Need advice about precepting!!!

[TigerGalLE, BSN, RN]

Hey everyone. I have been precepting a new nurse for 7 weeks now. She was an LPN at a LTC facility for 2 years while in school to obtain her RN. She now has her RN and decided she wanted to work in a hospital setting vs. the LTC facility she was currently at.

She has experience and her time management is great! We are approximately the same age and we get along great. We have a lot in common and she seems like a nice girl.

Here is the problem... I don't think she quite understands that acute care is different from LTC. She kind of has that I don't care attitude when it comes to acute issues. She thinks patients are whining or over reacting about everything. For example a pt was c/o chest pain one night and she said she didn't think we needed to call the Dr. b/c this particular pt was such a "drama queen." I agreed that the pt was a major drama queen but I also had to explain that this was a new issue, the pt was very ill already, and we needed to at least cover ourself.

Also when I try to teach her something new she does that... "ok ok I know I know" She turns away from me when I try to explain how to do something. I'm not sure if she just doesn't want me telling her what to do b/c we are peers or if she just thinks she already knows. If I check behind her I can tell she gets annoyed and it is like she doesn't want me checking on her.

Also she just goes and does without letting me explain (like when she gets new orders).. She will say... "well I just figured out how to do it." She kind of scares me because she doesn't ask and she just does.... And she will say "well at the nursing home we just did what we could with what we had."

She has even mentioned to me once that she doesn't give all her pts at the nursing home all their meds all the time b/c "they don't need all that stuff."

Hmmm... Makes me wonder......

The other night one of her patients was not doing well.. Her continuous O2 sat monitor kept alarming. The pt's sats were dipping into the 60s and I went into the pt's room with RT to check on the pt... She never even got up from the desk to help us.. Or see what was going on with her patient..... I asked her about it and she said... well I figured you guys had it covered... SO??? Don't you want to learn?

Right now we are on nights and she is taking 5 out of the 7 pts.... Should I back her down to less patients? I just don't know what to do... I'm really starting to worry about her.

Tiger

[BookwormRN]

Do you not have to fill out evaluations on this nurse?? I would definitely let my manager in on this nurses behavior!!! She sounds scary to me.

[mauxtav8r]

In my neck of the woods, the preceptor gets a bonus if their orientee makes it, but on the other hand they are held somewhat accountable if their orientee makes big errors.

Not that the new nurse is practicing under your license, but that they should know better.

Does your facility have a requirement for the newbies to read policy before getting off orientation? If not, maybe you could make that suggestion . . .

This sounds very dangerous. Please cover yourself.

[CHATSDALE]

this is a dangerous nurse in the making..you need to nip this in the bud

sid down with her and explain that she is endangering your license as well as hers

she is not in a ltc

this is not acceptable behavior in a ltc either

it is your duty to do teach her and to check behind her until such a time as you feel confident that her habits have improved and you feel safe to leave her with patients

[Blee O'Myacin, BSN, RN]

There seem to be a few things going on here. While precepting a new nurse, he or she is not quite a peer. You are ultimately responsible for the new nurses' assessments, interventions, and documentation. Liking her personally has to come secondarily to this. Sometimes you need to take charge even if she resists - like calling a doctor for CP, or a patient's sat dropping into the 60's - I imagine a RRT was called. There should have been no choice about her presence in the room. It is your responsibility to keep her on the course, even if you would like to be friends after you are done being her preceptor.

When I had a new grad, she and I would "rally" after a particularly rough patient. We talked about when she hesitated to act when an intervention was needed, and the initiative taken without my input - patients seen, worked up seen by the MD with me only checking charting and eyeballing the patient discretely from the hall. (I'm in the ED) But it wasn't me criticizing her - it was teaching. We talked about how she was feeling at the time. Her patient came in short of breath and talking, and we ended up doing a RSI, the patient then coded and died. Nothing that we could have done sooner would have saved this patient. It was a messy, long drawn out code and she hit it out of the park, but still felt awful. It was my job to point out all the things she DID do.

