Hi experienced nurses. I’m a 5 year med/surg tele nurse at a community hospital. It’s A large unit. I just started precepting a new hire/rehire about three weeks ago. She’s at week six already. I’m told she’s been working at an office as a health coach, but was in hospital several years ago.
shes been out of the hospital 8 years. Any tips on getting her better up to speed? She doesn’t seem to be getting it!
She’s very good with the routine head to toe assessment and charting the routine daily required documentation, but that’s about it.
It gets as basic as making sure she pulls two pills instead of one...always has to run back. Minimal critical thinking, time management skills, Where to find meds not just stocked in pixie, and some other everyday skills (discharge education, secondary bags often antibiotics, especially when not with current fluids and programming flush bag is needed)
Responses to attempts at guidance is usually me repeating five times for her to still not get after multiple times with skill.... next day, five times explanation of same common skill. And “oh!” Like she’s heard it for the first time.
I’m frustrated. Prior preceptors of hers experience same frustrations.
I’m starting to keep a log of these to turn into educators and manager.
Specializes in Critical Care; Cardiac; Professional Development.
21 hours ago, Sweetheart2005 said:
Hi experienced nurses. I’m a 5 year med/surg tele nurse at a community hospital. It’s A large unit. I just started precepting a new hire/rehire about three weeks ago. She’s at week six already. I’m told she’s been working at an office as a health coach, but was in hospital several years ago.
shes been out of the hospital 8 years. Any tips on getting her better up to speed? She doesn’t seem to be getting it!
She’s very good with the routine head to toe assessment and charting the routine daily required documentation, but that’s about it.
It gets as basic as making sure she pulls two pills instead of one...always has to run back. Minimal critical thinking, time management skills, Where to find meds not just stocked in pixie, and some other everyday skills (discharge education, secondary bags often antibiotics, especially when not with current fluids and programming flush bag is needed)
Responses to attempts at guidance is usually me repeating five times for her to still not get after multiple times with skill.... next day, five times explanation of same common skill. And “oh!” Like she’s heard it for the first time.
I’m frustrated. Prior preceptors of hers experience same frustrations.
I’m starting to keep a log of these to turn into educators and manager.
You definitely should be keeping a log and rating her competence with brutal honesty. If she makes it past the orientation time period and everyone thinks she is competent, it falls back on you. Protect yourself and the patients. She may need extended orientation or she may need to go back to health coaching.
OP Sweetheart - sounds like you should be commended for your patience & concern for this nurse and her future pts' safety.
As I read along, I couldn't help but feel she needs to be told, AT THIS TIME IN HER ORIENTATION, in no uncertain terms, that she's having problems. And that her future is in serious jeopardy. I'm not being mean, just honest. If on completion of probation, her continuation is based on a pass/fail type decision, then it sounds like she would or SHOULD fail and be terminated.
I agree with others to say that to blindside her will be devastating. And cruel, which I don't believe you want. It's just that's she's NOT UP TO PAR to being safe & efficient working on a gen'l floor. I doubt the facility would go out of it's way to provide her a coveted non-bedside position. So she needs to face the fact that this is NOT the position for her.
I'm guessing she has some positive attributes, but I have the feeling the writing is already on the wall. And have some quick down & dirty counselling sessions, letting her know that she has not shown satisfactory progression.
I came online to search for precasting tips and found this post. Everyone's comments will be helpful for me as I am struggling with my preceptee as well. Similar in nature, but he is a new, new grad. I will just have to remain patient when teaching and be honest with feedback.
I hope things get better for you and your preceptee, OP.
As I read along, I couldn't help but feel she needs to be told, AT THIS TIME IN HER ORIENTATION, in no uncertain terms, that she's having problems. And that her future is in serious jeopardy. I'm not being mean, just honest. If on completion of probation, her continuation is based on a pass/fail type decision, then it sounds like she would or SHOULD fail and be terminated.
Agree.
I just think this should be done respectfully, professionally and formally. The employer (representative of administration) needs to have some presence in a situation like this, not just leave it to the staff nurse preceptor to convey.
This protects everyone. It protects preceptors from being accused of NETY or lateral violence by the employer, and it protects the orientee from overly harsh preceptors who are unhappy people that don't give others a chance. **Please note I am not saying the OP is one of these latter people. But we all know they are out there.
How many other preceptors did she have? What is the management involvement in this?
Let her drown a bit while still on orientation and see what happens.
I would advise against the log, or at least share it with her ( previous posters have a good idea) before you take it to the meeting.
Examine your own feelings as a preceptor. You are there to support her and your patients. Criticizing her to make self feel better is wrong. "You" is on a far background.
How many other preceptors did she have? What is the management involvement in this?
Let her drown a bit while still on orientation and see what happens.
I would advise against the log, or at least share it with her ( previous posters have a good idea) before you take it to the meeting.
Examine your own feelings as a preceptor. You are there to support her and your patients. Criticizing her to make self feel better is wrong. "You" is on a far background.
Thank you!
She’s had two others before me. I know one of them discussed same concerns with the educator. Educator, management and charge nurses are aware of the situation. I was working a day with one of her other preceptors and she had addressed concerns while I was there with the charge nurse. I was nodding in agreement as I saw the same things. They say write these things down. Keep a log. Ongoing things that have been told to her time and time again.
I do feel it would be helpful to keep a log regardless. As we go and discuss both as we go and find a time each day. It will help keep me better organized, focused to discuss barriers of moving forward. Even as a set aside a time for same day discussion with her.
