Over Confident GN's

Nurses General Nursing

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I have only been precepting for a few months and I love it. I do however need some advice for one of my orientees. This person has no fear or messing up what so ever and feels she knows everything already (very scary) and the ironic thing is the orientees that are about pooping their pants with fear of making a mistake are doing really well; this one I can not even trust to draw up medications because I have watched her reconstitute things incorrectly after I have talked her through what she needs to do, calculate rates for IV medications incorrectly and try to hang meds without checking the compatability. She also does not do a name and date of birth check before meds I have to remind her, I found a pill on the floor and she insisted it was not from her med pass when the patient told me he dropped it after she gave it to him and walked out, thankfully it was tylenol. The list goes on and on. Besides this she used to be an aide and asked the other aides how it feels to have her in charge now :banghead: and she will shirk responsibilities that she feels are not "RN" specific. I would never treat any of my aides like this they work with me not for me and I tried to explain this to my GN. I am trying very hard to correct her in a positive manner and role model with the aides so she stops this.... it is not working. How can I approach her in a constructive manner without being abrasive. I don't want to make her orientation a negative experience and be looked at as one of those nurses who eats their young. Any advice from seasoned preceptors who have dealt with this type of new nurse before would be so appreciated.

Specializes in Telemetry.

First of all, I would like to thank the OP for taking the opportunity to handle this in a constructive manner rather than "eating the young".

Secondly, I recommend that you tell the Graduate nurse your concerns (and not lightly, but constructively). If after a few days, you do not see changes, the best thing to do is contact your nursing supervisor, and discuss your concerns with him/her. Ultimately it will be his/her decision to keep or fire the GN, but perhaps a more positive intervention could be recommended i.e. extend GN's training further than the average 3 month probationary period. And, if even after this intervention, the GN puts the patients at risk, the firing process can proceed.

Hope this helps!! It's sad to see a past aide being a horrible nurse. It's usually quite the opposite. Guess she doesn't believe in the saying "treat those how you'd like to be treated"

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Specializes in l.p.n.

Yes I agree with{ Blackheartednurse}. Get ride of her will never resolve the problem. She will work somewhere else and kill someone. At least you noticed her bad behavior try your best to direct her and then if she refuses to change then let her go. I wish she will be out of nursing once and for all. God knows we don't need that.

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Specializes in Cardiac Telemetry, ED.

You need to watch this orientee like a hawk, shadowing her every move, and be prepared to step in when she is about to do something that could harm a patient. You need to be up front with her about your concerns with her performance. Worry less about being abrasive and more about making sure she hears and understands what you are telling her.

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Specializes in Derm/Wound Care/OP Surgery/LTC.

She doesn't sound like the type that will take constructive criticism very well. Actually, she sounds more like the "in one ear, out the other" type of person. She obviously knows it all. People like this cannot be handled gently. Sometimes, they need to be shaken a little. My take? Take her off the floor. Keep her as observation only for the time being and definately remind her that she is still in her probationary period, working under YOUR license. I wouldn't candycoat anything with this type of person. She is probably very insecure and hiding behind a facade of bravado. She also seems more interested in intimidating those who she used to work as an aide with.

Basically, she needs to be brought down a notch before you lose YOUR license due to her killing one of YOUR patients.

Not worth it.

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i'm really interested how she responds to your accusations,does she show any verbal regrets for her inproper actions,makes up excuses for herself,i mean she must react some way or another.ok so you stated that she doesnt check compatibility of her iv meds,did she made that mistake only once or is it constant.i'm not trying to defend her but new grads do make mistakes during their first year..it is not like she hang iv potassium instead of ns....my point is that maybe she just simply forgot to check the compability and not that she didnt want to check it...keep in mind that we didnt focus too much on the compatibility issues,we barely got the chance to hang ivs....so possibly this new nurse is still learning what is what.about the math error,she definitely needs to invest in a good math book or math tutor...diluting the meds,again we didnt focus on that much in nursing school so was it possible she just need to practice on that more?? being a new grad i know how hard it is to make a successful transition from being totally green to becoming a competent nurse....

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Let me put it this way, if no one tells this nurse what she is doing wrong and I mean by ways of documentation and open communication, she will hurt someone and she will lose her license.

Don't be complicit in that.

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She's dangerous. You need to remind yourself of that and remember the patient comes first. You sound like a kind person and while you are trying to give the GN a positive experience the patients and yourself are having a negative one.

