Help me help a new nurse

janetrette · Nov 29, 2005

as a new grad, and a new nurse I think the best way to approach him would tell it to him honestly. Take a break for yourself. You need that break to help care for others. Make a general rounds of the patients. Give the assignments to the nursing aids. Give medication to the alert patient first. If medication like 10pm and 12mn. Prime all IV medication. Give the 10pm IV first. Continue for other patient care and by the time it finish you can start the 12mn IVs. It seems like he could have trouble delegating task to people. Chart the notes first. We have computer charting so I chart that first. Then take my 1 hour break. Come back and chart I&O's and notes. By that time, it's 5am. Ready for the morning medication.

perfectbluebuildings, BSN, RN · Nov 29, 2005

Yeah that, what she said!!

Just sit him down and tell him honestly what you think he is doing well, and what he needs to improve. It will help to give him CONCRETE things, because as new nurses sometimes we get conflicting or vague messages on what is priority or how to handle situations, which I can understand d/t the nature of the job, but concrete guidelines help when they can be given. It sounds like you are already being really helpful to this nurse, explaining things as you have. I agree he sounds like he has trouble delegating or admitting he needs help, I am the same way cause I feel like I should do EVERYTHING for my patients sometimes, even though I know that's not the case, or else I will be a bad nurse. Maybe reinforce the fact that he IS a good nurse, and to ask someone for help doesn't make him NOT a good nurse. (Does that last sentence make sense? It did in my head but that doesn't always mean a lot!)

It is so cool that you are making the effort to help him out. It means a lot to have nurses that really try to help us and who understand, that newness doesn't mean incompetence forever!

Daytonite, BSN, RN · Nov 29, 2005

Sounds like you've already identified his problem--slowness and problems with time management. Looks like you are just now finding out that he is also failing to get things done. To me, there's a difference here that you need to determine. It's one thing to forget to do something and quite another to just not get to something. Sounds like there might be some prioritizing he's failing with as well. These are not unique problems of new nurses.

I think that you need to figure out a plan to help him address and improve these things. Set specific defined goals for him to work on and then you must follow-up and check-up on him. For instance, with the med pass, set a time limit (you should have all your 9am meds passed by 10am). Check this every day. Help him analyze what went wrong that he didn't get the meds passed in the length of time he was allowed. That way you can help him identify things he may be spending extra, precious time on that he shouldn't, but still be expecting some accountability from him.

Find out how he's organizing his IVs. Many years ago we had a great system where we had a list of all the IV's on the floor (patient's name, fluid hanging, flow rate, piggybacks to be hung and times due, and how much was left in the bottle one hour before the end of our shift). Copies of these went to the pharmacy and it is how they got the next bottles to be hung ready for us. Most places don't do this anymore. These IV sheets, however, were a great tool for organizing our IV's. It's easy enough to put one together daily. Perhaps he has no way of organizing his IV's right now. You might have to get him started with that.

I guess what I'm saying is to work out a framework of what he should be doing and at what times during his shift, even if it's just a simple list of things to do. He should have that list in front of him every day and should be able to refer to it at a moment's glance. This structure, I think, is important when someone is having time management problems because it gives them a guideline to work from and to work toward. As his supervisor (preceptor? you didn't say) you need to be assessing this tool, perhaps daily at first, to see if it is working or needs adjusting. Also, with a time management problem I wouldn't ask him what I can do to help because he in all honesty can't assess his own situation well enough to tell you that. I'd assess the situation, figure out just how far behind he was getting and assertively jump in and say, "I'll take care of Mrs. Smith. You do some charting now."

I'd also speak to the next shift and find out precisely what it is that they are saying he is forgetting to do. Then these things have to be included on his list of things to do each day and worked into his daily schedule. I'd also get this man together (with you there) with one of these nurses and specifically direct the conversation toward discussing things he's failing to do. It helps him to realize he has accountability, opens the door of communication with the oncoming nurse, and eventually makes him less dependant on you and more autonomous as a practitioner. You also need to keep in communication with this other shift to see if things are improving or not and to make sure the other shift is not pouncing all over him in their frustration. (I'm always on the lookout for the eaters of newbies in order to put a stop to it and protect the newbies. If we don't, who will?) I'd probably start a check list for myself of things to double check to see that this person is doing. It is a flexible list as it may change daily or weekly. It only takes a few moments 3/4 of the way through the shift to give it a quick once over.

