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.

[Simply Complicated]

Not saying this is the case, but does she maybe feel like you are approaching her in a confrontation way at all? I don't necessarily mean that you are, but maybe she is perceiving it that way? Causing her to be a bit more defensive? I think a lot of times it's such a miscommunication problem, then attitudes get thrown in and it makes it way worse.

During my short stint in ICU, my preceptor and I had a hard time with each other. Which was new for me, as I had always gotten along with everyone. She felt I was constantly comparing things with my old job. In my mind, I was just trying to clarify the way things were done, as I traveled for a few years, and I had learned so many different policies and different ways places did things. I was trying to make sure I was doing things correct, and she took it as me being defensive, unwilling to learn, etc.

She could just be a know it all, who thinks she is all that, and no one is going to tell her different. So this could be irrelevant. But maybe trying to find another approach when you talk with her and the manager. Let her know that while she has experience, things are a bit different when you switch specialties. That her core nursing skills may be there, but you are concerned she needs to learn to prioritize things a bit different, so it is more appropriate to this specialty.

Good luck, let us know how it goes!

[teleRN08]

Not saying this is the case, but does she maybe feel like you are approaching her in a confrontation way at all? I don't necessarily mean that you are, but maybe she is perceiving it that way? Causing her to be a bit more defensive? I think a lot of times it's such a miscommunication problem, then attitudes get thrown in and it makes it way worse.

During my short stint in ICU, my preceptor and I had a hard time with each other. Which was new for me, as I had always gotten along with everyone. She felt I was constantly comparing things with my old job. In my mind, I was just trying to clarify the way things were done, as I traveled for a few years, and I had learned so many different policies and different ways places did things. I was trying to make sure I was doing things correct, and she took it as me being defensive, unwilling to learn, etc.

She could just be a know it all, who thinks she is all that, and no one is going to tell her different. So this could be irrelevant. But maybe trying to find another approach when you talk with her and the manager. Let her know that while she has experience, things are a bit different when you switch specialties. That her core nursing skills may be there, but you are concerned she needs to learn to prioritize things a bit different, so it is more appropriate to this specialty.

Good luck, let us know how it goes!

I don't believe I am approaching the situation in a confrontational way. I have precepted many times before with great success. I also wonder if the age between us could be a problem. I am 26 years old (been in this nursing position for 4 years) and she is in her 40s. I spoke with someone who knows her from nursing school and she states she's always been a very defensive and outspoken person.

[teleRN08]

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.

Thanks. I did speak with the manager regarding my concerns which is why I am having a meeting with my orientee and mangers after the next shift. My manager had a decent suggestion: we have a list of values we want in the staff and I can discuss my concerns in a positive manner by discussing what we expect from our staff. I think m plan in the meeting will be use the "positive sandwich" idea I learned in a clinical educator program (state a positive, then a issue/problem, followed by another positive).

As for report: She will jump right into something like "medicated so in so with this, at this time" and go on with other information... She also loves to repeat "really nice person" or "super sweet" numerous times- but never mention what brought the patient here, if cardio/surg consults, test results, important vitals, etc.

We shall see.. It will be a challenge but I'm trying to stay positive

[Simply Complicated]

I don't believe I am approaching the situation in a confrontational way. I have precepted many times before with great success. I also wonder if the age between us could be a problem. I am 26 years old (been in this nursing position for 4 years) and she is in her 40s. I spoke with someone who knows her from nursing school and she states she's always been a very defensive and outspoken person.

Well in that case, I'd just do what you can talking to her with the manager. You'll have a buffer, so if she starts getting defensive or what not, it will be the manager observing it and can step in as well. Some people are just like that unfortunately. You can't start a new job not be willing to adapt to the new environment, or take constructive criticism on things. You sure can't just go to break when there are issues going on.

[Simply Complicated]

Thanks. I did speak with the manager regarding my concerns which is why I am having a meeting with my orientee and mangers after the next shift. My manager had a decent suggestion: we have a list of values we want in the staff and I can discuss my concerns in a positive manner by discussing what we expect from our staff. I think m plan in the meeting will be use the "positive sandwich" idea I learned in a clinical educator program (state a positive, then a issue/problem, followed by another positive).

As for report: She will jump right into something like "medicated so in so with this, at this time" and go on with other information... She also loves to repeat "really nice person" or "super sweet" numerous times- but never mention what brought the patient here, if cardio/surg consults, test results, important vitals, etc.

We shall see.. It will be a challenge but I'm trying to stay positive

Can you guys maybe make up a template or a "mock report" so she can get an idea of what is needed in report? Something for her to actually visualize? Maybe if you make it up and have the manager give it to her as a learning tool, it won't be given to her in a way you are telling her she is doing it wrong, just more of a learning aid.. we like report to go something like this.

[MJB2010]

I think it might be a good idea to have another person precept her for 1 or 2 shifts, but give them NO info on what your thinking before they work with her. After, meet with them to discuss if they are picking up on the same issues. Sounds like they will, and you will not be the sole executioner if they let her go. It is always helpful to get a second opinion and second set of eyes.

