst many ICU nurses where I have worked ( not to offend anyone- I work there too ) regardless of being a newbie or not... So, I don't think the "know it all" personalities are restricted to just new grads. The whole orientation process is to make one comfortable with the unit, skills, MD's, etc and at the end of it all, we ( preceptors) want you to succeed and -- bottom line, we want to make sure that ur safe. I've found that most nurses, new grands and seasoned RN's, who don't ask questions end up making some big mistakes...

[Charlie409]

[i've found that most nurses, new grands and seasoned RN's, who don't ask questions end up making some big mistakes...

First ..I have been a preceptor for a long time...I love it

I tell every new nurse I get the same as some of the others...Ask me anything....No question is too silly or unimportant, and I mean it!

I never correct in front of anyone, including other staff nurses

I also hate the "I know"... if you do..great, consider this a review...

I explain that I may say "let me show you how I do this" that is a signal for later discussion.

But newbies... I also tell my new nurses, "If you feel we have a personality conflict, or you are haveing trouble understanding my teaching methods TELL ME!!! Don't get upset, don't undermine me, and don't quit" I will gladly make sure you get hooked up with a preceptor you feel comfortable with.

I will not take it personally... I will consider it a good thing that you recognize a potiental conflict. I WANT you to succeed, or I would not precept. So listen, participate, talk to me later, pull me aside....do anything

Lets take care of patients!

[kadokin, ASN, RN]

Yep, that's it: Arrogance. What frightens me more is when I see it in veteran nurses. They've been around long enough to KNOW they don't know it all. Yet, some of them persist in believing that they do. It can be frightening. But, I guess we're all human, aren't we.

[Heart4RN]

I'm starting my 3rd semester of a 2year ADN program and have been a medical assistant for 14 years, worked in medical office, clinic and hospital settings. I have seen the great communication between MD's, RN's, FNP's, PA's, CNA's, etc. and horrible communication too. It all boils down to COMMUNICATION! Doctors that have been practicing for 30 years discussing a patient or situation with another doctor that has been practicing out of residency for a year, nurses with nurses, doctors with nurses and vice versa. I've also seen the other aspect of it when the person gets their head bit off. Again, it all boils down to communication and not being afraid to ask the question. In this field we, meaning ALL medical professionals, are in a constant learning environment. You may learn something one day and the next day, or even the same day, it may change. That's why flexibility is a huge attribute in a person that chooses to go into this profession. This ability to discuss a patients condition or how to do a bed bath whether with your preceptor or, when on your own, another RN shows that you are open to new ideas and criticism if you will. I think I lost track of what I was saying but you get the jest of it. :lol2:

May God Bless!

[bradleau]

I precepted a new grad who truly needs help and does ask for it. She is now part of the regular staffing. Doctors handwriting is something we all have had and still have problems. At least she asks. When I was checking her off on TLC and PICC line draws, she would have been in a fix if I was not the extra pair of hands. I signed her off with the notation to have another RN with her during her next 3 times drawing labs from those lines. One problem ...she did not understand the need to wear gloves while doing it. But she did follow my instuctions and suggestions. And I did tell her that she will occassionally find a troublesome line....and call for help. You can not learn everything during orientation. She is one who realises this will be an ongoing learning on the job.

[kellyskitties]

Normally I just lurk, and somebody may have already covered this, but I just have to get my 2 cents in.

Recapping a needle using the scoop method: Not a problem. The issue with the needle no longer being sterile isn't an issue for me. I don't think you should use the same needle to draw up a med as you use to inject. I usually use an 18 to draw from the vials then change the needle to a new sterile one. Some medications can cause damage to tissue or pain if they are IM and are drug through the subcut/subdermal layers on the exterior of the needle.

As far as new nurses - I expect questions - lots. I try to always stay patient with them. And just FYI they tend to gravitate to me. I do let them do it wrong if it won't hurt the patient - and then tell them "Well, this might work better, this is how I do it." Little junk like air in the line that kicks the pumps off a hundred times cause they spiked a bag of fluids upside down... etc. Little stuff - let 'em learn by trial and error. Big stuff - you better ask questions. If a patient is endangered by a nurse on my floor (I'm usually the charge nurse) I lose it. That's when I "eat my young." I can say, being open for questions and nonjudgemental with them has made the times when I thought a patient was endangered very infrequent.

[maymay281]

I am a new grad, just out of orientation in November. I was top of my class, but that meant NOTHING once I started my new job. I was SO BLESSED to have an amazing preceptor that treated me like we were on the same level intellectually...and she wasn't afraid to say, "I don't know...let's find out!" It made all the difference in the world to have someone that answered my questions like a co-worker/friend instead of a boss. I quickly learned which nurses were NOT approachable...the ones that answered my questions with that "duh" look on their faces...or those who talked down to me and made me feel that I was in nursing school clinicals all over again! Lol. So I guess I just want to say thanks to all of those approachable nurses out there that make it so easy for us newbies to ask questions!! For those experienced nurses that are bothered by the questions...just try to remember back to your days as a new nurse...it can be scary! You're not just helping us out with your knowledge/experience, but you're helping the patients, too!!

[ak127]

I'm still a student. I think its funny in the first half hour or so I follow around a nurse, I get "Don't you have any questions? What else can I show you? You're so quiet!" The thing is, I won't ask questions until I get the lay of the land, so to speak. I have to observe for a bit before I know the right questions to ask, I have to get my bearings first. Then, you'll wish I wouldn't ask so many, because no one that knows me for more than an hour thinks I am quiet, once I get going I never shut up!

Moral of the story: maybe they aren't quiet because they think they know it all, maybe they aren't asking questions because they don't know enough to know what to ask!

Ok in a student, kinda scary in a grad.

[new er nurse, BSN, RN]

A nurse once told me while I was still in school, "when you graduate you will find out how much you don't know". He was so right. Don't be afraid to ask questions. The know-it-alls are the most scarey! I especially see this in the ER with students. They don't need to start another IV because they started one yesterday. Guess what!!! Each start is different and you learn every day. When you think you know it all look out!!!

[Becca608]

"Little junk like air in the line that kicks the pumps off a hundred times cause they spiked a bag of fluids upside down... etc. "

I know you like to lurk, but Friday is IV day for me. Is there a certain way to spike the bag to reduce potential problems? Should I turn the bag so I spike into fluid or reverse the bag so I spike into air?

// Wail of confused newbie!!! :)// I 'thought' :) that I knew what I was doing!!!!!

Thanks!!!

peace, JediWitch :smiley_ab

[NZ_RN]

In my experience as a student nurse, most nurses I worked with didn't want me around let alone to teach me. There are many different types of personalities that are a factor with graduate nurses and preceptors. You could have a young or mature student nurse who may be confident or not. It's a hard thing going into a new environment which you don't belong in and don't really know. As a new graduate nurse on a Haematology, Oncology and Nephrology ward, the small amount of confidence I had was not welcomed by staff and so was smashed to peices. I nearly didn't make it as I was too scared to do anything and nearly quit all together. Fortunately I have moved to a new ward (Neurosurgery) where I am treated with respect despite being a new nurse, though still guided in my practice. I don't have to worry about people judging me when I as a question, and people DO JUDGE.

Appearences aren't always what they seem and a new nurse who seems too big for their boots may just be covering up feelings of inadequacy. We're well aware of the strain we bring to wards as we are not skilled-up and senior staff have to keep an eye. This isn't easy to know.

I hope that funding in the future will allow staff numbers to reduce this strain on senior nursing staff.