Precepting Experienced Nurse

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Hello all! I am looking for advice for how to handle my present situation. I am an OR nurse with 7 years of experience and the past 5 have been in the OR. I have my CNOR and try to keep up-to-date with new info from AORN, so I feel pretty confident precepting others. I have helped many new hires transition into their new roles. I am currently stumped though. I work outpatient surgery, so it is fast-paced and not a lot of time for teaching.

We only hire OR nurses with previous OR experience. I have been assigned to precept a new hire, who has over 20 years of experience in various areas. She states she has basic circulating experience. She does not seem to take initiative, does not seem to grasp basic circulator duties, and lets me take the lead all the time. Even when I say, "Ok, this is your case and I'll help you if you are having a hard time," it is like she doesn't take action and needs reminders on everything. If one is an experienced OR nurse, then she would instantly be taking action because it is automatic type things that need to be done.

It seems that she "doesn't know what she doesn't know." How do I help her? How do I make her recognize the need to step it up? Do I tell her to read up on AORN materials? I feel that since she states she has experience, I can't insult her by implying her need for more education. Orientation is not long here. I only got a two weeks or so, because you are supposed to be experienced. Any tips in helping her succeed? I know I need to be more direct. It is hard for me as I am known for being the "nice one."

Thank you for any input. Sorry this is kind of wordy.

Edited to add: I have spoken to my boss about my concerns and so far, have been told to keep going and hopefully she will catch on.

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Specializes in OR, Nursing Professional Development.

It may take you stepping back and letting her take the lead. As in, you don't go with her to conduct the preop interview. You don't go into the room with her. Basically, if you're not physically by her side, then she can't be letting you do anything. When it's time for my preceptees to start flying solo, I'm not constantly by their side. They do the preop interview on their own. I'm in the subroom, readily available, but not in the OR where simply by habit the other staff may be turning to me to do things.

It may simply be that she isn't going to succeed in the ambulatory environment. Not every OR nurse is cut out to be in each of the different settings.

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She has 20 years of experience in various areas, but how much specifically in the OR? She may not have enough experience to really be ok in a fast pace setting, particularly if she said she has basic circulator skills; I mean why wouldn't someone experienced in the OR say they have more than the basics unless they worked for a short time? I would agree that you need to not be right there all the time, give her some time by herself to set up. I know how fast paced out patient is- even more emphasis is placed on quantity and turnover time. Being direct, I would ask her what she has done, what she feels she needs to get better with and what her level of comfort is. Decide where to go from there.

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Specializes in O.R. Nursing - ENT, CTC, Vasc..

I leave the room. I go do something else.

I can also speak from experience, I was a new nurse (never worked anywhere but an O.R.), and after about 6 weeks of "you're doing great" they decided to tell me, "Oh, we're extending your 90-day probationary period another 30 days because you're not taking enough initiative", etc. I cried the whole 30-minute drive home after that day. However... when I came back they immediately threw me into arthroscopic cases (I didn't have a lot of experience in there because the regular ortho nurses liked to have them all the time) in outpatient surgery by myself, because we suddenly got so short-handed they had no one to pair me up with. And that instant I was like "these people are yanking my chain...". I was never paired with anyone again, either. I thought, "If I'm so terrible, why are they OK leaving me alone suddenly?" And I knew even if I didn't know everything about circulating a certain kind of case, I could at least fake it til I made it. :) I hate to throw people to the wolves, as they say, but that's my M.O. when I precept. It's how I learned best. You take some time being embarrassed, hearing comments, seeing people roll their eyes, etc. But I'm still alive and kicking.

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Thank you for the thoughtful responses.

I will try to leave the room, but be in the near vicinity during simple cases. I have not been going to pre-op or pacu with her, but I think I will start doing a little disappearing act during the case, too. I am worried that I will be doing patient, surgeon, and scrub a disservice by letting her struggle without me, but it is going to happen eventually, so may as well happen on orientation.

Perhaps after a bit of a struggle, she will be more forthcoming about her real experience in OR and I will know how I can really help her. I believe I may have been mislead about her OR experience because basic circulating skills are lacking.

I will ask her directly about standards of care for positioning, counting, etc., then review as needed. Also, I will pick a simple case and disappear for a bit, but be nearby.

I have never been in this position before, where I feel like the person is not being forthcoming about their knowledge base. She seems very knowledgeable about nursing, but not OR. If she would just tell me flat out that she doesn't know, then I would gladly teach, but i feel like I am in a pickle, because she is supposed to be experienced.

Again, thank you for the responses. Your thoughts are greatly appreciated. Have a great weekend.

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