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

[GOMER-RN]

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.

[caliotter3]

Apparently your unit does not possess the same atmosphere as most places where I have worked, or the new nurse would know not to throw his weight around. Now would be the time for the group to see to it that the new nurse is unceremoniously put in his place, even to the point of assisting him out the door. Not saying this is good or bad, in and of itself, just that this group action is what I have seen in nursing workplaces.

[binhtruong1975]

Kick their ass to the curb!!!! No one has the time for that!

[caliotter3]

Sorry to be so blunt, but you're screwed. If you have the sit down, insist on a third party being present. Ask if he can be assigned to someone else, because I have a feeling he's going to drag any preceptor down the drain with him.

Agree. Management is probably already treating him with kid gloves to delicately avoid litigation. They will throw the rank and file, who are easy to manage, under the bus, instead of taking steps to prepare the "outlier" for new employment vistas.

[thevez]

Definitely a one to one talk.

[CamillusRN, BSN]

Agree. Management is probably already treating him with kid gloves to delicately avoid litigation. They will throw the rank and file, who are easy to manage, under the bus, instead of taking steps to prepare the "outlier" for new employment vistas.

I agree with caliotter - there's no happy ending with this tale. Either he will end up going and try to sue (bad for the hospital) or you end up taking the hike (bad for you). Not seeing any win-win. I think having multiple people in the room when you have this heart-to-heart is the best bet for getting management to see what you're dealing with. IMHO, he sounds like trouble.

[BecomingNursey]

Please let us know how your sit down talk goes. That's a very difficult situation to be in. Good thoughts/vibes heading your way!

I'm not telling you it's going to be easy, I'm telling you it's going to be worth it.

Author: Art Williams

[girlmeetsworld]

I had a similar situation where my orientee thought they knew better, and they would not take my advice. I ended up telling my manager what was going on. I gave specific examples. My manager arranged a meeting with the three of us. Things ultimately didn't change and she was let go for making a major med error and lying. She tried going to HR and blaming her preceptors (myself and several other nurses). Luckily I was safe though all because I documented the examples and my manager documented that we had a meeting.

[MatrixRn]

I would suggest a one on one talk BUT with HR present.

However, before you do the sit down meet with HR first. For that meeting gather info on the people he has complained about and be ready to explain to HR how those nursing actions were appropriate. Also bring up that he was a tech on the unit and you are concerned with his ability to fit in.

HR should take it from there....by letting him know the conduct of the nurses were appropriate, but if they were not he could let his MANAGER know NOT HR. He needs to learn to follow chain of command. Also, the HR can let him review the code of ethics for the hospital.....that probably mentions being a good steward and supporting morale of the unit.

[Mavrick, BSN, RN]

I KNEW you were talking about a guy before I even got to your first response.

This new grad has brought way too much unwanted attention to himself and nobody can withstand that kind of scrutiny. Everyone is waiting for that inevitable mistake and it will come under a glaring light of massive documentation.

Have your monitored and documented discussion. If possible, clearly define unwanted/inappropriate behaviors. Like with any corrective action plan, set the consequences and follow through. It is possible, though unlikely, this new grad is unaware of his behaviors and how disruptive they are to team cohesiveness. As satisfying as it might be (for us here at AN) to see him trip on his own shoelaces, I can't see a fine preceptor like you doing anything that irresponsible. Becoming a competent professional is not just about book-larnin' and skills. There is also the "works well with others" criterion box that has to be checked off. Delegation and collaboration is probably in the RN job description as well.

Totally agree insecurities bring this behavior out and he probably has a really small pick-up truck too.(couldn't resist, if you get my drift)

[jadelpn, LPN, EMT-B]

Op, what a hot mess. But good for you on attempting to guide this new grad in the correct direction instead of NETY. I think. HAHA!

I wonder if this nurse was a Medic before becoming an RN. I LOVE my Medics, and they are amazing in what they do. So this is not trash talk on the Medics. However, in sitting in numerous classes for continuing ed, I have come to find that Medics are told that they are medical practitioners. That their scope is at an alternate place to an RN's. And that they are somehow more skilled than a typical ED RN. Now, some Medics will take that with a grain of salt. Others become invested in knowing more, being better, and gain a sense of entitlement to a "higher" level of care. When becoming an RN (and mostly due to practice restrictions that a lot of facilities are placing on techs in the ER) they bring with them the sense of because they were once Medics, they are at a level above everyone else. Added to the fact that their job is immediate gratification in bringing people "back to life" on a day to day. This seems to inflate a sense of "god like" super power syndrome.

Even if the person was not a medic, the role of the tech is supportive. Therefore, techs do not get to the "meat and bones" of any one patient but rather skim the surface of multiple patients. And usually the ones who hear the "complaints" about the lack of knowledge of the nurse. So given any length of time, techs tend to believe that they are the sounding board and function assistant--and that attitude can carry over to RN- dom.

First off, a discussion on the fact that pre-hospital and hospital care are 2 entirely different things. Even as a tech in the ER, patients are more than a one man show to start getting out the paddles and yelling "clear", and that teamwork may take work.

Even if the tech was a former EMT-B or Intermediate, they are governed by a set of protocols and rules that can not be strayed from, period. That the RN doesn't follow 100% protocol 100% of the time "may" not be 100% accurate, but we are talking about people's lives and sometimes a nurse is experienced in a way that may not follow protocol all that time. A foreign concept to EMT's at all levels. You don't need critical thinking, you just need to follow protocol. And you can't pass the certification exam if you do not. I can remember taking the EMT after becoming an LPN, and I was going off in tangents--I was used to thinking globally. And the instructor looked at me and said "Jade, you are going off on paths. Stay on the road." To think of doing the opposite, someone who is learned in staying on the road doesn't easily branch off onto other paths. Hence the disconnect.

With all that being said, an improvement plan with timelined specific goals may be in order. With a "you were an effective tech for us for many years. Now I need you to be an amazing nurse for us, and here's how we are going to make that happen". "You are so used to following protocol, that now I need to help you develop critical thinking skills". Also discussion about teamwork. "A team needs to be a well oiled machine. So stop ranking on other co-workers, it mucks up the works." Don't get emotional, don't get "well, I know that you said to that one....." Just a knock it off. Period. "we have a zero tolerance for gossip, for trumping, for not putting patient's first, and for bad mouthing. So you need to be sure that you are checking whatever baggage you have at the door."

It is just a tough transition from a pre-hospital care situation (even if the techs experience is only in a facility as opposed to an ambulance) to a primary nursing role. Takes a whole other set of skills. You can't change a personality, and perhaps this nurse is all ego times 1000%, but if they endeavor to keep their job, it would be best to tone it down to a dull roar...

[Farawyn]

Totally agree insecurities bring this behavior out and he probably has a really small pick-up truck too.(couldn't resist, if you get my drift)

No, no, no! He probably drives a HUGE truck to cover the fact that he has a small truck!

[OCNRN63, RN]

Kick their ass to the curb!!!! No one has the time for that!