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.

[gmondina]

Put him in his place... He has more to chew before he can swallow... Haha😁. His time will come.

[BuckyBadgerRN, ASN, RN]

Would you believe about 3 sentences in while reading your OP, I said to myself "I'll bet this new nurse is a guy". Just a gut feeling.....

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

[mama.RN]

I was just wondering if he is still within a probationary period (isn't it 3 months, usually?) where the employer gets to decide that it just isn't working out. Given that that is usually the case with any new job, it makes no sense for someone starting a new RN job to act this way. There are plenty of deserving new grads that would be easier to deal with and happy for the job. We've had a couple of people come through the doors at my work who have had attitude issues, and they were set free early on. No tolerance for that which creates a difficult work environment, especially when there are lots of nice people willing to do the same work just as well if not better.

[RNsRWe, ASN, RN]

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.

Hooboy! It's a pretty common theme for new nurses to complain about "bullying" of said new grads, but somehow they fail to see that they themselves ARE BULLIES! This fellow you're describing is bullying everyone: both nurses and techs. Constantly reporting people (inappropriately) is a bullying behavior, as in "if you don't cowtow to me, I'll report you". Denigrating techs...well, if it's not bullying, what is it?

This one looks like he's ready to be cut loose. So....if he's here....READ UP and straighten up before Gomer sends your butt to the cleaners!! :)

[Iris_kt]

To OP I'm sorry you have to deal with someone acting like that. I hope a meeting would help. This reminds me of something that happened -sorry if it's long.

Last year at the beginning of my program, I was at work and heard a customer loudly proclaiming he is a nurse now but saying things that didn't add up (trying to sound like he knew everything about nursing but I've never heard an RN or LPN talk this way). I found out that he hadn't started a program yet but just got accepted. Then he proceeded to insult other nursing programs (including mine) so I wished him luck on his way to *eventually* becoming a nurse. Had to be careful what I said being at work, but it was getting ridiculous. I wonder how clinicals went for him with that attitude!

I'm still a student, so I can't really give advice. People like that are not only difficult they can potentially hurt a patient. I can't imagine acting that way now or after graduation especially at a new job.

[ixchel]

I think this kid needs a great big bus to be tossed under. Some people just do. I promise I'm not saying that to be heartless - it's just that some people respond to those sit down conversations and some people just rationalize them away thinking they're perfect. This sounds like the kind of person who needs to be in over their head before they know they need to learn more.

Being that it's an "HR on speed dial" guy, perhaps making sure others are aware of what is going on and making sure the situation is 110% safe first is a good idea.

[Been there,done that, ASN, RN]

There is no way you are going to teach Mr. Cocky One humility and respect. He is interfering with the functioning of the unit as well.

As his preceptor, you evaluate his performance on a regular basis. Make sure this is all thoroughly documented . Let management handle this.

[canigraduate]

I think you are working too hard to keep him. Is he worth the effort? Doesn't sound like it from this thread.

Maybe it's time to start documenting so he can be fired. Do you really want to work with this guy?

I wouldn't. I definitely wouldn't keep torturing myself by being his preceptor.

Just a couple of points for you to think about.

[golson]

I'm not a nurse, but I've been in very similar situations before, training in new folks right out of the schoolhouse or in some cases even training in my new superiors who are new to the field. I won't get into my past since that's not the topic at hand, but the stakes were similar to nursing. I've got to say, I agree with what Lev has posted above. The make sure you have a sit down that is direct and candid with this guy first. Some of us guys are dumb as a dump truck with social interaction and don't pick up on cues and hints easily. I'm not saying that is how you handled it, but it will only benefit you to make sure nothing is missed and that the newbie understands the gravity of the situation. Bringing in an outsider before the first serious sit down could easily be perceived as being thrown under the bus by the new guy. Let the new guy know that you want to have a sit down a shift or a couple days beforehand, and what the topic of conversation will be. Give them time to think of their own problems or concerns. At the session, make sure you bring up all of your concerns including specific examples of when their arrogance could have put a patient in danger. Reiterate that the nurses in your unit are a team and that trying to throw people under the bus without first seeking clarification (and even learning something) negatively affects unit cohesion. Make sure they understand what the consequences could be if there is no change in behavior. After all of your concerns are laid out, get their input and build a plan of action together. Revisit progress on this plan of action weekly, bi-weekly, monthly, or whatever timetable is feasible to assess and adapt within the span of the preceptorship (preception?, whatever you'd call it). You may even want to put this on paper, but make sure they understand this isn't a write up, just an informal tool for the two of you. Make sure that your leadership is appraised of the situation and what you're going to do about it. If there isn't progress in the time frame laid out in the plan of action, begin writing them up and having management or HR sit in on these meetings so you have an air tight case when discipline or termination happens.

[Libby1987]

I don't understand why as a preceptor you are responsible for setting this guy straight.

I give feedback to my director re a trainee's progress and any concerning issues, the only thing I do otherwise is re evaluate if there is a better approach that I can take and what areas need more concentration.

[Iris_kt]

There is no way you are going to teach Mr. Cocky One humility and respect. He is interfering with the functioning of the unit as well.

As his preceptor, you evaluate his performance on a regular basis. Make sure this is all thoroughly documented . Let management handle this.

This- especially since you can evaluate him. Wouldn't the unprofessional comments he made (from the original post) be enough to have him written up or at least talked to?

[theradiantforce]

I'm a new nurse and can see both sides of the spectrum. When I started, one of the nurses said their training was terrible and how rude people were. After some time it surfaced that the nurse acted like they knew everything and other nurses didn't want to be bothered. I think some new nurses have a chip on their shoulder especially, if they have worked as techs or even have a year or so of experience somewhere else. They try to establish themselves and lose sight of the fact that they are still new to THAT unit. Unfortunately, it tends to bite em in the butt later when they make mistakes that could be avoided.

It's all about the patient though, so it could be detrimental to allow this nurse to practice when he obviously doesn't know everything he needs to. I think a sit down with a mediator is needed. He needs to understand that his experience as a tech can be helpful, but nursing is a whole other beast. Also, it's not good to make enemies of your fellow nurses cause when ish hits the fan those are the very people you're going to be turning to for help! Have a serious, no nonsense sit down. Be candid about situations which have already taken place, and let him know his behavior is not being received well.

Once all sinks in, I bet you will hear something along the terms of "I didn't realize I was coming off that way....." Also keep in mind that new grads are still in the realm of somewhere between the school/NCLEX "hospital of perfect" and the real world. We are hypersensitive to things not being done by the book. Which is probably why he's reporting nurses left and right, smh. Just talk to him.