I would let this person know that his slowness is an issue and that he needs to improve this. Both of you need to determine why he's slow. Is it just inexperience with procedures that is taking up more time than it would for an experienced nurse, or is he dilly-dallying with patients because he feels more comfortable doing that than something else that he doesn't feel comfortable with? Procrastination is a killer, but if you help him recognize it and how to trick himself into not falling into it's pit, you'll have done your job. One of the biggest problems I see with new grads is their willingness to talk too long with patients or do aide work because these are things they feel familiar doing while a good deal of their other important RN work is not getting done. In the long run this stuff is killing their overall job performance because it consumes precious moments of time. This is a priority thing new grads do not understand. If he's doing things like this you need to figure that out and help him recognize how he's sabotaging himself and how he can overcome this. I wouldn't keep harping on it because I'm sure he is feeling a lot of frustration as a new nurse at this point anyway. However, I think it would be doing him an injustice to never mention that completing tasks faster is a goal. Once he's faster at his technical tasks he can jabberjaw with patients more. A preceptor and supervisor has a very delicate situation with new nurses. However, if you establish a nurturing, trusting relationship with this person so that you can both honestly lay out on the table and discuss these problems impeding his acclimation to the job, you will probably end up with an awesome nurse. New grads require a lot of one on one care and stoking which means a lot of patience is needed. With their nursing instructors now gone, they feel very, very vulnerable--similar to the old sink or swim situation. Even animals wean their young. We nurses need to do that as well. They are also very worried of being terminated for not performing well enough. Some reassurance of their job status has to be provided or it will eat away at the employee's emotional state making it nearly impossible for them to improve anything. Add a nasty preceptor or a cranky old co-worker to that and you'll have one paranoid, nervous new worker who is concentrating on his emotional state instead of his skills. That's where we have to re-direct their attention.

Hope you find some of this advice helpful. I had a very awful orientation as a new grad and never forgot not only how poorly I was treated (I was eaten!), but how no one was able to give me any constructive help at all.

Indy, LPN, LVN · Nov 29, 2005

I've been in this situation from the new grad's standpoint. My preceptor was good at surprising me when she knew I was behind, and saying, "I'm gonna go do your accuchecks, you chart" and voila, she'd appear a few minutes later with a list of blood sugars for me. I had a full load one night with a confused patient who wouldn't stay in bed or sleep; she told me to go get my other work done and sat down to handhold this lady to sleep so I could begin to concentrate on something else.

Looking at what she did made me able, the next really bad night, to tell those who offered to help what I needed done. Cup of water for X, towels for Y, tylenol for Z while I go manage chest pain on the other one... delegation is a skill that I really believe I had none of on graduation. As students we're on the bottom of the heap and things are being delegated to us, it's hard to let go when we're suddenly the nurse.

Last night my charge nurse had an awful night and got 2 hrs. behind on her charting through circumstances beyond her control. It was nice to be able to help her the way she helped me so often, just doing the little things that aren't charting and keeping her people stable so she could catch up.

