Orienting woes!

Katie5 · Jun 9, 2011

Have you tried talking to her on a more personal level and asking her what SHE thinks she's struggling with and what's inhibiting her success? You might be very surprised. I don't think you should go to Human Resources and just report her like that. That's not gonna help her. Maybe set some time after your shift to really talk to her. Don't forget, she's a NEW GRAD. Even if it's been five weeks, all this is still brand new to her. Not everyone learns at the same pace. But you need to talk to her little bit more seriously and find out what the problem is. Good luck

Very well said. Take it up a notch. Talk to her on a personal level.

BunnyBSN · Jun 9, 2011

"Don't forget, she's a NEW GRAD. Even if it's been five weeks, all this is still brand new to her. Not everyone learns at the same pace." Katie5

I do agree with this post. Maybe this new grad needs a new preceptor and learn a new style. I understand that she's told to ask questions. How do you respond - verbally and nonverbally. New grads need guidance, and not everyone learn at the same pace.

The heparin drip incidence; an error, I can understand, I've ever seen nurses with experience do this. However, crushing the Tylenol for infusion, is a first. Don't approach her with a punitive approach, she is still on orientation, period to learn. It is def. overwhelming for her and also you. There will ve time when her actions/skills will be refined, or the "sink or swim" tactic will be explored.

rnsrgr8t · Jun 9, 2011

I think what you can do is sit down and have a heart to heart with her as has been suggested already. Not in a punitve way but in an honest way. She may already be aware that she is in way over her head and waiting for someone to give her an out. I would write down your serious concerns and examples and present them to her (I would arrange a time to talk that is not involving a shift). You can present it in a way that you are only looking out for her career and license. See how she responds. If she has a good response and acknowledges your concerns, I would see if you can get her more orientation time. If not, then I would let your manager know your concerns and ask that she orient with someone else b/c obviously the two of you are not working well together (you can throw it on yourself if your manager is not receptive). I think the OP asked about going to HR out of feelings of concern, not to be punitive. She sees things that are grave patient safety issues and she does have the obligation to her orientee's future patients to make every effort to make sure they are addressed. I think she is just looking for any possible avenue since it appears that her manager is not listening/receptive. I think if you do all that has been suggested, your obligation has been fulfilled and you have done all you can. Just document and if you have to go to your manager, give her your documented list of concerns with examples and keep one for yourself as well.

DDdove, LPN · Jun 9, 2011

Five weeks ago I started orienting a new girl to my unit (IMC step-down). I have oriented 5-6 times before without many problems, but this girl takes the cake. I was already upset because I wasn't asked to orient her, she was just handed to me one day and they said "oh this is Megan, she'll be with you for EIGHT WEEKS". I like to be notified ahead of time so that I can get eduation stuff together and prepare myself for a few weeks of difficult shifts. But fine, whatever I've done it before, I'm sure I'll do it again.
Since she is a brand new grad who has never worked in a hospital I let her just shadow me for a few shifts, just to get the lay of the land. I started her off slow with one patient and me being with her every step of the way, and here we are five weeks into it and she's getting worse! She cannot handle one patient even with my help. I literally have to watch her every second of the shift, I'm terrified she is going to do something without asking me. She's a very nice girl who clearly wants to be a nurse, but I'm beginning to think she has a real inability to learn. I have always stressed the "ask questions! ask questions!" mentality but she's taking it to the extreme! Five weeks in and I'm getting questions like "Do I give this Tylenol pill IV or by mouth".. YES, she asked that last week. She turned off a Heparin gtt yesterday because "the patient said it was done". She makes the same mistakes over and over again! I must have told her at least 20 times that Lovenox sub-q does not go in the arm and that you need to check a BP when giving SL nitro, yet she cannot seem to remember those simple things. She and I have had numerous conversations about her performance and she always says she will improve but so far no luck. The nurse manager and I have had a few talks about her, but so far nothing has changed. I'm actually afraid for patients safety at this point. I've tried to be nice, I've tried to be stern....heck, I have tried every technique I know of! She is supposed to go to day shift this week for two weeks and then come back to nights on her own after that. I am actually sick to my stomach over the thought of this. My manager doesn't seem concerned, but all the floor nurses are terrified. Would it be inappropriate of me to go to Human Resources? Who else should I talk to about this??

