"I know, I know"

[Scrubby]

Just want some advice on an issue I've been having at work lately.

I have been working with this older nurse who has had lots of past OR experience. However the past 10 years has been in management positions. Recently she's come back onto the floor and working as an RN.

So anyway this nurse has clearly has been out of the loop for a while. She has the knowledge of surgical procedures, remembers instruments etc but struggles a lot with the technology as it has changed over the years and there is a lot for her to learn.

Every time I try and show her something she keeps saying 'I know, I know' but she clearly DOESN'T know. I know she doesn't know because I know that she's not getting it. I don't know how many times I've heard her say 'I know, I know' but it's getting annoying. Another nurse has already had a go at her and told her that she needs to stop saying 'I know' because it's obvious she doesn't know and we're not mind readers. It stopped the 'I know' for a while but it's back in force again.

I respect this woman's knowledge and I know I can learn a lot from her as she's been in senior positions. Management have not done her any favours at all by telling everyone on the floor that she's a senior nurse because she's still got a lot to learn. I'm wondering if it's insecurity that makes her keep saying 'I know'. But I really just wish she'd just shutup and listen to me instead of interrupting with 'I know, I know' and five minutes later does the wrong thing. I just want to :h sometimes. I don't want to be disrespectful about it but I'm concerned that if she's with other people who will assume she knows when she doesn't then this may harm the patient.

Any ideas?

[tewdles, RN]

my 6 year old grand daughter says "I know, I know" when being corrected...

My guess would be that she feels unsure and uncomfortable and this is how she is compensating. Someone needs to remind her that the language is a roadblock to her learning process...

[IHeartPeds87]

Perhaps trying to approach the topic with her in a different way might help?

Try to say something to the effect of "I know it must be really tough to get back into the workplace after xx many years. It would be difficult because on the one hand you have so much experience but on the other hand things have changed, it takes some time to get back into the swing of things, and some people just would have forgotten how to do certain things. I know that you have a lot of experience, but it seems like you could do xxxxxx this way and xxxxxx this way. If you need any other 'refreshers' I highly reccomend taking xxxx refresher course."

You could also ask her to show her something that she does really well that you want to know how to do.

Basically, approach the topic more like "lets exchange info on things we both do best" rather than a "you suck" type of attitude (which i'm not saying you have, but when you are the receiver of such information be wary that people may interpret it that way).

I agree with the last poster....the "I knows" are most likely a defense mechanism because the person feels insecure....

[Doza]

Is she easy to talk to? I mean if you don't mind maybe you can offer a few minutes of your time, in case you do, to familiarize her with the gizmos there. If you think she'll resent the help talk to your NM about the help she needs.

If that were me, I'd rather ask a fellow nurse than fumble and get screamed at by an impatient md because I can't understand the what they want me to do.

[CNL2B]

Are you orienting this person? If you're not, I would stay out of it.

She obviously doesn't want help -- at least, she doesn't want help from you. She has her own license. She has the right to figure it out on her own if she wants to. The only way I would get involved with what she is doing is if it was something that wasn't safe practice.

Likely this person is hurting herself and her ability to get up to speed, especially if she doesn't have previous inpatient experience (sounds like she doesn't if she's only been in OR and management.) Let her do it. You can't fix her attitude. She will either pick it up on her own quickly or fumble around until she does. Either way, it's not really your deal.

[redessa]

I wouldn't jump in if you simply overhear her saying it. But if you are the one teaching her then I agree you need to be able to address it. If you can manage a gentle tone, you may try asking if she really does know. "Do you really know how to use this? Could you walk me through it?" This can NOT be patronizing but in a spirit of helpfulness.

Sympathize that it must be frustrating for her to have to relearn some of these things but anyone would get rusty after 10 yrs in a different area. Tell her how quickly she's picking things up or that you've noticed how hard she's working or whatever compliment fits and ask her not to say she knows how to do something unless she really does. Make sure she knows no one is judging her for taking some time to get back up to speed. It's expected and you all just want to make sure she's familiar with the newer technologies and procedures.

[netglow, ASN, RN]

Ya know, it's a little lead time at first for her to get it all recalled. Sometimes a person is in the middle of hashing things out and a "peep" here and there can actually throw them off. I like Redessa's approach. I'd even go so far as asking her, "Am I throwing you off? I just want to be around for your questions and help, I don't want to screw you up!"

[jjjoy, LPN]

I hate to admit it but I think I do that sometimes. I know I need improvement there!

I think I do that when it's something that I have learned and understood before. I don't want the other person to think that it's totally new and unfamiliar information. I'm afraid if I simply stay quiet and let the explanation go on, the other person may assume that I know less than I do.

So what I really mean is "Now I remember" or "That makes sense based upon my other knowledge."

Hmm, now that I think about it... other times it may mean "I'm pretty sure I know that somewhere in my head but I've got too much other information to process right now, so please let's stop and let me take care of this next thing before I forget that! If it turns out that I need more info later, I'll figure that out then."

[PetiteOpRN]

Is this nurse your circulator? I know how frustrating it can be to ask for something, see it being done incorrectly, if at all, and not be able to do anything about it because you are busy and can't break scrub.

To other posters, it's not a matter of orienting this nurse or being on the same floor -- the dynamics of an OR team are a little different, and if the circulator doesn't know how to set something up or where to find something, surgery grinds to a stop, surgeons get impatient, tempers flair, and it's hard to get back on the right track.

The surgeons I work with are intolerant of this kind of behavior, and they would have told her how they felt by now.

I would wait until there is an event that get management's attention, even if it is a delay or something that really doesn't compromise patient safety and file a report along the lines of , "xxx occured because xxx was not properly set up. circ was offered instruction and refused."

[Scrubby]

PetiteOpRN- this nurse scrubs and circulates (we all do). And I am orientating her as well as being in charge of the clinic we work in.

Example: bowel resection. I asked her if she was comfortable with staplers and she said she might need help. I could see her struggling to reload and so I came over and explained that she had the reload cartridge facing the wrong way. Her response 'yes I know, I know'. Ummm no you don't know and now you've broken the staple gun trying to force the cartridge in and I've got three impatient surgeons staring at me because they're still waiting.

Example: she is on a late and has to scrub for a tibeal plateau. Has not worked in ortho for 15 years. Technology has changed a lot. She should not have done the case because she hasn't done an ortho rotation. The circulatory complained to me about her because she kept saying ' I know' and she had no idea. Surgeons getting angry,grabbing stuff off her back table. Absolute disaster.

[mammac5]

You've tried, the surgeons are getting itchy, and you're not the only one noticing her short-comings. Time to go to the supervisor. Although it can be difficult to come back to working with patients after being in management for a time, she needs more than understanding. She needs someone to pull her aside and tell her she will take a refresher course, accept training from others, and be up-to-speed within XXX amount of time in order to keep her job. She needs to practice safely or go back to management. Humbling? Yes. Necessary? Yes.

[Scrubby]

I think I'll have to have a word with the CNC about it. I don't want to do it because she's a very nice person to talk to , works hard and doesn't complain but I can't have her constant 'I knowing' preventing me from educating her to be able to do the job.

Problem is that she's friends with management and a lot of the surgeons as well because she's worked with them in the past. But management really didn't do the right thing by telling us how senior she is because in the role she's chosen she's just as junior as a second year at the moment. And so what if she was in management, doesn't make any different I'm trying to show her how to put something together and she's interrupting me telling me she knows when she doesn't.

It's a tough one.