Take the chance to talk to her when filling out all the paperwork. Tell her what's been going on from your end and see how she feels about it. There can be something going on with her that you are unaware of. Precepting is just as much of a learning experience for us as it is for the new grad.

Take care and good luck!

Blee

[mondkmondk]

this is a dangerous nurse in the making..you need to nip this in the bud

sid down with her and explain that she is endangering your license as well as hers

she is not in a ltc

this is not acceptable behavior in a ltc either

it is your duty to do teach her and to check behind her until such a time as you feel confident that her habits have improved and you feel safe to leave her with patients

As a LTC nurse myself, this is not acceptable, I totally agree. If I'm responsible for training an orientee...I act like a teacher and follow behind closely; remember, you aren't there for a popularity contest and if she doesn't like you following behind her, there is definitely a reason. Think of the patients and make sure she does too...I think in this case, you should be over assertive and "take charge" in teaching her. Just my humble opinion.

Blessings, Michelle

[Hands and Heart]

As a new grad myself, I WANT feedback and support from my preceptor. Soon I will be responsible for all my patient care actions and want to know when I flub up now so I can avoid repeating those mistakes. I want my work checked for thoroughness and correctness. Any new grad that doesn't want to be checked behind throws up RED FLAGS!!! As the preceptor, you must be the advocate for the patients' safety. Your nurse manager must be made aware of this nurse's actions and attitude. The point of a preceptor is to ensure proper enculturation of new nurses. Do you want the culure of nursing to reflect disregard for patient safety and care?

[Straydandelion]

I have a couple of thoughts.. she has been precepting with you now for 7 weeks, has she had this "attitude" the entire time, or is just developing it lately?

...we get along great

It almost sounds like she has some issues either with you or the facillity but I would DEFINITELY be worried.

She never even got up from the desk to help us.

I think it is time you take off the "nice" gloves. As her preceptor make sure she takes care of her patients properly and make a paper trail of all issues to discuss when needed with the nurse manager (I would also inform your nurse manager of your concerns). In this instance I would have gone to her and informed her of her patient letting her know you expect her to to take care of the patient.

[TigerGalLE, BSN, RN]

She has just started to develop this attitude lately it seems. Only during the past 3 shifts or so has she developed this attitude of not wanting to learn. But she has had the attitude of "I already know that" the whole time. At first I thought it was good that she had experience and I thought she was very knowledgeable... However, recently I've seen her pretending to know and not doing things correctly with me having to catch her in the act. During conversations I try to slip statements in about how it is okay to ask questions, and always ask if you are unsure, and how I used to always ask other people questions even if I thought I knew the answer just to double check... She agrees with me when I say these things and says things like "Oh yea I know I can always ask someone." But then she still goes and does stuff without asking me. I haven't caught her doing anything dangerous yet... but I'm afraid that will happen.

I'll just have to be more firm with her and hopefully the next few shift will go well... Wish me luck!

Tiger

[SoxfanRN]

Open communication is the only way to go. Sit down with her and ask what is with the attitude. Share your concerns. Have examples and objective data with you. Counsel her. Make her understand that this is a new setting and role. Also, make sure she understands that even though you get along great, you are her professional preceptor and this is a professional matter. After all that, document the meeting and share with the manager.

[classicdame, MSN, EdD]

I recommend weekly evaluations to our preceptors. That way they can cover issues as they arise, then when it comes up again, they have documentation that "we have already talked about this". Here is a model to use for evaluation: BEER

B- what is the actual behavior to which you object? BE specific. This also keeps it from being too personal.

E- what is the expectation? This makes clear why the behavior is objectional.

E-What is the explanation for how you really want it done?

R- what will be the result if the preceptee does not change behavior?

[MadzDAD]

Talk to this preceptee in frank, blunt language. Know-it-all attitudes usually know LESS... And are DANGEROUS... Imagine your mom, or child under her care once no one is watching over her shoulder. Scary stuff...and there's too many of them out there already.