How to teach an experienced nurse

[canesdukegirl]

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?

[dreamingofbeing]

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."

i think this is exactly what you need to say. she needs to do the work and prove herself end of story. with my job i watched the first 2 days and then was in the case. mind you i'm in interventional radiology and not or but i still scrub cases with the docs. if it was a procedure i'd never seen i'd watch it once then have a nurse scrub in with me the second time and be solo on my third. theres no reason for her to think she has a free ride for her entire orientation.

[leslie :-D]

as an experienced nurse, i would think/hope that she would want to jump in.

truthfully i'm wondering what's up with her.

yep, definitely time to observe what this "experienced" nurse is made of.

leslie

[llg, PhD, RN]

I agree with most of the others who are saying basically, "You need to be blunt and force her to do the care." Don't mince words. Perhaps she is feeling uncomfortable in strange surroundings with different policies, etc. So, take it 1 task at a time.

Step 1: Say ... "You do a,b, and c while I do x, y, and z." If she can't do a, b, c ask her why not.

Step 2: Say ... "Since you already know how to do a, b, and c ... now with this patient, you need to do a, b, c, and d."

If she doesn't do the assigned tasks, then you need to confront her directly, but politely. Ask her why she is not doing her assigned tasks. If you can address whatever the problem is, then address it. But if that direct discussion as to why she is not doing the specific tasks a,b,c, and d as assigned doesn't get you anywhere ... then you need to report to your educator and/or manager that this orientee has a serious problem. She may need to get "the talk" in which they tell her she will be fired if she doesn't raise her level of performance.

[canesdukegirl, BSN, 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.

I asked her this on my first day with her to sort of gauge where her learning/skills were so that I could understand better how to precept her. She told me that she left because there was new management and she didn't like the manager. I used to work as a traveler at the hospital that she left, and I know they have similar cases, so I know she can do the work.

[sevensonnets]

How do you know she actually has 17 years of experience? Maybe she's exaggerating her experience. It sounds to me like she's hesitant because she doesn't actually know what to do and doesn't want to admit it!

[OCNRN63, RN]

I asked her this on my first day with her to sort of gauge where her learning/skills were so that I could understand better how to precept her. She told me that she left because there was new management and she didn't like the manager. I used to work as a traveler at the hospital that she left, and I know they have similar cases, so I know she can do the work.

Then there really is no excuse for her not to step up. It puts you in an incredibly uncomfortable position, unfortunately, but I don't see any way out of a direct confrontation here.

With as difficult as the job market is these days, I find it hard to imagine someone would behave like this.

[joanna73, BSN, RN]

OCNRN, you said exactly what I was thinking. There are literally thousands of people who would practically kiss your *** and bend over backwards to do a good job, especially when someone is so clearly willing to help.

[Mulan]

I think I would refuse to orient her any longer.

Who are they going to come after when she is on her own and doesn't know how to do anything?

[canesdukegirl, BSN, RN]

Seven-I am getting the feeling that she may very well not know how to work on a busy shift. She apparently worked the night shift at her previous hospital. I know they are well staffed there, so she may have been able to just scoot by while letting the other nurses take on tasks. It definitely goes along with her behavior thus far. Thanks for bringing that up. I hadn't considered that.

OC-I am terrible at confrontation with peers. I will try to think of the best way possible to handle "the talk" with her before she gets it from management. Maybe she will, in fact, step it up.

Mulan-at this point, I am wondering if she will even be released from orientation. It is early though so she may actually wake up.

[OCNRN63, RN]

Seven-I am getting the feeling that she may very well not know how to work on a busy shift. She apparently worked the night shift at her previous hospital. I know they are well staffed there, so she may have been able to just scoot by while letting the other nurses take on tasks. It definitely goes along with her behavior thus far. Thanks for bringing that up. I hadn't considered that.

OC-I am terrible at confrontation with peers. I will try to think of the best way possible to handle "the talk" with her before she gets it from management. Maybe she will, in fact, step it up.

Mulan-at this point, I am wondering if she will even be released from orientation. It is early though so she may actually wake up.

I feel your pain on that one. I wish I could give you some advice on it, but I am terrible at confronting peers as well.

[OCNRN63, RN]

I wonder if the reason she didn't like her new manager was her new manager noticed she was a slacker and was pressuring her to step up her game. Just a thought.

[hiddencatRN, BSN, RN]

I asked her this on my first day with her to sort of gauge where her learning/skills were so that I could understand better how to precept her. She told me that she left because there was new management and she didn't like the manager. I used to work as a traveler at the hospital that she left, and I know they have similar cases, so I know she can do the work.

Whenever anyone says that they left somewhere because of management, I am a little suspicious that *they* might be the problem, not management. And I've left jobs because of management issues, too! I find more politically savvy ways to explain why I left until I know someone well and until they have the opportunity to get to know me well (not a good fit or a response that focuses on what positive things the new job has to offer or even they decided to move in a direction I wasn't interested in).

Keep us posted on what happens with this situation.