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?

[canesdukegirl, BSN, RN]

When was her last hands on experience and in what type of area? Was she at the bedside or in management? Once you determine this, you need to tell her that from now on, it is your show and I am not going to touch the patient unless you are killing them. Tell her that you have to see what she can do on her own. But you also need to determine if she is comfortable with you. Perhaps not. Have you had a sit down progress meeting between you, the educator or nurse manager and her. If she has been there for a couple of weeks now, it is time for a meeting.

Her previous job was at a similar OR. Same trauma level, same kind of patients, same routines. I used to work at the hospital that she left, so I know their routines.

I did think that perhaps she was uncomfortable with me. So I asked another nurse to precept her for a day just to make sure that this new nurse was not displaying this behavior as a reaction to my teaching methods. At the end of the day, I spoke with the precepting nurse and she shared the very same concerns.

I have spoken to the NE about this and I am sure she will make every effort to provide this nurse with the orientation she needs. I am not confident so far that she will make it through orientation. HOWEVER, if her unusual affect is actually the result of nerves, perhaps she will be more comfortable as the next couple of weeks go by and she will be able to deliver the care expected of a veteran nurse. I am hopeful, but guardedly so.

I appreciate everyone's comments and advice. As I stated previously, I do love to teach, but find it difficult to delineate an educational/orientation guideline for an experienced nurse. I will keep you guys updated.

[GHGoonette, BSN, RN]

I don't know if you have time to do this, but have you thought of doing a mock set-out to assess if she actually knows anything? I know you used to scrub, so if you tell her to set up the theater for a case, then have her "assist" you with the set-out, maybe her knowledge-or lack thereof-will be exposed....

[rntim49]

Sounds like your new employee has lied about her experience to land a job. I am sure this

happens more often than we think. I would love the opportunity to land an OR position, however ED nurses don't have the correct experience that is required to even get an interview. I can just see her standing over that pt with her arms folded behind her back saying to herself " I did it :yeah:I actually talked my way into a job. ha,ha

[aileenve, ASN, RN]

At the start of the shift you need to say, "You have been observing the shift for quite a few days now, so I will be here to observe YOU, if you have any questions about supplies, policies, procedures etc. I will be here to help you" Then if she is reluctant to work ask if there is a problem!!

[canesdukegirl, BSN, RN]

Update-I have spoken to a few surgeons and they are totally against this nurse continuing with orientation. I was chatting with them today about different subjects and this nurse came up. They had no idea that I had precepted her and were talking amongst themselves about "this new nurse that had no idea what she was doing and I don't ever want her in my room again!".

Before, only the nurses had concerns. Now the surgeons have concerns, and I feel that I must address this in a professional way with the NE. Although I feel bad knowing that this nurse was fired from her previous job (I also talked to a friend who currently works at her former place of employment and knows her rather well), I also feel that I must speak up now in order to save both the hospital's time and the nurse's time.

I absolutely HATE being in this position. On the one hand, I am the biggest cheerleader for nurses, but on the other hand, I also must recognize and be responsible for the safety of the patients. Does that sound totally altruistic? Do you guys think I am being harsh? Do you think I should let her go a few more weeks to see if she is more comfortable?

[leslie :-D]

i think that she needs to be told to step up to the plate, and let her prove herself.

if after that, nothing changers, then i think it fair to let her go.

but considering no one has actually expressed their concerns, she needs to be given a chance.

and no canes, you are so NOT harsh.

but then again, i'm quite biased.:hug:

leslie

[heron, ASN, RN]

Enough, already ... from what you've written you've gone through major contortions to try to get some progress and she just has not responded. I, too, am a major cheerleader for nurses (it's what got me fired) but there has to be a limit set. Seems to me that multiple approaches, straight talk and even changes in preceptors is plenty. If she was going to respond, seems to me she would have done it by now.

So ... no, I do not think you're being too harsh. If the patients' welfare, the surgeons opinions and the other preceptors' take on her isn't enough, imagine you and your co-workers having to pick up her slack.

There's being a supportive and encouraging teacher and then there is enabling incompetence. If your posts here are the whole story, then seems like you're right at the line.

[leslie :-D]

Enough, already ... from what you've written you've gone through major contortions to try to get some progress and she just has not responded. I, too, am a major cheerleader for nurses (it's what got me fired) but there has to be a limit set. Seems to me that multiple approaches, straight talk and even changes in preceptors is plenty. If she was going to respond, seems to me she would have done it by now.

yeah but has anyone actually and directly shared their concerns with her?

i was under the impression they hadn't. (i might have to reread this thread, though.)

leslie

[diane227, LPN, RN]

From what I am reading here this does not sound like an orientation period that was handled in the most appropriate manner. When I used to be the educator for a very large ED, I met with each orientee on a weekly basis, with their preceptor to go over what was going on... what they needed, how they were doing and what is the plan for the following week. We discussed issues early and had time limits and evaluation periods with regular, scheduled feedback. You should never put a new employee out with a preceptor and then say "GO!!". There has to be some monitoring and follow up or else you do the new employee, the preceptor and the facility a disservice. It costs a lot of money to hire and train a new employee. You must have some structure and a feedback process.

[Up2nogood RN, RN]

Oh she's been fired.... I was under the assumption she quit d/t new management. That changes things. I think she deserves one more chance and if she doesn't step up, find some way to get over her 'nerves' than she should be let go. You've given her plenty of learning opportunities and she should be 'getting it' by now. At my place of employment management doesn't have to play by the same rules during the orientation period. One can be let go rather easily if things aren't working out and an employee is having major issues or aren't a 'good fit'.

You sound like an awesome preceptor so don't beat yourself up it sounds like you've bent over backwards to help this lady and she just doesn't get it.

[Pappilli0n]

Not having worked as an OR Nurse, I'm unsure how you assign patients to the individual nurses. On the floors

there's an Assignment Board for each shift. Because of Hippa only the room and bed #'s are listed by my name. If you have an Assignment Board in the OR, give it to her and let her see HER assignment for the shift. Nothing

more should need to be said. Of course verbalize your supportive role and that should be it, UNLESS, she does

not pick up and do her assignment, THEN a meeting with your Head Nurse should follow. Perhaps the woman/

fellow is having second thoughts. Perhaps she/he is in over their head!!

[OCNRN63, RN]

Update-I have spoken to a few surgeons and they are totally against this nurse continuing with orientation. I was chatting with them today about different subjects and this nurse came up. They had no idea that I had precepted her and were talking amongst themselves about "this new nurse that had no idea what she was doing and I don't ever want her in my room again!".

Before, only the nurses had concerns. Now the surgeons have concerns, and I feel that I must address this in a professional way with the NE. Although I feel bad knowing that this nurse was fired from her previous job (I also talked to a friend who currently works at her former place of employment and knows her rather well), I also feel that I must speak up now in order to save both the hospital's time and the nurse's time.

I absolutely HATE being in this position. On the one hand, I am the biggest cheerleader for nurses, but on the other hand, I also must recognize and be responsible for the safety of the patients. Does that sound totally altruistic? Do you guys think I am being harsh? Do you think I should let her go a few more weeks to see if she is more comfortable?

You've been anything but harsh. I think giving her more time is just going to prolong the agony. The docs have their faces set against her. You and I both know what that means. You need to start thinking about protecting your own career at this point and not letting this girl suck you under. I don't know you personally, but from here, I am confident that you are a skilled OR nurse, the kind I would want taking care of me. Don't let this foolhardy individual drag you down.

If you ever feel the need to really vent, feel free to PM me. I love to listen.