Training a new RN

[catlvr]

I was assigned to "work with" a new RN in my LTC last week; I'm an LPN. She is almost off of orientation and is moving to the 3-11 shift and they wanted me to show her the routine on two assignments, so we were together two nights - one easy assignment and one busy assignment. I've been a nurse for about five years, but vividly recall being hyper-conscious of safety - the new nurse anxiety to not kill someone, lol. I emphasized my personal philosophy - safety before speed, speed comes with time. I think that she got off on the wrong foot because she didn't listen to report, and just wrote down the pt's names; we got report from a great nurse who pointed out who needed blood sugars, vitals, etc. She tried to give a cup of pills to the wrong pt without verifying who they were; drew up the wrong insulin (humalog instead of lantus); poured morning meds instead of evening meds. In each case, I allowed her to go only so far before asking her if she was certain that she was doing the right thing and gently pointing out where she was going wrong when she insisted that she wasn't. Before hanging an IV, I asked her if she was certified and comfortable with our procedure, and she replied yes. She didn't wash her hands, didn't wear gloves, gave the hub a two second swipe, and tried to use the same saline flush to flush both ports. When I tried to draw her attention to each of these items quietly so that the pt wouldn't become concerned, she blew up and said that she saw things done this way by "nurses more experienced than you" when she was a CNA. I said that when we were working together that we would follow policy and she could do as she wished when she was on her own, but hopefully she would review central line infections first. That wasn't well received. I offered praise for everything that went right, and encouragement when things didn't. I haven't been to work since that night, and frankly dread going in tomorrow. I'm a pretty quiet person and not popular, and can't imagine that this will help my reputation at all. *sigh*. I"d be appreciative for ways in which I could have handled this situation better.

[Orange Tree]

I'm not convinced this is an LVN/RN problem, but there is definitely a problem. Aggressive and dangerous is a very bad combination.

[anotherone, BSN, RN]

Tell the manager everything. Doubt anything would improve

but it is your obligation to do so . We have had a few new hires like this and most were rns trained by rns. One of the reasons most nurses on my unit dislike or refuse to precept

[newrnltc]

sorry this happened! When I was a new RN in LTC, LPNs and CNAs were crucial to my success as a newbie! They knew who those 100 residents were and they knew them well! I am saddened this nurse is giving RN's a bad rep. Truth be told there are good and bad nurses/docs at every level. I think you gave very constructive information if she is not more careful perhaps her first med error will put things in perspective. This is not a profession where we can blow off important information due to pride! If your management doesn't care it would still be good to document this (email to self) in case this ever comes back to you as her preceptor.

[catlvr]

The new nurse came to me last night (I've been off for five days, huzzah) and hugged me. Said that she appreciated my help and asked me to sign off of her items. I first showed her the IV policies and reiterated about central line infections, rights of med admin, etc, and said that I'd sign off over the weekend when we worked together again. My sense is that she feels a bit chagrined by her behavior, and hopes to learn and grow - that's my hope as well! I really don't think that it is an RN/LPN issue; I think that she's seeing different styles of work and she'll either decide to be a "safe" nurse or not.

[imintrouble, BSN, RN]

I personally don't care about if the new hire is rude or disrespectful when I orient. I really don't even care if I like the person I'm orienting. What would have had me a basket case was the level of errors you describe.

I would not have oriented that new nurse a second night if all those errors you describe happened in one 8-12 hr shift.

[bebbercorn]

Maybe she saw this post and recognized herself?

[PatMac10,RN, RN]

I applaud your approach. Some people just push themselves into crashing and burning before they Realize they need to stop, learn, and listen.

[fmxkrazyone]

Wow, if that had happened on my floor that nurse would not have lasted through the night, if nothing else she should be putting patient safety first, my first med pass must have taken hours longer than it should have and sometimes still does, but I haven't made a med error yet and praying I don't. I've worked in LTC, I realize how "different" it is, but it doesn't make it right. Glad you spoke up even if they don't do anything about it, hopefully she will wake up and not kill anyone.