Setting my orientee up for failure?

[NightNerd]

I'm precepting a new grad who will be on nights (I'm day shift - lack of evidence staff on nights meant that I was chosen to precept for her first several weeks). We are in week eight by now, and I'm starting to feel like I've failed her. ? I'm hoping to hear any advice you guys have; I've got one more week with her and then she'll orient on nights for two weeks, then be on her own.

Our biggest issues, apart from normal stuff like time management, is retaining knowledge and being self-directed. She comes to me with the same questions over and over again, she wants help doing the same skills we've already practiced several times, and even balks at going into rooms by herself or recording her own assessment until she's talked to me about it. After eight weeks, not only am I exhausted, but I sort of feel like I can't trust her to do anything on her own. I have been working so hard to turn her questions around on her (I.e., "What do you think we should do next?" "What supplies do you need?" "What are your priorities this morning?") and to let her figure things out as much as possible without severely delaying or interfering with care. It's not just that she needs a lot of direction, but most of the time, she will not, say, draw labs or start new meds or whatever, until I remind her to look at her new orders.

Another coworker precepted for me last week one shift during a pre-planned vacation, and she is reporting the same issues. She said she spoke to our manager about it, and I also have been talking to my manager and our unit educators. Nothing is helping. My manager seems to think I'm being too nice, but I'm doing everything I can to let her work things out herself; there are times, though, where if I don't step in eventually, things won't get done at all.

I've precepted new grads before and typically enjoy it, but I feel like this is just not going well at all. I've also never gotten any formal training in precepting, so I'm wondering if anyone has any other thoughts or ideas? She is a very sweet woman, very earnest, and I know she was going through school at the height of the pandemic - but I don't know that this unit and hospital are going to give her the time and training she needs to succeed, and I worry for what will happen when she's off orientation.

[maryellen12]

Being unkind will not help at all. 

All this would do would be to create more stress for the learner.

My guess is that there is enough stress already and stress is not conducive to learning.

[cgw5364, ADN]

I loved precepting new grads and new hires. I had a new grad very similar to what you are describing very sweet and tons of book knowledge. However, she just could not function on her own. She never could develop a system of organization for herself. She actually had 6 weeks orientation on days and then 6 weeks on nights with me. She was able to go into a patient's room alone and do assessments though. But anymore than that and she would completely shut down. She could not do a patient's assessment and give meds all in one go. She ended up transferring into home care where she could just focus on one patient at a time and this was better for her. I always wondered if she had a learning disability. My high functioning autistic daughter shuts down if I tell her to do more than one thing at a time and that new grad was very similar. 

[SmilingBluEyes]

I was far from "useless" as a PRN nurse. I picked up weekend nights for 14 years. EVERY weekend. And I had the nerve to have two kids.

[NightNerd, MSN, RN]

Thank you all for continuing to share your thoughts and stories - it is super helpful! I was definitely able to use a lot of your suggestions for our last week together. She was a little better with taking initiative on some tasks, and we got a chance to review some topics we previously had no time to cover.

There were some improvements, but I still have some significant concerns, as she seems to feel she is making more progress than I'm seeing from my side. Unfortunately she is off to night shift now, so we'll see if maybe the new shift will help her get a better grasp on things. If not, I'm hoping my manager can help her get some share time on a less acute floor; I do think she's coming along, just not far enough for this unit at this time.

[Crystal-Wings, LVN]

Sounds like a tough situation for everyone involved. Hope you find a solution that works for everyone.

[sleepwalker, MSN, NP]

"I do think she will be a great nurse someday, but this is a smaller, weirdly fast-paced unit where she will not have the kind of support she will probably need"

You answered your own question...she has a place in nursing just not the one where's she currently located

[Hannahbanana, BSN, MSN]

My initial impression after your description is that she’s still operating at the student level- needs constant reinforcement, afraid to take initiative, can’t enter a room s the instructor, doesn’t trust herself, imposter syndrome. There’s a middle ground between handholding and sink or swim/drowning. You got one really good script on specific feedback to get her focused, and there’s a time where “Get in there and do this yourself” is going to have to occur. 

[2BS Nurse, BSN]

One of the most memorable comments made by a nursing instructor... "Before the NCLEX and results were available online, we had a nice, long time on orientation". They spent months waiting to see if they passed the exam and worked alongside their experienced peers while waiting. I feel sad that new grads are denied the time necessary to earn their wings. It's not your fault.