New grad know it all

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Most new grads are great and have the insight to ask thoughtful questions rather than debating their preceptor. Please consider keeping an open mind when someone with experience shares their knowledge. Maybe there is a slight chance that you don't know better just yet? :uhoh3:

Specializes in Trauma Surgery, Nursing Management.

I am a primary preceptor in my specialty. The new nurses that I LOVE to precept are the ones that ask, "Why?". Now I am not talking about the "why" questions that a 5 year old asks at the end of every explanation...I am talking about the "can you explain the rationale behind your decision to do XYZ." That lets me know that the new nurse is trying in earnest to conceptualize and comprehend the rationale of my implementations.

I recently had a new nurse that questioned my every decision. I had to bite my tongue and remind myself to be patient, but his questions came across as challenging. He would debate the implementation of a safety belt application before induction of surgery because he knew that the surgeons would just release it after induction to prep or to position. I explained that it is A SAFETY ISSUE during induction and then went on to explain the pharmacomechanics of induction agents and the resulting fasiculations that are commonly observed immediately after induction. He continued to scoff at my explanations, and then made a downright bad decision. I was teaching him how to place a foley in the OR. I stressed that if he met any resistance AT ALL, he should stop advancing the foley. I explained my rationale, including teaching about strictures. I also made it very clear to him that when cathing males, advance the foley all the way to the "Y" of the foley. He proceeded to tell me that he didn't think it was necessary to do this, and that there is no possible way that the foley would need to be that far advanced before deploying the balloon. I again explained that to advance the foley all the way and THEN deploy the balloon slowly is a safer method, and that after the balloon is inflated in the bladder, the extra length of the foley will come out. As many times as I explained this to him, he just wouldn't do it. You can guess what happens next. After he was on his own, he didn't advance the foley as I taught him, he inflated the balloon while it was still in the urethra, and a 14 year old kid now has damage to his urethra.

This is just an example of what can happen when a new nurse thinks that they know it all. A patient was harmed, and even more heartbreaking, a CHILD was harmed.

I welcome all kinds of debates and questions when I am teaching, but I also expect a new nurse to TRUST in my rationale. If they still have doubts, then they should ask their NM for clarification.

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I have worked for YEARS to ensure that I have at least some social graces, as I have this habit of being very direct....So yes, I will be remembering to tread carefully, but confidently.

I don't think you really have to justify why you're asking anything..... people will expect you to be asking questions. You could try something like "I've been wondering why you didn't wear gloves when we did x, they told us in school to always wear gloves, does it depend on the situation?" rather than "I can't believe you didn't wear gloves when we did x, gloves should always be worn!". Not really a good example but the best I can come up at the moment, can you see the difference? This also gives the nurse the opportunity to explain why she felt gloves weren't necessary in that instance, and you can (privately!) either take this on board or not, depending on what you think of her reasons.

A lot of it is in the tone of voice, body language and general attitude, and waiting until you both have a few spare minutes rather than jumping on the nurse when they're in the middle of something. Also, try to remember that even if you've been a taught a new or better way of doing something, it doesn't necessarily mean that the 'old' way is 100% dangerous and wrong. Often the new way is just slightly better, or somewhat more safe, and sometimes it's neither, it's a just a different way of accomplishing the same thing.

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As someone who tends to blurt out whatever passes through my head

That is SO me....A thought just came to mind, as well...I wonder if all these new grads are spending so much time quoting their textbooks and "proper procedures" because of the severely limited allowances today, in regards to mistakes (being fired over one mistake, sued, losing their license, etc), as well as our amazingly ridiculously litigious society??? (that was a mouthful...Sorry I have no clue how to word that last sentence, any better!:D)

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now, see even if I just say things bluntly, there is no way I would continually ARGUE with the person in charge of teaching me what I needed to know. The guy has some nerve, doesn't he??

That would be lunacy and seems to me, would be especially dangerous. How sad for that poor kid.

I am a primary preceptor in my specialty. The new nurses that I LOVE to precept are the ones that ask, "Why?". Now I am not talking about the "why" questions that a 5 year old asks at the end of every explanation...I am talking about the "can you explain the rationale behind your decision to do XYZ." That lets me know that the new nurse is trying in earnest to conceptualize and comprehend the rationale of my implementations.

I recently had a new nurse that questioned my every decision. I had to bite my tongue and remind myself to be patient, but his questions came across as challenging. He would debate the implementation of a safety belt application before induction of surgery because he knew that the surgeons would just release it after induction to prep or to position. I explained that it is A SAFETY ISSUE during induction and then went on to explain the pharmacomechanics of induction agents and the resulting fasiculations that are commonly observed immediately after induction. He continued to scoff at my explanations, and then made a downright bad decision. I was teaching him how to place a foley in the OR. I stressed that if he met any resistance AT ALL, he should stop advancing the foley. I explained my rationale, including teaching about strictures. I also made it very clear to him that when cathing males, advance the foley all the way to the "Y" of the foley. He proceeded to tell me that he didn't think it was necessary to do this, and that there is no possible way that the foley would need to be that far advanced before deploying the balloon. I again explained that to advance the foley all the way and THEN deploy the balloon slowly is a safer method, and that after the balloon is inflated in the bladder, the extra length of the foley will come out. As many times as I explained this to him, he just wouldn't do it. You can guess what happens next. After he was on his own, he didn't advance the foley as I taught him, he inflated the balloon while it was still in the urethra, and a 14 year old kid now has damage to his urethra.

This is just an example of what can happen when a new nurse thinks that they know it all. A patient was harmed, and even more heartbreaking, a CHILD was harmed.

I welcome all kinds of debates and questions when I am teaching, but I also expect a new nurse to TRUST in my rationale. If they still have doubts, then they should ask their NM for clarification.

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Something tells me you're going to do just fine greenfiremajick. I would wish you good luck but I don't think you need it, you sound like someone I would love to work with.

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Something tells me you're going to do just fine greenfiremajick. I would wish you good luck but I don't think you need it, you sound like someone I would love to work with.

How wonderful of you to say so. TY.

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