Orienting New Grad advice

CRIMSON · Dec 23, 2009

I would not chart something at a time I did not do it. That is a bigger issue of falsifying records.

Snickerdoodles · Dec 23, 2009

Well, although she did not get into the room until almost 0500, I am sure at some point you were in the room prior to that between 0000 and 0500. So you/her could have charted on the PCA pump at 0200 or 0300, whenever you were in the room. Let her know its ok for her to chart more that the required times if the issue was "falsifying" records.

As for her not wanting to chart you could also explain to her the importance of charting for her own liscense and if for whatever reason she has to go to court. If she won't listen to you just make sure that when you are training her all the patient charting is done, even if you have to do it yourself. You have brought it to your supervisors attention. If this nurse chooses not to follow the rules when she is on her own, its her own liscense.

Another suggestion might be to talk to the supervisor and just tell her that you guys have personality conflict. Its common, and they should not look down on you. It happens and sometimes people just can't learn from other people. Plus, if this new employee goes to another RN and recieves the same complaints then maybe your facility will take more action with her.

Ivanna_Nurse, BSN, RN · Dec 23, 2009

If it was the first night, I would have al least waited till the second encounter... perhaps she is a bit off her game due to the switch of preceptors. Although the routine is "up to her" I find that the way a night went for me depended somewhat on my perceptor's style. I know that you only get one chance to make a first impression, but maybe she was stressed from jumpstreet with taking the transfer, coupled by the fact she was with a new preceptor, it may just have went downhill from there. :)

I am playing the devils advocate, but remember, we all wore *new nurse* shoes at some point in time, and for a new grad, especially on med-surg, those are *big* shoes to fill. I hope you have a better shift the next time you work together. :) Ivanna

Student2Registered · Dec 23, 2009

In my experience, it was very hard to have a rhythm with my preceptor and then have a new one who did things so differently. I'll never forget the day my main preceptor had me in tears because it was 0850 and we were still passing 0800 meds. The next day I was with another preceptor and it was 0905 and we were walking into our last patient's room with 0800 meds. I turned to her and said, "Isn't this bad that we didn't get these passed by 0859?" She laughed and said "Geez, I thought we were doing good on time - you're fine!" Another example is I&Os...one preceptor told me they HAD to be done at 1330, then the next day with a different preceptor, she said "heck no, the docs just want to know the balance at the end of the shift, if you get them in my 1500 you're fine!" Just saying, expectations are different between preceptors and she's 16 weeks in - she's probably in her routine.

fiveofpeep · Dec 23, 2009

she may have said she didnt want you to wait for her to get report or did the assessment without you because she didnt want to be an inconvenience to you and slow you down.

GOMER42 · Dec 24, 2009

I have to agree with the orientee in that I would not chart a pain assessment at a time in which I didn't do it- even if your unit got docked by JCAHO.

Sounds like you should be focusing on her integrity rather than nitpicking her to death.

oliveralways · Dec 24, 2009

I just want to clarify that I was not asking her to falsify documents. I told her that she can check the dosage/attempt logs to find the attempts and dosages from 0000-0400 and correct it. She refused to do that.

Virgo_RN, BSN, RN · Dec 24, 2009

1. when i was coming on shift, she was helping to transport another patient. i waited for her to return to receive report together and when she gets there she asks why are we waiting on her, we could have started report without her.

this is fair. she probably didn't want to hold you up.

2. after report, i ask her how many patients she is taking, does she have any questions, what is her routine. i inform her that i want to do assessments/rounding with her. and to please feel free to ask any questions. but just as we are about to go into one of the patients rooms, another nurse stops to ask me a question and she goes off starts the assessment.

again, fair. she probably didn't want to hold you up. she can get started on the assessment and you can catch up.

3. i am checking her charting with her. one of her patients has a pca pump and therefore needs to be charted on every 4 hours. however, she has a 0000 assessment and 0500 assessment. i have re-inforced to her several times that the pca and pain is every 4 hours. she states that she didn't get in there until almost five and that is when she is going to chart it. i tell her that she can go back into the machine and find the dosage and attempts from 0000-0400 to correct it. she tells me she's not going to do that, that the other nurses told her to chart it when she did it. i explain that accurate assessment and charting of pain is important to patient safety, hospital policy, and jacho standards (beside the point the unit just got seriously docked by jacho for sub-par pain charting). she says i'm not trying to argue with you, but i'm not doing that. i tell her she needs to understand the needs for these assessments and charting, but she doesn't seem to understand that this isn't what you want to do, but what needs to be done.

if she didn't do a pain assessment at 0400, she shouldn't chart a pain assessment as having been done at 0400. she is correct that the pain assessment needs to be charted as having been done at the time she did it. i'm gonna have to side with her on this one. what i do see as a problem is not getting in there at 0400 to do the pain assessment. was there something of higher priority occurring at 0400 that prevented the assessment from being done at that time?

meandragonbrett · Dec 24, 2009

While the hospital policy is to document the PCA every 4 hours.....She could have gone and looked at what had been used between 0000-0400 and documented that on the MAR. That's not saying that she did this at such and such a time. On the pain assessment.....chart it when you do it.

I've had several disagreements with preceptors in the past about my charting. One time, I handed the preceptor a pen and told her than she could change it if she didn't like the way I had done my assessment.

carolina4 · Dec 24, 2009

umm..its not really a situation worth reporting...it's a PCA..half an hour (or so) after 0400 she checked it? she's only human. i don't know...just not understanding why this is so devistating..