Need Advice with Encouraging Staff to Precept New Hires!

[That Nurse86]

I am hoping some of you have insight/experience with difficult employees not being friendly with new staff and refusing to train as well.

I am an education coordinator at a large SNF/Rehab facility. For our new nurses and CNA's I do general orientation and basic training with them for a week then they get assigned to a floor staff member to precept them on their assigned hall. We are having trouble specifically with our night shift staff refusing to train new staff for nurses and CNAs. I think a main reason for this is the senior staff are set in their ways and get upset when they get "bumped" off their assigned unit to precept a new person. It's in their union contract that new staff stay on the same unit for so many days which is why the person precepting has to train the new hire on the floor the new hire will be assigned to. Then we have staff train that are not very friendly or welcoming to our new hires and those that do not get scared away don't receive a very thorough training. On top of all this many of the current staff do not get along, are constantly fighting with each other, and I fear teamwork/communion is just not what it should be. Like most LTC facilities we struggle to retain nursing staff and have many open positions. Since this is a facility that mandates nursing staff you would think they would welcome new hires with open arms but sadly this is not the case.

So the point to my long saga here is I am wondering if anyone has had similar experiences to this and did any interventions work? I want to improve the work environment and the way we train our new nursing staff. Also to help engage floor staff to wanting to train.

[SummerGarden, BSN, MSN, RN]

OP: Your post reads as if there are multiple issues wrapped up in the outcome of staff not being welcoming to new comers. I think there are two approaches you can take in partnership with managers.

One, survey staff regarding job satisfaction and look at areas of perceived needs from the night shift staff. Then show the results of the survey to management and partner with management to meet those needs. As an aside, if you have staff fighting and arguing with each other in the workplace, you also have supervisors and managers who are not doing their job and tolerating poor behaviors.

Second, design and offer a course on being a preceptor, where the expectation of being a preceptor includes being evaluated as preceptors after precepting. This way, if employees are poor preceptors after being trained, you can identify reasons why and support that staff member to be better, but remove them from that role if supports do not work. Poor preceptors, as you have written, run off new talent.

As far as convincing staff to become preceptors? You will need to partner with management to offer incentives (rewards) for being a preceptor.

By the way, these are just a few ideas off of the top of my head. I am sure that there are more things you can do... I look forward to reading the ideas of others. ?

[caliotter3]

One big detractor I witnessed in more than one facility where I worked in the past, is that some facilities boil down to an employee population that is very, very homogenous, for whatever reason, over time. When this occurs there tends to be a level of "incest" (can't think of a better term right now) that can become impossible to break. I have seen many a manager who did not fit the majority "mold", that would not lift a little finger about anything, because they feared the repercussions. Rot from the bottom, rot from the middle, or rot from the top, it all adds up to the same dysfunction. The group decides if you go or stay, if your stay will be horrific while you are there, or if and when you will be accepted. I learned the hard way to avoid such places for employment.

[amoLucia]

to caliotter - WOW!! First thing I thought after reading your post. WOW!! Something I had never had thought about before. And like you, I worked many a LTC facility (good, bad and UGLY). But you do have a cogent point there.

to Summer - you've hit a nail on the head re managers & supers not doing their admin responsibilities. They may be feeding into the precepting problem directly and indirectly. That needs to be addressed as well. But not dove-tailed onto your training.

I support your idea re incentives. Folk always seem to respond better when there's something in it for them. But any incentive must really be a worthy one. Not just meal vouchers or designated parking spot. Like what good are they for most NOC employees!?!? ('Nuff said!')

I semi-support your idea re a Needs Assessment Survey. I really do like them, but I would be very cautious about pushing the bit about a preceptor being evaluated by the new precepting nurse. To me, it would make me, the experienced nurse/CNA, feel like being setup for potential punitive action. (And I don't know that a Union would be too happy with that sentiment also.) Not a bad idea though to somehow measure or 'track' (FOR YOUR EYES ONLY) who's leaving, who's doing substandardly and then WHO was the preceptor.

to OP - Is this problem being only noted in your nsg dept? How are the other depts doing? Too few new employees to be a prob, yes?

How is scheduling being coordinated? Are both employees' scheds the same? Can they be matched for continuity of training?

How long do they orient? Can you dedicate some of your time, even for a short time as nec to touch base re SPECIFIC items that are covered on a cklist?

Are any type of exit interviews being done? I doubt unhappy employees will be much avail or coop/honest for such an interview. Maybe you could mail a SHORT questionnaire post-separation? (SHORT and with a return envelope.)

I'm guessing that you have detailed orientation guidelines and checklists. You need a way for yourself to track the orientees while orienting. Maybe some kind of 1:1 meeting with them freq, if even only for a few mins.

Can you make some things self-learning modules/exercises?

Hope some of my ramblings help. I could think of more if I thought about it long enough. I liked Staff Devel Coord and I liked to floor orient as staff as well. I always even gave down & dirty orientation for agency float nurses. I just wanted to feel comfortable for MYSELF that I was leaving the next shift agency nurse a little better prepared for her new shift - like showing her the keys to get into the locked staff bathroom.

[Conqueror+, BSN, RN]

Pay them extra when precepting and lighten their patient load because a shift takes twice as long when you have to train someone.

[TriciaJ, RN]

I would hold face-to-face meetings with the night staffers during the night, when it works for them. During the meetings, tell them what you told us in your original post. Why it behooves them to help train their coworkers.

ASK them what is getting in the way of them being able to do this. Is it possible they are so short-staffed that they just can't attend to another task? Is it because there is such a high turnover they don't want to put time and energy into a bottomless pit? LISTEN to what they have to say and don't allow generalized ***ing. Require specifics. pertinent to the problem at hand.

Some of them may have good ideas or at least good information. Try to schedule follow up meetings with these people individually to get a better grasp on what's happening. (There may be a ringleader that no one wants to risk outing publicly.)

Ask what type of incentives would make it worth their while. Schrute Bux and ice cream socials probably aren't going to cut it.

Just the idea of management willing to turn up in the middle of the night and address issues head on might be a bigger morale booster than you expect.

[amoLucia]

15 minutes ago, TriciaJ said:

... Just the idea of management willing to turn up in the middle of the night and address issues head on might be a bigger morale booster than you expect.

So very true.