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.

[/username, BSN, RN]

Towards the end of the orientation process, you have input on whether or not he's ready, right?

[hppygr8ful, ASN, RN, EMT-I]

I like the idea of a "Come to Jesus" meeting. It must be done away from other staff so they can't say you embarrassed them in front of their peers. I recently took a new grad who "Knew it all" into a break room and said "The good Lord gave you too ears and two hands but He only gave you one mouth because you are supposed to listen more and do more and talk less.

Hppy

[johsonmichelle]

I'm happy to see this post, I'm just in nursing school but I see this all time. Students trying to tell instructors what to do just because they have some medical background. One of my instructors actually told a student that she was not fit to be a nurse just because of that cocky attitude. A new grad is a new grad, yes having some medical experience can be helpful but at the end of the day we will be considered a new grad because we do not have REGISTERED NURSING EXPERIENCE. For some reason, I tend to see this cocky attitude from people who have some medical experience, such as techs, medical assistants, emts etc. In order to be successful in any profession, you need to be respectful.

[No Stars In My Eyes]

Not just in new grads! I worked a PDN case with a woman who was 70-ish, she was a CNA who did night shift.....and I recall several times when she drew herself up to her full height and proclaimed to me, "Well, MY father was a DOCTOR!"

Oh, pardon ME!

[kbrn2002, ADN, RN]

Male, female..doesn't really matter. It's the attitude that matters. I agree with those that suggest a witness for the "here is how it is and here is now it needs to be" meeting. As this new nurse has already reported nurses it's almost guaranteed that he will report you when he doesn't like what you have to say and he sure won't like what you have to say.

[TriciaJ, RN]

Not just in new grads! I worked a PDN case with a woman who was 70-ish, she was a CNA who did night shift.....and I recall several times when she drew herself up to her full height and proclaimed to me, "Well, MY father was a DOCTOR!"

Oh, pardon ME!

That's funny. 70 and still dining out on what her father did. Actually, though, it's really quite sad.

As far as the cocky orientee, it all depends on what kind of support you get from your management. If you document and communicate your concerns, they should be able to take it from there. If, however, they are determined to see this person as a Golden Child, he'll have to kill a few patients and cost them a few bucks before they see a problem.

[ixchel]

Not just in new grads! I worked a PDN case with a woman who was 70-ish, she was a CNA who did night shift.....and I recall several times when she drew herself up to her full height and proclaimed to me, "Well, MY father was a DOCTOR!"

Oh, pardon ME!

I never did understand that mentality. It's like the doctors' wives at my kids' school. They're cliquish and think they're ahhhhhhhmazing, as though marrying up made them better. Sorry, but you don't earn street cred by marrying into the mob. You get street cred by shanking someone yourself. (Or by BEING a doctor, rather than MARRYING one.)

[RNsRWe, ASN, RN]

Not just in new grads! I worked a PDN case with a woman who was 70-ish, she was a CNA who did night shift.....and I recall several times when she drew herself up to her full height and proclaimed to me, "Well, MY father was a DOCTOR!"

Oh, pardon ME!

Makes me think my response would be along the lines of "Well, if I was a patient of your Daddy's in 1910, then I might listen to HIM...."

[Thought, BSN, RN]

As a new/old grad having difficulty finding a job, I'd be thrilled and honored to have such a dedicated and compassionate preceptor. Nursing school teaches you the basics, you learn so much more afterwards. I don't know it all, and I admit it. I also feel the day you believe you know it all, you should get off the floor and stop nursing. At that point, you become a dangerous nurse to your patients. Our patients put their lives in our hands and trust us to take good care of them, it isn't fair for their care to be jeopardized.

With all that said, I also agree about having a conversation with both him and the manager. More than likely, other members of the staff have went to the manager about him and the manager is aware. However, document everything he says and does. By doing both, it will CYA. Since he has the HR on speed dial and is quick to call them about a coworker not doing something right or "bullying" him, he'll be quick to throw you under the bus if you approached him alone.

Good luck, let us know how it goes!

[Sugarcoma, RN]

I have worked with a few and personally precepted two of these know it all types. I enthusiastically agree with the poster/s who suggested you distance yourself from this person ASAP. I would most definitely speak with your manager about your concerns ASAP. Any candid conversations or come to Jesus talks should really come from management. Know that they will most likely receive a new preceptor, not because your manager really thinks it will make a difference but so they can defend that every possible avenue to facilitate development was taken.

In my experience these types of nurses take any type of intervention as further proof of their superiority (everyone else is clearly threatened by their greatness and out to get them). They glob on to protocols with all their might and are quick to throw anyone who deviates under the bus. They lack the ability to ascertain when deviations may be in order. They are unwavering in their beliefs. And make no mistake these types of nurses are absolutely unsafe because they lack the ability to see when they are in too deep and need help.

I think it is very commendable and speaks well of your character that you would like to attempt to foster a sense of humility and humbleness in this person. Personally I don't think humility or humbleness can be taught. You either have it or you don't. Unfortunately for these types of people they are so insecure that looking good themselves trumps relationships with their coworkers and even their patient's well being.

You really do not want this type of person as a coworker. Because they seem so sure of themselves patient families and even other coworkers, docs, etc. will often believe that they really are great nurses. They are fabulous staff splitters and can really bring down the morale of a unit.

Often times these people will be transferred out to other units ASAP. If not new to nursing they will often have a history of multiple jobs or transfers. We had one who had been written up 3 times and the rule was in order to transfer to another unit you had to have one year write up free. The minute this nurse expressed interest in another unit to my manager she was on the phone and by the end of the day had somehow managed to arrange a transfer.

I truly feel for you and I hope that you can find a resolution that leaves your sanity intact and this persons future patients safe.

[SmilingBluEyes]

Good luck. Just precepted one like this. Tried to tell the manager he was trouble, but she and others think he is "cute" and he IS smart. But he has already gotten himself in some hot water with his know-it-all attitude and is starting to see he is not so clever after all. Very humbling. Luckily he works a different shift so I don't have to deal with him much. But the patients see right through him as do some of the docs.

Time tells. And he is not as cute and clever as he thinks.

[la_chica_suerte85, BSN, RN]

I've worked with people like this in a non-nursing setting and what is hardest about it is that this is just the way they are wired. I would just model good teamwork behavior, correct them when they are not behaving as such and point out the consequences. Any disagreement on their behalf is something they just have to work out for themselves.

I would just hold their feet to the fire and make them accountable (though, it is likely if they mess up it will be because they "weren't trained for that yet" among other excuses). Then, remind them that if they act like they know everything then they will be treated and held accountable as such. Point out specific instances where they have behaved this way. As long as there's no serious behavioral defect, they should start seeing it for themselves. The "come to Jesus" moment for these people must come from within. You just have to be consistent in what you tell them and in the behaviors your model.

It sucks that there are adults out there like this but.....well, it takes all kinds?

Good luck! I hope to be taught by someone like you someday soon!