How to teach an experienced nurse

[canesdukegirl, BSN, RN]

What is the best way to orient an experienced nurse? I am having trouble precepting a nurse with many years of experience because she is taking on an observer role rather than being involved in patient care. I have asked her if she is uncomfortable delivering patient care and she just laughs and says, "Nope, been doing it for years!" I have shown her where things are, how to chart on our computer system and what the policies are at our hospital. She was given 2 weeks of both hospital and unit orientation before being paired with me. Her nurse educator told me to let her do everything and just be there as support if she has questions, but when a patient rolls into the OR, she puts her hands behind her back and watches. I have prompted her to go ahead and deliver patient care, but she continues to just observe. I don't think it is my place to tell her how to be a nurse because she obviously knows how to do the job-she has been an OR nurse for 17 years. Since I have already asked her if she is simply uncomfortable doing patient care (she smiles and says no), and her nurse educator has released her to do patient care, I am at a loss. I have no idea why this nurse won't jump in and get involved with care. What should I do? I want to be supportive, but I also don't want to be patronizing. She has been at our hospital for a little over a month now. Suggestions?

[NanikRN]

Nurse ABC

This is a little awkard to talk about but it's almost as if our roles are reversed.

I need to let you know that nurse educator expects you to be doing all the pt care with me as a backup only. I know you know how to do pt care but----what can you do? you know how it is with management rules. yada-yada-yada

Blame it on protocal, orientation guidelines, etc but get her to switch roles. Maybe she doesn't understand what is expected of her and will appreciate the clarification. Or maybe she's looking for an "easy ride" for the next 2 weeks.

[OCNRN63, RN]

Have you said something to her flat out like, "I want you to assume responsibility for this next case," or something like that? What is she waiting for, an engraved invitation?

[prettyinblu]

How about right when the shift starts say " OK today you will do be in charge today and Im only here for support!" She has the experience and has had plenty of orientation so let her fly solo!!!!

[tyloo]

I would tell her that you have to sign off on her paperwork and don't feel comfortable doing so if you never witnessed her doing the actual care.

[sarafina]

I agree she is probably just looking for an 'easy ride with pay' for a couple of weeks before she has to get going. Heck that is a great way to get a paid vacation.

[canesdukegirl, BSN, RN]

Have you said something to her flat out like, "I want you to assume responsibility for this next case," or something like that? What is she waiting for, an engraved invitation?

Yes, I have told her that she needs to take on the care for the next case. She understands that this is expected of her. But for some reason, she just smiles, starts humming and watches. I have never had an orientee quite like this one. I have to assume that she is simply nervous. I have asked her if she was, and she says no. I was watching and listening to the surgeon when he was putting plates and screws in so I could keep up with the implants, and she started talking to me about making a car seat for her dog. I politely told her that now is the time to listen to what is being implanted so that she can chart it. I may as well have been talking to a brick wall. She went on to tell me about the car seat and how ingenious her invention was. Her affect is very unusual, and the only assumption I can make is that her behavior is spawned by anxiety...but that has been addressed. I am completely at a loss.

[canesdukegirl, BSN, RN]

How about right when the shift starts say " OK today you will do be in charge today and Im only here for support!" She has the experience and has had plenty of orientation so let her fly solo!!!!

Since I addressed my concerns with her nurse educator, she told me to do exactly what you suggested. I was outside of the OR in case she needed me, and told her that I would be there. Next thing I know, the surgeon is calling for me because, "Nurse X seems kind of lost, so can you come help?" I can't very well leave the surgeon to do everything, so I must be in the room, despite what the nurse educator told me. I shouldn't have to prompt this nurse to actually do patient care, as she knows this is an expectation. Kind of like you expect the surgeon to scrub his hands before gowning...it would seem condescending to say, "Nurse X, you gotta actually DO patient care in orientation."

[OCNRN63, RN]

Yes, I have told her that she needs to take on the care for the next case. She understands that this is expected of her. But for some reason, she just smiles, starts humming and watches. I have never had an orientee quite like this one. I have to assume that she is simply nervous. I have asked her if she was, and she says no. I was watching and listening to the surgeon when he was putting plates and screws in so I could keep up with the implants, and she started talking to me about making a car seat for her dog. I politely told her that now is the time to listen to what is being implanted so that she can chart it. I may as well have been talking to a brick wall. She went on to tell me about the car seat and how ingenious her invention was. Her affect is very unusual, and the only assumption I can make is that her behavior is spawned by anxiety...but that has been addressed. I am completely at a loss.

I don't think you have a choice but to report this to either your manager or the educator. I am loathe to suggest this, but come on! You try to get her to step up and she talks about doggie car seats? She sounds like she's one sandwich short of a picnic. Or else incredibly lazy.

I can't imagine that surgeons are going to put up with that kind of chatter for long. Either you're going to have to nip this in the bud or one of the docs is going to put the hammer down. At least if you do it there may be a chance she can pull herself together and save her job. You and I both know what will happen to her if an unhappy surgeon goes complaining to management.

[pers]

We had a new hire like this a few months ago on our unit. She was an experienced LPN who was due to graduate from an RN program in less than a year. When it came to doing anything though, she would want to "watch" rather than actually do. Since she rotated through several different orienting nurses, the majority of her orientation was watching rather than doing. Sure enough, when she got off orientation, she would hunt down other staff to help her with everything because she didn't "do" that on orientation. There was even an incident where she didn't give any IV medications to one of her patients because she didn't know she was supposed to! Thankfully she did have multiple nurses orienting her so when she claimed she wasn't taught and multiple nurses insisted that she was, the nurse manager held her responsible.

I'd politely but firmly insist that she needs to do everything for the patients. You need to know she can handle things before her orientation ends and while she may be an experienced nurse, every unit is different. Things that were (or weren't) acceptable at her old job may or may not be acceptable at her new job. If she's still resistant, I'd bring it up to the nurse manager and make it clear she's getting a poor orientation not because you aren't providing opportunities but rather because she's refusing to participate.

[OCNRN63, RN]

canes:

Do you know anything about where she came from before being hired by your facility? Has she discussed why she left her other job? I guess I'm wondering if you can get a feel for if she has any sort of "baggage," if you get my drift.

[joanna73, BSN, RN]

I did my pregrad placement in the 0R. After 3 weeks, I was working with minimal supervision. Since this is an experienced nurse, her lack of initiative is ridiculous. The next time you start a shift with her, as previous posters have mentioned, let her assume the work. Otherwise, can I please have her job? I loved the 0R :)