Orienting an experienced RN

I would certainly bring up my concerns to your supervisor. Just because an RN is experienced, doesn't mean she has the developed skills to work in a higher-acuity environment.

I know of many that I wouldn't trust my dog with, and I know of many newbies who are brilliant.

It depends on their intelligence level (yes, believe it or not some brain power and faculties has to be above and beyond AVERAGE).

Not everyone is smart, and not everyone is meant to be in a sicker environment. It is the way of the world.

I agree that you need to let your supervisor know exactly what you wrote above. As her trainer, do you want to have a finger pointed at you for not speaking up when (and you know it will happen) she messes up and possibly jeopardizes a patient's health? Give your supervisor your assessment on her skills in writing and keep a copy for yourself just to cover your own butt.

I'm very curious as to how the RN feels about her own readiness to be off orientation? Perhaps figuring that out could help you determine how to proceed.

For instance, if you ask her if she feels prepared to go it on her own in a week and she blithely answers 'yes,' (as I suspect), then I would think you definitely must go to your supervisor with your doubts.

If she is as aware of her deficits as you are and owns up to that, then perhaps you can go to the supervisor together to address the issue.

Out of curiosity, why is further orientation out of the question? I've rarely seen a hard and fast policy against orientation extensions as necessary.

Thanks for the responses so far.

As far as why no more orientation... I guess money? Another nurse asked for more orientation time a few months back and received a definite "no". It happens this nurse has since left our unit. Maybe this contributed to her request to transfer, can't know for sure. I guess I can always ask. The next schedule is out with her name solo already.

I end each shift with: "How did you feel about today?" "Do you feel like you are managing the computer charting okay?" "What do you think you need to work on?" "is there anything you have questions about?"

I mainly get yes, no, shrugs... She seems to be processing information... but then no obvious return demonstration or verbal acknowledgement.

I can, in hindsight, see that I made the error in assuming the computer charting and calling residents would be the primary areas of weakness because they were her most obvious challenges. I didn't properly assess basic nursing skills. My bad. If a nurse self reports on the training form that she is at an independent level for all assessment skills, how much should I question it?

This is the first time I have trained anyone. And I am learning a ton too! I have stepped into remind her what we are looking for with the various types of patients we are getting. Her number one question is, "Is that typical?" Working with residents nothing is hard and fast. We get a new rotation every month. Different night call every week. May is nothing like July. Typical in not typical.

My unit supervisors have been asking me about her progress. I have been cautiously optimistic because I wanted to keep things positive. I have told them she hasn't been fully challenged, but doesn't seem to have a high gear. She has mastered the computer, as far as appropriateness but not speed. Unfortunately, we have only had one shift where she really needed to pick up the pace. She ended up in tears twice. The worst thing that night was her inability to ask for help. That will get her in trouble in the future. I don't think she gets what she is in for. It has been *atypically* slower than the norm.

I will definitely keep the lines of communication to the top open. The other nurses on the unit have commented she is a little slow moving and to pick up on things. I try to let the other nurses know where we are in our training program and what the learning goals are for the night. I have definitely let her know that if she needs a different explanation for something than what I can provide that we can bring another nurse into the loop to assure clarity. She hasn't chosen that so far.

As far as awareness of deficits? hmmm Good question. As I mentioned above, she doesn't say a whole lot.

I have a new experoenced RN at my hospital that resumed 12 years of level 1 trauma surgery. She didn't know What regular insulin was and can't set up for a lap appy. These are about as basic as you can get. All I can say is that it takes all kinds........

I feel I must butt in here, to the new RN's orienting experienced RN's. Argo- in your case,I'm trying to get the senerio correct. Are you infact with only 3 yrs experience and in a periop arena and the RN you are speaking of with many more years than your self and who is just returing to practice. If so, what was trauma nursing like back in her day, could you maybe get her perspective on where her paractice was then compared to the unit she is now in? How many trauma alerts are called for -lap appy's? Is regular insulin a common drug in a ED level 1 Trauma setting some how I am guessing -not. A regular ED but not a level 1 trauma.

SunDazed- if I am reading correctly-you self admitted to 22 months of nursing paractice experience and this is your first time precepting. How many years of experience does the nurse you are now precepting have compared to your 22 months. What kind of floor did that nurse practice on- acutiy level, types of patients? Did that older RN take a break from practice?

Please stop bashing these older RN's- if you look more closely- you might just learn something.

The worst thing that night was her inability to ask for help. That will get her in trouble in the future.

This is the worst thing to me. Every type of nursing is different, depending on where you work. I hear when you start in a different type of nursing, you're like a new grad all over again. But you should always, always, always ask questions if you don't know something!!!!!!

Kcmylorn- Simmer down a little bit....

Maybe try rereading a few of the posts. The OP is NOT bashing older RN's. She admitted her years of experience and that it's her first time precepting, and that she is still learning too. It does sound like she has survived her unit well and is pulling her weight. She is trying to stay objective over her situation but worried about when this new old nurse is off orientation.

The OP stated the nurse in training came from a smaller community hospital that is at a slower pace than the unit they are currently on. Everything that sounds snippy in your reply (and typing can be deceiving, maybe you are intending that) and your questions has been clearly stated in a polite manner in previous posts.

To the OP- Some of the OTHER nurses on this site have written with good advice. If you feel (since you are there and we are not) that her being off orientation might affect patient outcome and safety AND THAT IS THE ULTIMATE CONCERN (!!!) then it is your obligation to speak up. Hopefully you are wrong, she'll become independent and fit on the unit well. Good luck and let us know what happens.

What type of unit did this nurse work on before? Did she take a break from nursing?

We are getting tons more nurses in LTC who are either changing careers or picking up extra hours. For the most part, it is awesome to have experienced nurses.

What type of unit did this nurse work on before? Did she take a break from nursing?

We are getting tons more nurses in LTC who are either changing careers or picking up extra hours. For the most part, it is awesome to have experienced nurses.

The OP is in a larger teaching hospital, not LTC. I /think/ by residents she meant medical residents.

There is a saying that it is possible to have 10 years of experience, or 1 year of experience 10 times. Just because someone is "experienced" does not mean they are competent. To defend a dangerous practioner because they're "experienced" or "older" is inane. Either your able to develop into a competent provider or not.

As a preceptor it is your job to note defecincies and offer methods for correction. It is then up to your preceptee to follow through. This requires being honest and open about thier shortcomings, which is not always a comfortable position. However, if you have not been 100% up front with her about her failings, then you have failed in your responisbility.

I don't feel I'm all that boiling over to be told by a 28 yrold to "simmer down". If the older nurse discussed in the original post who is the new orientee only shrugs yes or no to a preceptor of 22months out of the starting gate, maybe it's more of the way the younger nurse is coming off to her- that not geling. I'm thinking that older RN is not all that boiled over with the younger nurses she has to work with- perhaps that's why she is so quite. Maybe she is biting her tongue so as not to offend. When there is a whole lot she'/he is not saying. I find that many times in the younger nurses this is not the case. I have also worked at this age in my life with afew RN's who are older than I, who were OR nurses back in their day, quit working for years and years, took a refresher course, came to the stepdown unit, are what 'seems' very slow moving, soft spoken, don't say much, but can tell you in report every wrinkle in an elderly patients body. One old nurse I worked with as a younger nurse, counted how many floor tiles the patient soiled in a diahrrea explosion. One smart assed young doctor learned very quickly not to argue with another old RN, when she was able to tell him the exact time to the second when his drug seeking patient opened her bag and began to self medicate-- Looks are deceiving. Some how I don't think that older RN is going to stick around on that unit- and not because she can't do the job.