Trying not to get frustrated with a new grad

[rn undisclosed name]

I am trying real hard not to lose my patience with a particular new grad. He's probably been on the floor 5 months and I remember what it was like to be a new grad and I've worked with quite a few but this particular one I am having a problem with I feel as though he is not getting it. He works night shift and I frequently follow him. I feel like report time is me educating him and he is not taking what I say and his responses are very flippant. It is my gut feeling he does not ask for help and when he is unsure of something he just does it and doesn't ask for help.

Most recently there was a pt who had a trach and he had probably never taken care of a pt with a trach before. During report I want to know (1) what kind of trach the pt has (2) what size it is (3) if emergency equipment is at the bedside. Anything else pertinent (suction requirements, difficulties with trach etc. I like to be prepared when it cames to trach patients (or any pt for that matter). I'm probably anal in that respect. He did not know the answers to any of those questions. At the very least you would know the size if you change the inner cannula. I gave a little mini education on trach's. His response to me is I'm not good with trach's. I felt like I just wanted to scream when he said that to me. Mind you this pt came in with respiratory distress b/c of the trach.

I had another pt who had a prolonged hospitalization and was admitted with hypoglycemia, seizures, respiratory and cardiac arrest. Pt was having a procedure done but his glucose from his BMP was in the 50s. He acted on that by calling the physician and changed ivf from 0.9 to D5 0.45. We have a protocol that is followed. 1st you treat the hypoglycemia with juice, 1/2 amp of D50, or glucose tablets and keep rechecking until the sugar is >70. Then you notify the md. When I started at this hospital it has always been stressed you follow the protocol and if you don't you are written up for it. So this is not typically missed. I provided education (again) and told him how he needed to follow protocol no matter what. His response was "Well I got the order from the dr." Well, that's fine but you don't stop there.

I have received a pt in respiratory distress who I ended up needing to transfer to CCU and needed to go on Bipap.

I have spoken with other nurses on the floor about this nurse and their response is he acts like a know it all. I have spoken with the charge nurse but I kind of feel like they're not taking my concerns the way they're intended. I feel like additional education needs to be done and coming from another staff nurse is not the way to go. I am talking with my manager tomorrow and hate the thought that I am tattling on him but feel like something needs to improve before something happens to a patient. Almost 6 years later I still ask a ton of questions and have done so since day 1. Is there anything else I can do in this situation?

[Been there,done that, ASN, RN]

You needed to go to management on his obvious lack of experience a long time ago.

(Be prepared for that response)

Your observations and concerns should have been reported to management and nursing education promptly.

It is NOT up to you to continue his education(especially if he declines your instruction).

You are NOT tattling.. you are bringing up the FACT he is not following protocol.

Good luck.. sometimes the messenger gets shot.

[rn/writer, RN]

Wanted to gnash my teeth over the, "I'm not good with trachs," comment. How does he think a nurse becomes good with unfamiliar things? By avoiding them at all costs? Or is he not-so-subtly saying that he doesn't intend to become good with trachs so he won't have to take care of any?

If you haven't seen improvement in five months' time, it's entirely appropriate for you to let management know the score. Someone like this is dangerous and could cause serious harm. Both the ignorance and the attitude need rapid adjustment or he should be shown the door. There are so many new grads who would be only too happy to take his place.

Hope you are taken seriously.

[Aurora77]

I agree with the others. He sounds dangerous. At five months how does he not know the hypoglycemia protocol? If, by some chance, he doesn't, why didn't he ask one of the other nurses or look up the protocol?

If he's not good with a procedure/care (and at five months, who really is unless you're doing them all the time?) what did he do about it all night? He should've known the details and used the opportunity to learn. Surely he had to do some care with it overnight.

I'm a new grad myself, at 8 months now, so I can understand that he's not going to know everything, but by five months he should be able to do the basics and be able to think things through.

I hope your NM is more receptive than the charge nurse has been. Something needs to be done about this guy. He needs more education, for his patients' and his sake.

[rn undisclosed name]

I have already gone to the nursing educator regarding the insulin issue. I do not know if anything has been said or not. I was told they are keeping a close eye but that was over a month ago. The educator was helping me that day on the pt who was in respiratory distress because quite frankly I had more than I could handle. On this particular day he left me with 3 patients that had a SBP in the 70s (did not start on his shift but at the beginning of my shift), low blood sugar (not following protocol), and pt who was having some moderate respiratory distress. The educator knew about all that but I have not heard anything.

Thanks for your reponses. I guess I just wanted some validation before I speak with my manager today.