Try having her get a piece of paper and write down important info.(Lovenox sub-q/stomach)SL nitro/B/P) Or maybe you could do it at home to give to her so she can look at it before doing the skill. I think sometimes it is performance anxiety and if she feels you are upset, that is all she is thinking about. If she know you have talked to other nurses about her she is probably really nervous. Have some of the other nurses try and maybe she can work better with them.

Residentmaid, MSN · Jun 9, 2011

Wow, sounds stressful for BOTH of you. I am being precepted now as an RN, and it is so stressful. There are so many terms for that are synonymous with each other, abbreviations, nick names. Yesterday during an intubation in the chaos I though I heard the doctor ordered 100 of sux, my preceptor told me to go pull sux, I was like...WHAT IS SUX???? ( I may have been a little stressed!) ... She said just go tell someone you need it.... And I sux...cessfully pulled the correct med. ( first intubation witnessed.... Terminology is a huge help. My preceptor and I laughed later how bad the day did sux, and now I am on line researching the med and intubations so I am better prepared when it does happen. I did have to request a change of preceptor at the beginning, because the first one wouldn't let me do anything.... Not even press the "weigh" button on the bed.... I knew I would not learn with her . I amquite thankful for the one I have now, she picks assignents that challenge me .... Is not easy, but I am learning a lot!!! Good luck!

whichone'spink, BSN, RN · Jun 9, 2011

And this stupid fool gives new grads a bad name. Sorry to call her that, but it's the truth. That unit will now be a little more cautious when hiring a new grad.

Seas · Jun 9, 2011

A new grad doesn't know tons of things and needs to ask and learn a lot. BUT, asking if a PILL should be given IV or PO is ridiculous and has nothing to do with being a new grad. I wonder what kind of nursing school she graduated from.

nicu4me · Jun 9, 2011

In our unit when orienting you journal every shift and then after about 2 weeks it is gone through with the manager. Have you been journaling positive and negative? I couldn't wait to be off orientation so I could do it my way and within policy guidlines. Be glad she is asking those questions it may be on u if she actually tried to crush that tylenol and route it IV. Be a friend to her, but also tell her that you think she needs more help. Get your manager involved, unless they don't care.

NurseLoveJoy88, ASN, RN · Jun 10, 2011

I agree with Katie. OP I would identify the learning style of this new grad. Maybe she needs more classroom time or time in the lab to practice.

Obviously she has some potiential to make it through school and pass boards.

Talk to her and see what is really going on. Maybe she has a problem at home that is clouding her thinking.

Amy3901 · Jun 10, 2011

Well, I thought I would give my two cents considering I am also a new grad. There are a TON of things that I ask questions about, but these statements from your new grad sound like she is a little immature/insecure (turning off HEPARIN because the patient said it was done??)

I will be the first to admit that I googled, "Can Tylenol be given intravenously" lol... but if you were to give me a pill form of Tylenol there would be no doubt that it needed to be given PO. It sounds like you take your job of orienting students very seriously and I am sure that you care about this person... but in my (very little experience) you have to put the patients first. I think that with your previous experience orienting, your NM should take your advice and think twice about this new employee... maybe she could have a longer orientation?? I know that if at the end of my orientation if I or my nurse does not feel that I am ready then we can lengthen my orientation time. Good luck and thank you for taking your "orientation" so seriously!!!!

tmartin83 · Jun 10, 2011

Being a new-grad nurse reading this freaks me out! I'm pretty sure she means well, but at the same time that's Level I stuff that you learn in nursing school... wowie...

Good luck!

hecallsmeDuchess · Jun 10, 2011

Awww, I really do feel for the orientee and you the preceptor. Who knows how scared out of her mind and overwhelmed she is? I know she's asking tons of questions over things you've told her multiole times but maybe she forgets, there are so many things to learn about once one hits the floor. I remember very well not too long ago when I was a fresh new grad orientee, I had to write stuff down and take it work everyday which helped a lot. I know you are trying but please have some more patience and approach her if you can and ask how she thinks she can improve, she might even hold the key to her own success and not even know it.

I do hope for her sake and the sake of her future patients, she gets it even if it means a longer orientation. :nurse: