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.

[PeaceonearthRN]

I think the entire problem is FEAR.

I too educate nurses and support staff; it's amazing how once you establish the expectations w/out the FEAR factor, things change. :)

[Jerrysdogmommy]

You need to unload this individual. She will leave as soon as she finds something else...that's the type of person she is. I cannot understand how these people go through nursing school and do not get found out by their clinical instructors. Unload her, fire her, do whatever it takes to get rid of her. She's a burden on everyone and probably gossips behind your back about you. We had someone like this on our unit who left after a few weeks. She was downright horrible in every way imaginable. Then, she did not tell anyone she left, just did not show back up. She was lazy and would sit all night reading her magazines and occasionally help a patient. Do your unit and the nursing world a favor and unload her, find a new GN/RN that's eager to learn and move on. She's not worth your kindness.

[babynurse428]

Been there and done that! After we were concerned about a new hire that wasn't doing well and was having a bad attitude when questioned, we started digging into her references, etc! Turns out her license was fake! I almost threw up! I cannot stress enough to make sure they have the proper credentials! Best of luck! Some people are just attitude ridden. If it makes it hard on the patients, she may not fit on your unit.

[Over-the-hill-Nurse]

I also think your orientee is afraid. She may be feeling overwhelmed by some situations and instead of saying she doesn't know, she is giving the attitude. I also precepted many during my years of nursing. One thing that I did whenever precepting was have a one on one chat with my orientee and gave them my opinions of 1)you are doing great in your assessment skills, do you feel that there is anything that you could do better in? 2)Here is some things that you need to work on (give her a written down list that you saw from that day(s) of observation) examples- 1)prioritizing and give her some ideas on improving it. (such as patient safety) 3)let her know again that you are there to help her. Maybe give her info on the doctors that will help her communicate with them, give her pointers on what is expected on your unit. Lastly ask her how she learns best, such as hands on, or show me first. Sometimes it is a matter of how she learns. Just because she has been a nurse for 4 years does not mean that she knows how to take care of patients on a cardiac floor. She may have resp down pat and for the most part, it sounds like she does have the skills for assessment, etc. When she is not giving a correct answer to something she should know cardiac wise, I would wait and then take her aside and ask what her rationale was for her answer? Give her time to answer, and if she just brings attitude with you, remind her that you are there to help her and want to make sure she understands what supports that rationale and what doesn't. Its all a learning curve and sometimes its hard to get under that shell that they have arround them for fear of being totally wrong and embrassed. I am sure that all of us were precepted at one time or another and each of us more than likely tried to put the best foot forward and also stumbled a few times our selves. I truly feel that you should sit her down and let her know what you have observed. Making sure you are positive on what she does great at and what she isn't so great at.

I know it seems silly but it works if you take the time to do this after each shift so its fresh. Writing it on paper helps them to see what the issues is, some suggestions to help, if its a policy thing, make sure she knows where and how to find the policy and procedure books so that she can look it up for your unit. If its a defiant type thing, just let her know that you are there to see her fall on her face but to make sure she doesn't and can handle everything and anything with dignaty.

I did this on everything that I precepted someone and I let them know first thing in the moring that I was going to be reviewing her notes, talking with her patients (such as is she recieving good care, is she getting her needs met, etc..I also told them that after our shift was over the pros and cons that I see that needs work on, and gave praise for all the things they did right.

My point is that the communication between the preceptor and the orientee should be after each shift so that the orientee knows what you expect them to work on the next time. Then ask her if you can buy her a pop or a cup of coffee and walk her to her locker.

Since you have been with her, I would do just that and see how it goes that next day. Many nurses do put on a front when they have worked elsewear for 4 years. You just have to gently remind her that you are at such and such hospital and this is the way it is done here. Continue to bolster her unspoken need to feel comfortable in what she is doing, she will get there but not with only 4 days of orientation. She needs to stay on orientation until she gets it. Good luck to you both.

[hiddencatRN, BSN, RN]

Any update on the situation?

