I just don't know how to do this....

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I'm having a problem with a newer RN. She is a VERY nice woman, don't get me wrong. But, whenever anyone gives her report, there is a problem. She doesn't do anything that you tell her about when you leave...and then you come back in and when you ask a question...blank stare.

We have a pt who has massive leg ulcers on a wound vac...with one wound that we need to do cleansing and dressings on once a shift. So, it was done the night I got him from another floor. when I left yesterday, I gave detailed report about the wound care and said "it's in the chart, and all the stuff's in the room. If you have questions, it's written there.' also, said exactly what we were doing.

When I came back last night, nurse tells me "oh, I changed the bandage to the heel." Oh, ok, how bout the wound care? "uhh....what wound care?":banghead::banghead:

His IV system was open at the cartridge, so when I went to hang antibiotic, I got a yellow antibiotic bath....ugghh.

Then, doc wrote orders for another pt to have a foley removed, PVR done 4 hrs after, and PVR once a shift. AT 9AM! It was still there when I came in...at 5P.

She has had 1 less week orientation than me...and still only can handle 2-3 pts...only if they are stable. (I was a CNA for 2 yrs before, but that can only explain so much).

When I was giving report, the day RN asked me to write a "paper trail" for our boss...over the next few shifts I work with her....not because we're out to get her...but because the concern is for pt safety and orders being followed/carried out.

I am NOT the kind of person that wants someone to fail...but I almost want to grab her and say "wake up!" If you don't get it, you'll be gone! I am planning to keep a sheet here and there...but only on "major issues" (like the wound care order.....Foley order, etc.) Any advice?

Specializes in LTC, home health, critical care, pulmonary nursing.
Your "paper trail" for the boss sure does make it seem like you're out to get her. I can't help but notice you mentioned that she's a newer nurse. Try taking her to the bedside and physically show her what needs to be done. I'm new too, and I still need a lot of people with things I'm not familiar with, such as vacs, PCAs, special wound changes, and so on. SHOW HER. sometimes new RNs like myself want to prove ourselves so we wont ask the questions we should. Politely fill her in on it, take her to the beside and do a return demonstration if that is how she learns. sometimes it takes multiple times doing the same thing before you get the hang of it without needing help. and stop trying to get her trouble with the boss (whether you think youre doing that or not). how on earth is firing her going to make her better at another job she finds when no one has taken the time to do show/do things with her at your job?

An RN gave me detailed instructioned on how to change a PCA vile during report. step by step. I got to the beside (alone) and I had no idea what to do. text to reality isn't the same thing at all

That being said, as a newer nurse myself, if I don't understand something, I have a responsibility to my pt to take the initiative to ask for help. It is not acceptable to endanger a patient by simply ignoring something because you don't know how to do it.

If she isn't providing safe nursing care it needs to be addressed. Perhaps one of the seasoned nurses should bring this to the attention of the NM ASAP. She might need more one-on-one before being left to her own devices and taking on her own patients. This is something the NM can decide and if experienced nurses make her aware patients are suffering I'm sure it can be addressed quickly. Continue to document, document, document in the interim.

Specializes in Homecare Peds, ICU, Trauma, CVICU.

I don't understand. If you are working a different shift, why are you responsible for "teaching" her. Are you being compensated for this extra time beyond your shift when you are going above and beyond the time normally spent for report at shift change? And if she is on orientation, where is her preceptor and why is she not being held responsible for the things not getting done?

It doesn't sound to me like this nurse is overwhelmed- it sounds like she just doesn't get it.

Someone who is overwhelmed can be assisted with prioritization, time mgmt, skill honing, and will improve.

But this is different- the OP gave this nurse specific instructions in report about changing the wound vac dsg, told her where all the stuff was, etc., and I'm sure it says on the kardex to do the dsg change once a shift. Yet, when the OP returned and asked about it, this nurse says "what wound care?" !?

These are big red flags, imo. Being a newbie and being clueless are two entirely different things, and this woman sounds clueless.

If a pt is harmed to due her actions/inactions, and other staff are aware, but not fully documenting and following up, the other staff can be held partially responsible.

Even though it may make us feel bad to leave a paper trail of negatives about a nurse (I've had to do it), it is necessary in cases like this- for the safety of the pts and for your license.

