Performance improvement plan woes

Home Health Columnist / Guide · Sep 12, 2019

The Foundation for Critical Thinking has several articles that may help you:

Learning the Elements and Standards of Critical Thinking

Quizzlet has a 20 question quizz: Critical Thinking in Nursing Practice

kp2016 · Sep 12, 2019

Med errors, performance improvement plan, not preforming at the level of others.... honestly this sounds to like the paperwork trail that leads to you being fired.

Honestly if I were you I would start applying for new jobs. You are a new nurse and if they have identified these issues and not assigned anyone to work with you and help you develop as an RN this is not a good learning environment for you and the writing is probably on the wall.

I’m sorry your first job experience wasn’t better. Best of luck!

lorias · Sep 12, 2019

Over the two weeks I have another nurse following me.

Swellz · Sep 13, 2019

11 hours ago, lorias said:
Over the two weeks I have another nurse following me.

What's the expectation after this two weeks is up? What are the goals for you to accomplish during this time? Is this person guiding you like an extension of orientation or looking for problems to report to the manager?

lorias · Sep 13, 2019

That's my point. The goals aren't specific. It's vague, like work on critical thinking and decision making. The person guiding me is treating it like an orientation, but also reporting back to the manager. I asked about what happens after the two weeks and was told we'd have to wait and see how I do over these two weeks. Doesn't exactly give me a warm feeling of job security.

nursej22, MSN, RN · Sep 13, 2019

I feel like your supervisor doesn't know what she doing. I would expect a new nurse to think more concretely, and develop critical thinking as she gains experience. According to Benner's stages of nursing competency, it takes nearly 2 years to reach the "competent stage". 4 months is nothing, especially considering how little time is spent in clinical in nursing school. A competent manager should be able to give you clear, achievable goals.

I agree, that this place of employment may not be a good fit. However, I would make sure there is documentation in your employment file about your requests and her/his denials for providing improvement goals. It could also make a difference if you file for unemployment.

llg, PhD, RN · Sep 13, 2019

I agree with the others that you should be preparing to find another job ... but ...

I also think you are focusing too much on your opinion of your supervisor rather than focusing on being a good nurse -- and that misplaced focus is what may cause you to lose your job. If you have been making mistakes, errors, poor judgments, etc ... then your specific goal should be to make zero mistakes/errors/poor judgment calls. Period.

Communicate with your preceptor (or whoever is "guiding you") regularly during your shift. Ask them whether they believe you have made any mistakes or poor judgments. If they say, "No, I think you have been doing a good job," that is great because asking for feedback will stimulate to notice what a good job you are doing. If they say, "Yes, I think you could have done a better job with ... whatever .." then you will have a specific example of something you need to improve.

I believe you are focusing on critiquing your manager's performance to avoid having to face the fact that she might be right. It's easier to criticize the person criticizing you than it is to accept that critique and run with it.

MEINstudent · Sep 13, 2019

I agree with above comments that it takes years to be comfortable and confident. I would say actually, about 10 years, personally. But... you should not be making med errors or any serious errors. That is carelessness and not paying close attention.

Focus on your doing your job well. If you have questions, or any doubt about something you are doing or a med you are giving, ask a peer for advice and help. Don't worry about someone watching you and reporting back to management. Use that person as a resource to learn.

Did you just get off orientation? I went through 12 weeks of orientation on a basic med-surg floor as a new nurse. It's not right if facilities are not giving a decent orientation to new nurses and then are critical if their performance is sub-par afterward.

choksantos, BSN, RN · Sep 15, 2019

On 9/11/2019 at 8:44 PM, lorias said:
I want to know if this is the correct way to evaluate a new nurse. I have been a nurse for almost 4 months and was put on a performance improvement plan because of med errors and according to my supervisor "not performing at the level of the other nurses on the unit." While she has told me a handful of specific things I have done wrong, when I ask her for tangible goals to work on, she says that nursing is,not black and white, that she can't just check off a list of goals to determine whether I've improved or not. For example, I have to work on critical thinking but she can't tell me how to do this. It's like she's saying improve in these areas, but we can't tell you specifics on how to improve, but you need to improve. How do I know if I'm improving when the so called performance improvement plan is so vague? I came up with goals on my own and at first she was impressed with them but then later says that it's not that black and white. Feel like I'm at the whim of her subjective feelings about my performance as a nurse. I realize that some things can't be measured, but still, this doesn't seem right to me. Am I wrong? And she said I am performing at the bottom compared to the other nurses. But, that would make since since the others on the unit except for one have 2 or more years,experience in the area I work in. The other has 7 months.

Being new is hard but the supervisor gave you a hint though, med errors. Med errors tell you quite a lot about your practice, you can analyze why the mistakes were made, apart for the errors as part of the system, look for the causality of such errors on your part, were you not thorough enough? Did you relate the patient's VS to medications even without parameters (critical thinking). Were you rushing that's why you made the error?(time management and prioritization). She appears to be vague and maybe purposely so which I feel is not a good sign of you.

CharleeFoxtrot, BSN, RN · Sep 15, 2019

rIn reading this thread and this other thread, it's pretty apparent that the OP really needs to take a step back and appraise her practices and the way she is doing things because something isn't clicking for her.

You can't erase your past at this job, so overhauling everything including how you are reacting to constructive criticism would be the place to start. Focus on the 5 (or ias it 7 now?) rights. Critical thinking is something you must practice every minute of every day until it becomes second nature. Focus on accuracy, and speed will follow.