TypicalFish · Nov 30, 2005

Sounds like you've already identified his problem--slowness and problems with time management. Looks like you are just now finding out that he is also failing to get things done. To me, there's a difference here that you need to determine. It's one thing to forget to do something and quite another to just not get to something. Sounds like there might be some prioritizing he's failing with as well. These are not unique problems of new nurses.
I think that you need to figure out a plan to help him address and improve these things. Set specific defined goals for him to work on and then you must follow-up and check-up on him. For instance, with the med pass, set a time limit (you should have all your 9am meds passed by 10am). Check this every day. Help him analyze what went wrong that he didn't get the meds passed in the length of time he was allowed. That way you can help him identify things he may be spending extra, precious time on that he shouldn't, but still be expecting some accountability from him.
Find out how he's organizing his IVs. Many years ago we had a great system where we had a list of all the IV's on the floor (patient's name, fluid hanging, flow rate, piggybacks to be hung and times due, and how much was left in the bottle one hour before the end of our shift). Copies of these went to the pharmacy and it is how they got the next bottles to be hung ready for us. Most places don't do this anymore. These IV sheets, however, were a great tool for organizing our IV's. It's easy enough to put one together daily. Perhaps he has no way of organizing his IV's right now. You might have to get him started with that.
I guess what I'm saying is to work out a framework of what he should be doing and at what times during his shift, even if it's just a simple list of things to do. He should have that list in front of him every day and should be able to refer to it at a moment's glance. This structure, I think, is important when someone is having time management problems because it gives them a guideline to work from and to work toward. As his supervisor (preceptor? you didn't say) you need to be assessing this tool, perhaps daily at first, to see if it is working or needs adjusting. Also, with a time management problem I wouldn't ask him what I can do to help because he in all honesty can't assess his own situation well enough to tell you that. I'd assess the situation, figure out just how far behind he was getting and assertively jump in and say, "I'll take care of Mrs. Smith. You do some charting now."
I'd also speak to the next shift and find out precisely what it is that they are saying he is forgetting to do. Then these things have to be included on his list of things to do each day and worked into his daily schedule. I'd also get this man together (with you there) with one of these nurses and specifically direct the conversation toward discussing things he's failing to do. It helps him to realize he has accountability, opens the door of communication with the oncoming nurse, and eventually makes him less dependant on you and more autonomous as a practitioner. You also need to keep in communication with this other shift to see if things are improving or not and to make sure the other shift is not pouncing all over him in their frustration. (I'm always on the lookout for the eaters of newbies in order to put a stop to it and protect the newbies. If we don't, who will?) I'd probably start a check list for myself of things to double check to see that this person is doing. It is a flexible list as it may change daily or weekly. It only takes a few moments 3/4 of the way through the shift to give it a quick once over.
I would let this person know that his slowness is an issue and that he needs to improve this. Both of you need to determine why he's slow. Is it just inexperience with procedures that is taking up more time than it would for an experienced nurse, or is he dilly-dallying with patients because he feels more comfortable doing that than something else that he doesn't feel comfortable with? Procrastination is a killer, but if you help him recognize it and how to trick himself into not falling into it's pit, you'll have done your job. One of the biggest problems I see with new grads is their willingness to talk too long with patients or do aide work because these are things they feel familiar doing while a good deal of their other important RN work is not getting done. In the long run this stuff is killing their overall job performance because it consumes precious moments of time. This is a priority thing new grads do not understand. If he's doing things like this you need to figure that out and help him recognize how he's sabotaging himself and how he can overcome this. I wouldn't keep harping on it because I'm sure he is feeling a lot of frustration as a new nurse at this point anyway. However, I think it would be doing him an injustice to never mention that completing tasks faster is a goal. Once he's faster at his technical tasks he can jabberjaw with patients more. A preceptor and supervisor has a very delicate situation with new nurses. However, if you establish a nurturing, trusting relationship with this person so that you can both honestly lay out on the table and discuss these problems impeding his acclimation to the job, you will probably end up with an awesome nurse. New grads require a lot of one on one care and stoking which means a lot of patience is needed. With their nursing instructors now gone, they feel very, very vulnerable--similar to the old sink or swim situation. Even animals wean their young. We nurses need to do that as well. They are also very worried of being terminated for not performing well enough. Some reassurance of their job status has to be provided or it will eat away at the employee's emotional state making it nearly impossible for them to improve anything. Add a nasty preceptor or a cranky old co-worker to that and you'll have one paranoid, nervous new worker who is concentrating on his emotional state instead of his skills. That's where we have to re-direct their attention.
Hope you find some of this advice helpful. I had a very awful orientation as a new grad and never forgot not only how poorly I was treated (I was eaten!), but how no one was able to give me any constructive help at all.