Specializes in pedi, pedi psych,dd, school ,home health.

I have to agree with Valerie. this person is not just overwhelmed; especially if she accompanies constructive criticism with anger and fingerpointing.

Lorenzo, as difficult as it is you NEED to do the paper trail. As a NM myself, I cant do a thing about a situation until i have the facts.

discussing her issues among the staff wont help her or the patients. If you do take the extra time (which she should appreciate) make sure to document that.

You are trying to help, I know; however you need to protect your license and the patients.

Specializes in Acute Mental Health.

I don't understand. If she's still in orientation, where is her preceptor? It's called orientation for a reason. There must be somebody that oversees her right? It sounds like she needs more 1:1 with a nurse, at least with procedures she seems to be unaware of. I agree that telling me step by step in report would be difficult once I got to bedside, but I would ask a fellow nurse to watch me and guide me through anything I'm not comfortable with. How frustrating for everyone! I can hardly wait until its me out there. :doh:

Specializes in Ortho, Neuro, Detox, Tele.

That's just it. I don't think she's going to last...and I don't know why the preceptors aren't being held responsible. I'm starting paper trail on everyone. I received a wrong report today about cumadin vs lovenox....and the system says NO cumadin was given, and the lovenox was....I wasn't told about the lovenox, and the cumadin was given per the report I got. By the time I checked the chart for past shift orders, It's 2AM. Whoa...where'd this come from?

My own personal opinion now is, I'm not out to get anyone, but pt safety comes first. I'm covering my butt, reporting off, and saying...."ok, I'm not being mean, but here's what's happened?"

The biggest issue that I think is causing this is that the preceptors are signing the orders....not the orientees...WE all know that if you are the one who verifies it, it will probably stick out versus going "whoops, didn't see that.." or the preceptor showing you, and then expecting you to remember later.

But the medication issue is BIG to me. (that one is a newer orientee...so I'm cutting as much slack as I can.)

Thanks all again for your opinions. I'm just going to do what I think is right.

Specializes in onc, M/S, hospice, nursing informatics.
Your "paper trail" for the boss sure does make it seem like you're out to get her. I can't help but notice you mentioned that she's a newer nurse. Try taking her to the bedside and physically show her what needs to be done. I'm new too, and I still need a lot of people with things I'm not familiar with, such as vacs, PCAs, special wound changes, and so on. SHOW HER. sometimes new RNs like myself want to prove ourselves so we wont ask the questions we should. Politely fill her in on it, take her to the beside and do a return demonstration if that is how she learns. sometimes it takes multiple times doing the same thing before you get the hang of it without needing help. and stop trying to get her trouble with the boss (whether you think youre doing that or not). how on earth is firing her going to make her better at another job she finds when no one has taken the time to do show/do things with her at your job?

I disagree. It's not your job to be her preceptor. If she didn't learn what she needed to know in orientation, then it's up to her manager to re-assess to see if she needs additional orientation. If not, then she should be going to her charge nurse to seek guidance. One shift's nurse should not be expected to bottle-feed the next shift. I don't think that you are trying to get her in trouble. But patient safety comes first, not her job or her ego or anything else! Keep that paper trail and don't feel guilty about it. You have done much to try to help her.

I have to agree with Valerie. this person is not just overwhelmed; especially if she accompanies constructive criticism with anger and fingerpointing.

Lorenzo, as difficult as it is you NEED to do the paper trail. As a NM myself, I cant do a thing about a situation until i have the facts.

discussing her issues among the staff wont help her or the patients. If you do take the extra time (which she should appreciate) make sure to document that.

You are trying to help, I know; however you need to protect your license and the patients.

To me, a big red flag would be with how she handles constructive criticism. If she gets angry and defensive, she won't learn anything and a patient could get hurt. Please let us know what happens.

From reading this thread, it does not seem that the nurse in question is getting angry or defensive- she's just not taking care of her pts, and not doing her work- she's just not getting it.

Specializes in Operating Room Nursing.

As a new nurse you do have to speak up and say 'I'm not sure how to do this, can someone please help'. Just being passive and doing nothing, showing no initiative is unsafe for patients and not fair on the other nurses who have to pick up her workload.

It sounds as though she needs to be supported and encouraged by her preceptor. If she still doesn't get it well maybe she's just not going to be capable.

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