Orienting a new hire - issues

[teleRN08]

i am currently orienting a new hire rn. i work on a telemetry floor at a community hospital. the new hire is from a large magnet hospitals respiratory floor and has 4 years experience.

i have oriented her two nights and the second night made me have some concerns. i realized the new hire gets very defensive when questioned. she gets very agitated around an md asking her to do some asap and stated, "i won't deal with attitude" even when attitude was not being given. she gives nasty looks to the cna's even after i stated that they are very helpful. her verbal report is very confusing and not informative (which i have been giving helpful hints about) and when questioned about cardiac issues she tries to fake an answer that does not make any sense. after telling her multiple times i think she should get vitals and call the md regarding an increased hr and her then stating she is going on break, i preceded to call md and admin the needed medication.

so after our shift, i spoke with my manager who was not impressed because we already have a lot of issues with attitude from some nurses. we are having a meeting after our next shift..

i was wondering what is a nice way of discussing these problems with the new hire in the meeting without sounding like i am bashing her in front of the managers. constructive criticism is all.

[bratmobile]

from what you described it doesn't sound like there is a nice way to tell her anything..

[classicdame, MSN, EdD]

poor attitude is a reflection of low self esteem. That may be a problem, but it is not MY problem and I think you did the right thing by talking to the manager. Lots of this to deal with from people in general anymore. What ever happened to good manners?

[nurseprnRN, BSN, RN]

i have seen that kind of behavior in two kinds of people: those with significant mental health issues, and those with faked credentials. neither can face reality and don't know what too do with it if it comes up and bites them in the ***.

[teleRN08]

I can see this blowing up in my face.. lol...as I can already see her deciding I'm the "bad guy" from all of this...

She has a very strong personality and for the most part she is very nice. However, I am concerned with her defensiveness, as well as her "I don't deal with _____" attitude . I think since her 4 years of experience were focused on respiratory only, she may not understand the importance of cardiac issues? They only planned on her orienting 4 nights and even though she can make it through a shift very effortlessly, I am concerned about the safety. The verbal report she gives just does not make sense and I feel like she just does the tasks and does not think critically. I have been checking her notes and cardiac strips, all of which are good. When she has more than one thing to do at the same time, she asks me to do one, which is fine however I want her to now pretend as if I am not her sidekick.

Grr.. the glories of orienting a new hire. I prefer a new grad who has lots of questions and eager to learn!

[wish_me_luck, BSN, RN]

maybe faked credentials or thinks the 4 yrs makes her superior. I disagree with the mental health issues...that has no bearing and quite frankly is offensive to people who are stellar at work and have mental health problems. I think it is due to her being a nurse for 4 years and just being a know it all and like she is a god or something. Anyway, if she is a new hire, that needs to be nipped right away. Good luck with the meeting :)

[wish_me_luck, BSN, RN]

tele, thanks for the new grad comment. We love nurses like you too!

[Merlyn]

Looks like you have what we refer to in medical terms as a Queen Bee. You have to clip her wings soon. You stated that she fakes the answer on cardiac issues. That could be deadly and lead to the thinking that if she lies to me about this what else is she lying about. You are walking a fine line between being to forceful and not being forceful enough. I don't know if you will every reach the Queen, but maybe you can show the manager the dangers of having her around.

[teleRN08]

Thanks everyone!! I don't think there will be an easy way of discussing my concerns. I have one more 12 hour shift followed by our meeting. Maybe I will have a stronger idea and better examples after that.

[Good Morning, Gil]

What is it about her report that doesn't make sense? I guess I don't understand how a report wouldn't make sense. I mean...you're giving a report on PMH, allergies, full code, current issues/asst...is she just not organized? That should be an easy fix, but for someone that cannot take constructive criticism, it won't be. You're going to have to mention the report issues as well as her, and you could say it like this to the manager..."While her experience is valued on this unit, I think because of that, she has a harder time taking constructive criticism, and learning to improve and ask questions about things she does not know. Because of this, I'm concerned for patient safety." Your manager will know what that means lol, and you're saying it in a diplomatic way. Is there any way you can tell your manager this ahead of time, and then when the time comes for the meeting, he/she can broach the subject?

If your preceptee gives you attitude, you can just tell her flat out: It's a patient safety issue, and you need to ask questions when you don't know something, and need to tend to patients needs first rather than just running to break. I mean...seriously....if a patient is having an acute issue, you don't just run to break; that's a real patient safety issue.

Sorry you're having to deal with this, but I guess that goes with the territory sometimes, probably why many people don't precept lol. Hoping your next orientee is eager to learn, and humble. You really have to be in this profession for patient safety. I would like to precept in the future once I'm more experienced, but there are going to be some people like you mention that don't make it a very enjoyable experience lol.

[HouTx, BSN, MSN, EdD]

You seem to be a great preceptor. One of the most difficult things an educator must do is deliver constructive feedback to unreceptive people. Their reaction can be unpredictable -- anything from tears to rage/threats of reprisal.

Try to remain focused on the goals that have been established for your orientation period. Using very objective terminology, compare her performance to the established expectations... "the goal is for you to be able to manage a full patient load with minimal assistance, but whenever you are responsible for more than 3 patients, you ask me for help with even the most basic tasks" Based on the information you have provided, she will most likely react with over-the-top defensiveness & possibly anger. Just keep your cool and try to remain as objective as possible. It's probably a very good idea to make sure that a 3rd party is present.

Make sure you enforce behavioral limits - don't allow the conversation to become disrespectful or abusive towards you. It really doesn't seem like this one is a "keeper" - and that always makes us sad, but even the best preceptor can't change her underlying personality.

[NurseOnAMotorcycle, ASN, RN]

Is there any way that you can give her a little more confidence to be honest by acknowledging the things she's good at? If it's a low self esteem problem then she may thaw enough to learn something new, knowing that you respect her for an experienced professional in her area of expertise.

If it doesn't work and she just gets worse with it, then maybe you have your answer and it's not a self esteem problem and you might have to cut her loose.