First thing I would do is document everything and start a paper trail to your boss. This helps you to protect yourself and your manager can't ignore it as easily as she can a verbal convo. Let the GN know your concerns and put them in writing to her as well. Get everyone on the same page.

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Specializes in Telemetry/Med-Surg.
i'm really interested how she responds to your accusations,does she show any verbal regrets for her inproper actions,makes up excuses for herself,i mean she must react some way or another.ok so you stated that she doesnt check compatibility of her iv meds,did she made that mistake only once or is it constant.i'm not trying to defend her but new grads do make mistakes during their first year..it is not like she hang iv potassium instead of ns....my point is that maybe she just simply forgot to check the compability and not that she didnt want to check it...keep in mind that we didnt focus too much on the compatibility issues,we barely got the chance to hang ivs....so possibly this new nurse is still learning what is what.about the math error,she definitely needs to invest in a good math book or math tutor...diluting the meds,again we didnt focus on that much in nursing school so was it possible she just need to practice on that more?? being a new grad i know how hard it is to make a successful transition from being totally green to becoming a competent nurse....

well it was her reaction to these mistakes that really sent up the red flags. i was a gn just 2 years ago myself so i know how hard it is, however when i made a mistake i was always very upset and terrified of doing it again. she will question me like i am wrong and then be very nonchalant like oh well i'll just do it your way to make you happy. when i asked about compatability i said okay, so before we hang this is it compatibile with the patients fluids and she said yeah i think and goes to walk in the room! that is when i stopped her and asked did you look it up and i was told no:banghead:. now i knew that they would work together but she did not. so i had her look it up. anyway i am going to talk with her tomorrow morning and use some of your advice about all of this and see how it goes. hopefully she will become more mindful of what she is doing. if not maybe i'll tell my manager that the gn should precept me since i dont know everything yet and she seems to know it all :chuckle. thank you all for your great advice!

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
if you present the information to her in a professional/respectful way then you won't look like one of those nurses who "eat their young." that term comes from nurses that are verbally abusive to younger nurses and it does not seem like you are one of those.

i do not claim to have any knowledge of where the term "eating their young" came from. but nowadays it seems to mean "anything i don't like/don't want to hear" regardless of how well-meant or kindly spoken it is. any preceptor who is doing her job has probably been accused at one time or another or "eating her young." even if only over drinks behind her back. operating with the stated intention of not being accused of "eating young" is a worthy goal, but relatively incompatible with precepting.

knowitall nurses are the most dangerous kind: it's difficult to teach anybody anything when they already know everything.

all i can say is be very specific about what it is that is required of the orientee. it must be written down, because these sorts of folks can usually say "the policy doesn't say i have to have five rights. it only mentions four." so haul out your policy for med passes, chest tube removal, ng tube insertion -- whatever it is she's going to be doing. and then make sure she has an opportunity to actually read it. that will take a bit of time, but you only have to do it once. next time she does a med pass, she's already read the policy and be expected to be responsible for the contents. then, with policy in your hand, note where she succeeded and what she missed. (that's going to be the hard part because policies aren't written for entertainment value, and you already know this stuff, right? that makes for very dry reading!) document, document, document.

at the end of the day, you will have a very specific and relatively objective list of what she did right and what she did wrong.

it only took two days for my "knowitall" orientee to realize that she did indeed have quite a bit to learn. your mileage may vary. if she doesn't get it, you'll at least have ample documentation to take to your nurse manager to illustrate exactly what the orientee is doing wrong -- and perhaps to human resources as well, if it comes to that.

as far as nurses "eating their young", it sucks to be accused of that after you've done your darndest to be fair and helpful. suck it up, because it won't be the last time you hear the accusation.

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I'm a new grad looking for my first nursing job, and I HOPE and PRAY I get a great preceptor like you!!!

How dare this idiot squander the opportunity she has been given!! I've known students like this. You almost wanna say "hey..big shot. Know your role".

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Specializes in Telemetry/Med-Surg.

well put thank you very much!

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Specializes in Community Health, Med-Surg, Home Health.

I think that an honest conversation with her is the way to go, and explain to her how far her actions can really get her into hot water if she continues. And, state that you do have to document and report the behavior if it keeps up.

It may be true that she graduated with a false sense of confidence and a know it all. But, tell it like it really is in the world of nursing and how quickly she can get jammed for arrogance. Heck, even those who are careful can accidently screw up...imagine someone who believes they do NO WRONG?? Good luck...she seems like a headache.

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