[teleRN08]

There was a definite improvement the next night. She stated most of her defensiveness was her being "overtired." I spoke with the manager again and she stated she still planned on having her come off orientation after the next night and will have a meeting with her in a week or two.. We will see.. I still have concerns over this because her bad attitude did come out again on the last night of orientation. We shall see how things go now that she is off orientation. I'll update in a week or two again.

[Over-the-hill-Nurse]

Glad that she did better but being overtired runs with the territory. I hope she does do better with her attitude issue and being off orientation. Precepting is not a easy task and I hope that it doesn't discourage you from continueing to orient after all this. Spotting someone's weak area's and following up on them is great. I would love to know how she does on her own. Hopefully with more time under her belt, it will improve.

[Merlyn]

There was a definite improvement the next night. She stated most of her defensiveness was her being "overtired." I spoke with the manager again and she stated she still planned on having her come off orientation after the next night and will have a meeting with her in a week or two.. We will see.. I still have concerns over this because her bad attitude did come out again on the last night of orientation. We shall see how things go now that she is off orientation. I'll update in a week or two again.

I need to ask a question of you and I hope you do not think I am sexist, But do you think it could have been that time of the month. You understand that I can only go by observing my wife and other women. I have notice that sometimes the days building of to their period women become cranky. Sometime my wife became most unpleasant to be around. in all seriousness, could it be that?

[teleRN08]

I have no idea Merlyn. She stated she never works back to back nights (which is what we did). In her last job she would swap with nurses to work on-off-on schedule. However, that shouldnt be an excuse either, as every weekend is a two on type schedule. At our facility, nurses most likely won't swap because no one on our night shift likes an on off schedule like her. I hope things work out though. I'll keep everyone posted.

I do love orienting. It's a great experience. I'm currently getting my MSN in nursing education

[canesdukegirl, BSN, RN]

These types of nurses are difficult to deal with: you find that they are spot on in some areas, and lacking in others. Any feedback you are giving her is met with defensiveness. That is challenging.

Take some time with her in a private setting and tell her that you don't want her to feel that you are picking on her because she has proven to have some great skills. Tell her that you want her to succeed on the unit, and there are a few things that you would like to help her with in order to succeed. Mention one or two things that need improvement and then ask for her opinion.

"Mary, I wanted to talk to you today about giving report. The flow of your report should be logical and factual. I see that there are a few things that you are leaving out in your report. Would you like to work on a checklist or a sheet that you can work from to give a more clear report? I would be happy to develop that with you. You have a great deal of knowledge and perhaps you need a more focused and detailed worksheet/checklist to help you gather your thoughts for report. What do you think?"

This is a clear cut way for you to state your concerns without putting her on the defensive. You are at once acknowledging her strengths as well as pointing out her challenges-which you will offer assistance to overcome.

Precepting is difficult, no doubt. To be a preceptor is to be a leader, and sometimes leaders find themselves in uncomfortable situations when it comes to giving feedback that isn't well received. Recognize that your orientee is new, and being new is always awkward. State that fact to her, and let her know that your position is to help her to succeed. It is very likely that she will be receptive to you and respect you for being forthright.

[canesdukegirl, BSN, RN]

I need to ask a question of you and I hope you do not think I am sexist, But do you think it could have been that time of the month. You understand that I can only go by observing my wife and other women. I have notice that sometimes the days building of to their period women become cranky. Sometime my wife became most unpleasant to be around. in all seriousness, could it be that?

A valid question, but moreover, I wonder if it is just anxiety in general that is prompting this new orientee to be defensive. It could be that this new nurse doesn't have a healthy coping mechanism to deal with the anxiety of change. It is extremely stressful to orient to new surroundings, a new unit, new co-workers, new docs, a different patient population. She may be trying to prove her worthiness by overcompensating with made up answers. She is clearly scared, and the only way for her to overcome that is to feel safe. If the OP and the orientee can have a discussion regarding her performance and a reasonable plan to target her challenges, she may very well be receptive.