This is not the first time I’ve precepted. I typically love precepting. This one is a very difficult one, that has me about to loose my patience, and I’m usually an extremely patient person.
I’m not criticizing to make myself feel better. I’m sorry if it’s coming across that way but that’s not the intent. I’m truly just extremely frustrated with the issues with the progression and concerned that not only she will drown but harm someone or not catch something that leads to harm in the process.
Tomorrow I start week 3 of my orientation as a new grad. From a preceptee point of view - this is what my preceptor does:
1) we have paperwork we both fill out every day and she has to complete it at the end of the week. We both write, a 1 word description of the day, what went well, what didn't and what to focus on the next shift (like 2 sentences each). I honestly couldn't tell you what she fills out on the back of that sheet.
2) I take our whole patient load and do as much as I can. She stays behind me and "catches me up" when I get behind either by doing many "little" things that I just haven't gotten to because I'm working on a bigger thing that she and I are both comfortable with me doing or she does the big thing and I do all the little things. The goal is for me to do more and more each shift and eventually she won't need to "catch me up". Right now IVs get me in the weeds all the time - I'm just so slow but I keep trying.
3) She checks my charting and leaves me notes for things to pay attention to - not necessarily that I did wrong (sometimes it is), but its things to look out for during the assessment. Things that may not seem critical at the time, but could be.
4) We have meetings after every shift to discuss the day. Others have told me that they don't like the way she talks to me - I'm trying to save lives so I don't really care how it comes out of her mouth - its the words she says and not how she says it and she is looking out for me. She is the 1 thing between me staying in this position or getting booted. I need to listen to her. Id have the same opinion if I wasn't new.
5) We do have meetings with the 2 of us as well as our residency mentors - together. I haven't had one of these yet.
On the flip side - we do see one - do one - most of the time. Sometimes its talk me through it while I do the first one and then get watched on the second one without being told what to do at all. She would not tolerate me not knowing how many pills to get out of the Pyxis. My first week, me and the Pyxis had a rough time. I shut drawers with too many pills still in my hand, shut doors that I thought didn't close but really popped open again so I could get out the next med... dropped pills on the floor and had to waste and get a new one. That is all on me now - she will make me work hard before she shows me how to get in there and do that again. Crossing meds over and printing lab labels or adding lab orders to existing things in the lab - nope. She would tell me straight away that I either need to get it or I'm not cut out for this. She will allow me time to write things down and go over it again right then (the first time) if I need to, but if I didn't write it down I'd better try to ask someone else on the sneaky but she will find out. If these were my shoes, someone would be sitting me down explaining reality to me right now, helping me figure out what direction we should head. They wouldn't let me go further. My orientation is 12 weeks and at most I'll be allowed 2 additional weeks. I know at the end of each week if I'm "on track". Each of us is different, but as long as my preceptor thinks that I'll be able to be own my own at the end - then I'm on track.
After thinking for a moment - have you asked her how she feels? I'm acutely aware of where I lack most of the time and admit it and I can verbalize it. If she is clueless that she is lacking, then maybe there are bigger problems.
She’s had two others before me. I know one of them discussed same concerns with the educator. Educator, management and charge nurses are aware of the situation.
But when is the meeting. The one with the person who is actually the subject of all of this?
I don't mean to get testy about this and yes there are orientee situations that are much more difficult than others.
At this juncture there is no excuse for one more orientation day to pass by without having accomplished a review meeting.
The problem with everyone consulting each other and concurring that yes they've noticed the same thing is that it is an awful lot like useless gossip if no one is going to take further action.
Some people cannot make it; they just aren't going to make it. But in my opinion they deserve everyone's best effort before that is decided.
But when is the meeting. The one with the person who is actually the subject of all of this?
I don't mean to get testy about this and yes there are orientee situations that are much more difficult than others.
At this juncture there is no excuse for one more orientation day to pass by without having accomplished a review meeting.
The problem with everyone consulting each other and concurring that yes they've noticed the same thing is that it is an awful lot like useless gossip if no one is going to take further action.
Some people cannot make it; they just aren't going to make it. But in my opinion they deserve everyone's best effort before that is decided.
We’ve individually have had meetings with the educator and she has individually had meetings to go over things that have been discussed with the educator. As of yet at least since I’ve been precepting her (three weeks or so) there has not been a meeting with me, her and the educator.
We’ve individually have had meetings with the educator and she has individually had meetings to go over things that have been discussed with the educator.
I've been involved in programs that operated this way before and worked to change it.
If you think about it, isn't it such an awkward thing? I put myself in the shoes of the orientee and just find it so awkward that their preceptor has a meeting with someone else about them, then later they go meet with the other person to hear what someone else said about them.
Plus the communication ring is not closed (or not guaranteed to be closed), it's a situation that can go wrong in several ways. The other reason I don't tolerate is because it gets dicey as soon as someone else (educator) is telling another person (orientee) what I *supposedly* said about their work.
My comments aren't against you, it's just that I find this set up completely unacceptable. It's so disrespectful to the orientee and preceptor.
I hope you can convince people that all of you should meet together, and I think you should advocate to stop such terrible communication practices in your orientation program.
Good luck getting through this and maybe getting some changes made! ??
Nurse SMS, MSN, RN
6,843 Posts
You definitely should be keeping a log and rating her competence with brutal honesty. If she makes it past the orientation time period and everyone thinks she is competent, it falls back on you. Protect yourself and the patients. She may need extended orientation or she may need to go back to health coaching.