:yeahthat: :yeahthat: :yeahthat: :yeahthat:

medicrnohio, RN · Nov 30, 2005

I think it is great that you as a supervisor want to help this new nurse. So often we don't see supervisors who are supportive live that. Many people have given excellent advice here and I hope that it will help you out.

giada23 · Nov 30, 2005

I would say that to tell him what his weaknesses are, but don't make him feel bad about his performance. When we start something new, we all have a tendency to try to overacheive, and try to make the less mistakes posible. He may be very well aware of his less than perfect job performance and just may need some reassurance and some tips on how to make his shift run a little smoothly. I think its wonderful that you would even go out of your way to post this to look for more ways to help this nurse be successful in his career. I think you are an excellent supervisor for doing this.

greatshakes · Dec 3, 2005

Hi all

Why weren't you around when I started my first stint as a new RN. You may have been but I have just noticed your theads and they are all fabulous. Sadly I resigned but at least I'll know where to look for direction. I hope to do a post grad next year. Thank you all so much.

ShayRN · Dec 3, 2005

Thank you all so much. I really believe that everyone should be told of their weaknesses and encouraged and shown how to improve. I believe units that harrass and destroy the self esteem of their new grads should be made to go to other units and work for a week. Something completely out of their specialty. Say a NICU nurse should go to a telemetry unit, maybe that would remind them what it would be like to be the new guy, lol. I don't tolerate negative behaviors on my unit and because of that, I hope, it is a great place to work. I am going to talk to my new nurse next week, he wasn't there on Wed. and on Thur there was a staff meeting, I didn't want to put him further behind and Fri I was off, lol. I will let you all know how it goes....

samdombek · Dec 9, 2005

I have just one more week of school before I finish up my ADRN coursework! While I'm excited about beginning this new career in my advanced old age (46) I'm also scared to death because I can forsee that one of my major problems is going to be organization and time management. I intend to start on a med/surg floor where I know those skills will be important.

"Daytonite" mentioned a form that she used that helped with organizing things to be done, etc. Is there any way that anyone could somehow supply us "organization-skills-challenged" with such a sheet that they use and find helpful to give us new nurses a head start on the organizing game? Would appreciate it so much!! Thanks!

Jerico, BSN, RN · Dec 9, 2005

...make sure the other shift is not pouncing all over him in their frustration. (I'm always on the lookout for the eaters of newbies in order to put a stop to it and protect the newbies. If we don't, who will?) .....
...I wouldn't keep harping on it because I'm sure he is feeling a lot of frustration as a new nurse at this point anyway. However, I think it would be doing him an injustice to never mention that completing tasks faster is a goal. Once he's faster at his technical tasks he can jabberjaw with patients more. ....
However, if you establish a nurturing, trusting relationship with this person so that you can both honestly lay out on the table and discuss these problems impeding his acclimation to the job, you will probably end up with an awesome nurse.
....New grads require a lot of one on one care and stoking which means a lot of patience is needed. With their nursing instructors now gone, they feel very, very vulnerable--similar to the old sink or swim situation. Even animals wean their young. We nurses need to do that as well. They are also very worried of being terminated for not performing well enough. Some reassurance of their job status has to be provided or it will eat away at the employee's emotional state making it nearly impossible for them to improve anything. Add a nasty preceptor or a cranky old co-worker to that and you'll have one paranoid, nervous new worker who is concentrating on his emotional state instead of his skills. That's where we have to re-direct their attention.
Hope you find some of this advice helpful. I had a very awful orientation as a new grad and never forgot not only how poorly I was treated (I was eaten!), but how no one was able to give me any constructive help at all.

Daytonite: BLESS you for saying all this.

:loveya: :bow:

I had the worst experience at my first nursing position. I had a preceptor who just was awful! I went to my nurse manager twice and they didn't help any either. I ended up quitting. I was at the top of my nursing class, have three degrees, successful in everything I've ever tried hard at...and I ran into this preceptor and situation that felt so WRONG.

Hearing from you on this subject makes me feel so much more confident. I was told over and over I wasn't FAST enough...but in an ER situations are ALL different and until you build up some TIME, experience, and confidence as a new grad you are going to be slow. I think preceptors and nurses on units need to remember they probably were not tornadoes when they started either....

I found a new nursing position beginning in January...and this has given me HOPE that I will find a preceptor/coworkers that have the insight and wisdom you have regarding new grads.

Thanks so much. I'd love to have you for a preceptor.