Orienting woes!

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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?? :confused:

I'm sorry but I dont agree with those who keep wanting to give her more and more chances just because she might be scared and intimidated. I'm not even a new grad yet, I graduate in Dec. but I'm 3 weeks into my externship this summer and I'm already taking on 2 patients every day, including charting. And I'm not claiming to be the worlds best student, I know I still have a lot to improve upon and learn. Yes, being a student or a new grad can be very intimidating at times but thats no excuse, should we just excuse her when a pt dies because she was a scared new grad??? I'm not saying to yell at the girl but come on! asking to give a pill through an IV??! Though I obviously havent been in your shoes, I would agree with those who said to sit down with her and give specific examples of where she's lacking. Maybe she does not understand what she needs to improve and that's why she hasnt.

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I always read and never write...I couldn't resist this time...I too did great on my preceptorship (at Stanford) but had a very hard time as a new grad....now practicing on my own. Question for you OP, are you sure she was referring to Tylenol? Any chances that she called a different drug to be administered Tylenol? Any chances this pt has an NG or Gtube? And she meant the liquid tylenol and not IV but through the tube...? Just a thought.

I recommend you request her to have a different preceptor. I went through a 12 week new grad program and it was very difficult to learn form my preceptor. She has been practicing for 10+ years at the hospital. She knows everyone, very assertive and often charge. She was very though and I was very nervous.....I am doing well now...at some point a realized I was too anxious and went from 2 cups of coffee to 1/2...I also started walking slower and thinking before talking or doing....it worked....

If you request for her to have a different preceptor and give reasons to management you are giving her the chance to learn from someone else and getting ride of "the problem"....

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Specializes in Post Anesthesia.

There is a difference between knowlage deficit and a total lack of judgement. Some things are self -evident. Tylenol IV?,

D/C ing a medicated drip because a patient said so?!, No BP before ntg SL?!! This person has to have learned these things in nursing school- first year. I suspect she is in a blind panic and is suffering from "brain freeze". There is NO WAY she should be taking on the responsibility of a nurse in a critical care unit. Talk to your manager- give her the clear understanding that this person is not progressing in any real way and would represent a liability to the unit and the hospital. You aren't doing your orientee any favors by prolonging what appears to be a losing battle. What happens when your management staff decides she is "ready" (the orientation budget isn't unlimited)and boot her off orientation?- Do you want her to be your back-up on a busy Saturday night? The poor girl is going to end up playing "Russion Roulette" with her licence and her patients lives. There is nothing wrong with someone needing some time to learn the ropes in a lower acuity setting. Can your hospital offer her a position on a med-surg floor? Talk to your manager and/or the staff development department (if that is who coordinates orientation at your hospital) before you talk to the girl any more. She has to know she is floundering, but if you don't know where the people in charge stand, you can't give her a realistic assessment of how things stand. I was dangerous on my first job. I did my clinicals at a much different type of hospital. I couldn't handle a small community hospital with a weak nursing department when I educated at a large, urban, teaching medical center with a strong nursing leadership. I couldn't get the "flow" of the floor down no matter how hard I tried. I was completely uncomfortable in my role as a nurse. I went back ot the hospital where I did my clinical training and things just fell into place. This girl deserves the opportunity to look elswhere for her "nitche" before she ends up killing someone and having her licence, or at least her employability go out the window.

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Specializes in Urology, ENT.

I've been on the opposite end of this. I was the student who the nurses were afraid of. Yes I know, the difference is student, not new grad, but I may have inkling about how she feels and how she thinks she's being perceived. There's a thread about it somewhere here.

That aside, I don't know if she's run out of chances with the unit/you/the nurse manager, but as others have mentioned, she might need another preceptor or there's the possibility of her trying another unit. You're probably at the point of "I don't care how she feels -- she's a danger to my patients," but this is a jump from school to the real world. Completely understandable for you. Someone earlier mentioned she's probably terrified out of her mind, and she might be over thinking a lot of things. You might be an awesome preceptor, but you and this person aren't on the same level of understanding, and your styles don't mix.

Whatever you decide, don't go to HR. She just graduated so she still has time to find her place and where she comfortable.

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Specializes in Med Surg, Nursing Education.

I have to agree with BayArea2010 in wondering About the Tylenol. Are you sure what you heard is what she said? Was the Tylenol order clearly written on the screen as PO or IV? Is it possible that her question was about what the order actually stated, rather than the interpreted 'can I crush Tylenol and dilute it and give it IV'. That really does sound like a stretch to say that she thought she would do that. Also, do you LIKE her? Your personal feelings toward her could be adding more stress onto her, and she is already stressed enough. I agree with posters who state a new preceptor may be helpful.

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Specializes in Clinical Research, Outpt Women's Health.

I think the problem will take care of itself with the 2 weeks of day shift. She will either start to get it together or flame out. I would do nothing but give the manager and the orientee an objective assessment of where she is now and what she needs to work on.

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Specializes in MCH,NICU,NNsy,Educ,Village Nursing.

The comment about her questioning if the Tylenol is IV or not reminded me of the student who once was preparing to flush IV tubing at the sink with tap water.....I wonder how in the world your preceptee graduated? She wouldn't have passed my semester, that's for sure. Serious safety issues I think. To put it mildly.....

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Specializes in Med/Surg, Ortho, ASC.

Our facility uses IV acetominophen. It's my understanding that it's been in use in the UK for years.Just sayin....

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Specializes in Nephrology, Cardiology, ER, ICU.

Agree - there is IV tylenol and it is in use in the US:

http://www.signonsandiego.com/news/2010/nov/02/cadence-pharma-wins-fda-approval-iv-acetaminophen/

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Specializes in Gerontology.
As an older experienced person, but new grad nurse who is 2 months into a 4 month orientation, I would like to give you my perspective about preceptors. I have been working with 2 different nurses, mainly. Once in a while 2 others. I have gained a lot hearing things from different perspectives, some have ways of doing things that I can relate to better than others. One thing they all have in common is that when I asked a question about a drug or compatibility, etc, I am told to look it up. I don't ask anymore! Perhaps your new grad would benefit from another person's teaching methods. From your point of view, if you shared with another preceptor who had your same results, you have more documentation to do what you have to do!

I tell students,new grads whatever to look it up because I have found that if people search for the info themselves they are more likely to remember it. Also, I am teaching you to be self-sufficient. Frankly, I don't think I should have to tell a new grad to look up something. If they don't know the drug, they should be able to figure out that they need to look up the info somewhere. I shouldn't have to spoon feed you everthing.

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Specializes in ED, Informatics, Clinical Analyst.

Do you think maybe it's because she's working on night shift? I know when I had to do more than one night shift in a row I did not have the capacity to learn anything new or retain information because I couldn't sleep during the day and was overly tired.

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Specializes in New PACU RN.

Her question, though, was "Do I give this tylenol PILL by mouth or IV?"

That is scary.

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