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?

[caliotter3]

I would not be surprised to find out this person has suffered some kind of brain injury recently, a stroke. I hope that someone is able to get her the help she obviously needs, over and above the job situation.

[canesdukegirl, BSN, RN]

I would not be surprised to find out this person has suffered some kind of brain injury recently, a stroke. I hope that someone is able to get her the help she obviously needs, over and above the job situation.

You know, cali, when I was venting to my BFF about "a new nurse that I was having difficulty training" and went through some of the described behaviors, I said that she was from the hospital that he worked for. He asked, "Is this new gal Nurse X by chance?" Apparently she has exhibited this behavior for many years. Before I knew that, I was thinking either traumatic brain injury, lack of socialization or benzo use. I think she is just...different.

[canesdukegirl, BSN, RN]

but how does she respond when directed to, "you need to do a, b, and c", or "i am assigning you these 3 pts"...

what does she say?

i'm 'assuming' that she has been given imperatives.

leslie

I did just that Les...I told her that when the pt comes into the room, you need to a. get warm blankets b. help transfer the pt onto the OR bed and c. apply the safety strap. So the pt comes into the room, I am nodding my head to her to go ahead and do what we discussed, aaaaaannnnndddd....nada. Nothing. She stands there with her hands behind her back and smiles. Looking on.

When a third nurse was precepting her, she gave the very same directions. The nurse's response was, "I know." She still failed to engage in pt care. This has become a big concern to all of us and as I posted previously, the managers are meeting Monday to discuss further orientation for this gal. I swear, I have never seen anything quite like it.

[Kim5/08]

Given you have done everything you have to this point, If I kept getting the answer "I know." I, being a bit blunt myself (but I hope polite) would respond with "Then why haven't you?" If she then continued to be evasive I would (again because I am blunt) state, "That is not my question. You know you are supposed to get warm blankets, help the patient transfer and secure the safety strap. Why didn't you do that?" Have you been documenting this orientation? Date, tasks assigned, "counceling" when tasks not performed, names dates and times of meetings/emails sent to superiors, etc? Just my suggestions in case you get her for "further orientation"!

[ukstudent]

What has been the out come? Is she still with you or has she been let go? Or is she now doing pt care?

[canesdukegirl, BSN, RN]

She was with another (experienced, reliable, caring) nurse this past week. The nurse STILL had to be prompted to do patient care (ugh!) and had to be stopped from harming a patient, so my guess is that she will be gone soon.

[klone, MSN, RN]

Update: y'all...(pulling my hair out a la "Tommy Boy") she is not getting better. The situation is now going to our DON. I mentioned in my original post that this nurse told me that she decided to leave due to new management. My BFF works at the hospital that she left and told me that management cut her loose.

So now it is week 3 and she is still not doing patient care. I have refused to orient her further, and am hearing from other nurses precepting her that she is simply at a loss. When she is prompted to do something, she just stands there, smiles, and says, "I know." One of her preceptors came to me yesterday to vent because she was beyond frustrated. This preceptor is absolutely STELLAR in her gift of teaching. She is very patient, she is assertive and she takes into consideration that a new nurse is lost at times. The straw that broke the camel's back was when this nurse answered the phone, ended the conversation, and didn't hang up the phone. She just left it on the table. Her preceptor said, "Uh, you wanna hang up the phone?" The nurse said, "Oh I guess so."

I think that there may be something seriously wrong upstairs. She does not act nervous, does not act intimidated by the care itself, does not shy away from conversation...so I am out of reasons as to why she is acting the way she is. My guess is that come Monday, she will be OTD.

THis sounds a lot like a nurse several of us precepted. She was a new grad, so we tried to cut her slack for a long time (I think 6-12 months), but she didn't get it. You'd say something to her, and she'd just stare at you and smile. She would say some really off the wall and inappropriate things to patients. It was really odd. She was let go, and I think she quit nursing altogether.

[klone, MSN, RN]

She was with another (experienced, reliable, caring) nurse this past week. The nurse STILL had to be prompted to do patient care (ugh!) and had to be stopped from harming a patient, so my guess is that she will be gone soon.

Dang, this sounds SO much like the nurse I mentioned in my post above, it's eerie!

I think it was determined that she was on the autism spectrum. She did really well in nursing school with the book learning, but just couldn't deliver good patient care.

[GHGoonette, BSN, RN]

Dang, this sounds SO much like the nurse I mentioned in my post above, it's eerie!

I think it was determined that she was on the autism spectrum. She did really well in nursing school with the book learning, but just couldn't deliver good patient care.

I thought this could be the case when I read your previous post; such a tragedy, and I hope she eventually found a niche that was within her functioning level.

[eriksoln, BSN, RN]

Funny, I'm orienting to a new unit and I have the opposite problem. My preceptors do too much for me. I want to gage myself and can't. Every time I turn around, they are doing orders for me or getting a pain med.

When I was a travel nurse, I had nurses with less experience orienting me a few times. Not an issue. It went like this:

Day 1 - I follow, assist with care and "fetch" things to learn where they are.

Day 2 - I take a few patients completely under my wing.

Day 3 - Assignemnt is mine, I do it all, they let me know if I missed anything.

The person you are with isn't motivated and, unfortunately, that won't improve when they are on their own. Once, while I was charge nurse, I had a person just like this. Always had her nose burried in the policy manual, loved watching pt. care, not too in love with being involved in it. She had to pass meds, so I told her preceptor to let her do it for a few people before I signed off on it. She magicaly became ill when we told her she'd be passing meds and proceeded to inform me she'd be spending the day (again) reading the policy manual.

I told her "You can't stay here if you are sick". Sent her home. She tried to reverse her story and all of a sudden was no longer ill, but.......we wouldn't have it. Supervisor agreed with me, didn't want someone taking a dive while on the premesis either so......away she went. When she was off orientation and on the floor alone, she lasted one week. Turned out the position was "too much work".

[GHGoonette, BSN, RN]

Erik, I suppose you're too young to remember Barbara Woodhouse; I think your preceptors would benefit from some "SIT! STAY!" training.

I think Canes' preceptee differs from the one you describe in that there are definitely some mental issues with this one. Your experience appears to have been with one suffering from the dreaded Terminal Inertia...

I also sincerely hope that your former preceptee gets the help she needs; I would prescribe repeated kicks to the butt and Smart Ejector Chairs, pre-programmed to forcibly eject all those who over-utilize them...