[stargazer88]

The nurse is a licensed RN with 4 years of experience! If she has bad nursing skills it will come out eventually. Why is it that many preceptors treat nurses like they are students? Is this the new way? The nurse you are talking about is probably nervous, is still learning the unit. Giver her the benefit of the doubt.

I am speaking from experience (a horrible one) I started in a new hospital, was started on day shift to orient. Not only was I learning the unit, the routines, where things are located, but also the computer system. I could hardly function with the preceptor following me around, standing over me while I charted, did my assessments, and gave meds. Honestly, one time she took me to the tele monitor at the ns and asked me to interpret the rhythm in front of everyone. Of course, my mind went blank.

She never gave me the chance to figure out my own system, to organize my day or check my own charting. I was so nervous knowing the opinion of the preceptor would mean the difference between job and no job. And jobs are hard to come by right now. It is very difficult to perform well under that kind of pressure and stress.

You have actually seen very little of what she is capable of. She's made it 4 years she must be doing something right. Give her a chance. Wait until she's more familiar to the job. Let her skills speak for themselves over the long run.

In other places I've worked, the person orienting , or "precepting" did not judge another nurses skills. It was assumed that if the person passed the boards, could call herself an RN, then she had the skills. The job of the preceptor was to guide and help her (or him) learn the unit until she was familiar enough, and fast enough to take a full patient load on her own.

I think an RN deserves the respect that she has earned. A person works hard to get through school. If you pass the instructors scrutiny, and the boards, isn't that enough?

[stargazer88]

MJB2010 Has the right idea.

In my case, I did great with the preceptor who let me work and said "I'm here if you need me" Some people just don't do well when being observed knowing they are being evaluated.

Might not be the case with her. Then again, it might.

I don't think preceptors should be given so much power. Just my opinion

[stargazer88]

Also, she may have felt overwhelmed and needed a break.

Matching her with someone closer to her own age is a good idea.

I get the feeling that you don't like her much

[stargazer88]

When people feel threatened, they sometimes get "defensive" She knows you have the power that could cost her her job.

Have you ever thought about the way you communicate?

Do you talk to people in their 40's the same as you talk to 20 somethings? Do you talk to this nurse as a peer or are you more formal?

Where I work now there is a BIG communication gap between the older (paper age) vs younger (computer age) nurses. They just don't seem to see eye to eye. They don't like each other much and it shows.

I also wonder why you are talking to "someone who knew her from nursing school" rather than just the manager?

Where I come from, that's called gossip.

[teleRN08]

when people feel threatened, they sometimes get "defensive" she knows you have the power that could cost her her job.

have you ever thought about the way you communicate?

do you talk to people in their 40's the same as you talk to 20 somethings? do you talk to this nurse as a peer or are you more formal?

where i work now there is a big communication gap between the older (paper age) vs younger (computer age) nurses. they just don't seem to see eye to eye. they don't like each other much and it shows.

i also wonder why you are talking to "someone who knew her from nursing school" rather than just the manager?

where i come from, that's called gossip.

this is not my first time precepting. i have had great experiences in the past. i do not talk to her any different than i talk to any other peer i work with. i am precepting her, but i am not following her every move. i have told her, "i'm your back up, if you need me." i do check her documentation etc because that is part of my job as the preceptor, to make sure she is doing things correctly per our policies, etc. she has the ability to do the nursing tasks just fine, that is not the problem in the slightest. my concern was taking a break when a patient obv needed medication and attitude. i just feel as though the manager should know if i sense an attitude on day two of my precepting of her. i spoke to the manager and she was glad that i went to her, which is why we are having a meeting to discuss how orientation is going. i am just looking for the best way to approach this situation in the meeting.

she has been precepted by 3 other nurses, unfortunately, each nurse only had her one day. i spoke with one of the three and she did state she noticed an attitude but was unsure if it was a one day thing or not.

i have a close friend that i have known for years who i knew went to nursing school with her. i did not gossip with her at all. i only stated i was precepting her and my friend starting telling me her opinion of her back then. i did not disclose how i felt about her at all. but it was helpful to know if this was a new thing or not.

thanks for your thoughts though

[Been there,done that, ASN, RN]

The meeting is not the time to be nice. It is the time to state your observations.

It is surprising that previous posters bring up the age discrepancy issue. It is a moot point.

I have 30 years of experience, as a traveler.. I listen.. and listen hard.. to my preceptor.

If your orientee is faking answers to cardiac issues... she is not competent to do the job!!!

And dangerous to boot.

Saw that situation before. The new nurse couldn't even apply leads correctly.. yet was very vocal about how the floor should be ran. In this particular case, she ended up getting caught by a doctor for falsifying documentation on a tele strip.

The doc had security open the shredder bin... voila.. there it was. That nurse ended up getting the option to resign or be fired.

Bottom line, you have raised huge red flags.. after only a few days... these problems you identified are only the tip of that nasty iceberg.

Good luck.