What type of role do you take as a preceptor with non GN nurses?

[Codeblue1982]

I am just wondering what type of role you take as a preceptor with nurses that have some nursing experience? Everyone seems to have a different style and level of involvement. I work ICU at a large teaching hospital and when new nurses transfer in I like to get a feel for what their overall practice, knowledge level and work ethic is like, so I feel like I have more than a responsibility that simply teaching them about Vents, gtts and ICU interventions; I want to know that they are competent at baseline before we go jumping into taking patients on hypothermia with 10 gtts running. Some of my coworkers choose to take a more passive approach and go over just the ICU pieces and leave it at that. My issue is recently I have oriented a nurse who is very flip about everything, will surf the internet instead of seeking out learning opportunities, misses key pieces of basic assessments, becomes defensive with constructive criticism about incorrect practice issues and document interventions that were not done. My concern is that the previous preceptor passed on to me that this person was doing wonderful . I am not an eat your young type of person and try to promote learning in a non threatening way by talking through scenarios. I was told by my orientee that this makes them feel put on the spot and is stressful. I explained that it will be more stressful when an emergency is actually happening to a patient as opposed to just talking about it and that I am not doing it to make them feel dumb but as a learning exercise. I learned early on that this person does not like to be wrong or made to look like they don't know something which to me sends up red flags as being dangerous since none of us know everything.

So any input from other preceptors would be much appreciated!

[icuRNmaggie, BSN, RN]

These are serious issues that can not be ignored. If you have given feedback that was not received, then put it all on her weekly evaluation, dates times and incidents of false documentation, missed assessments and incorrect practice issues. I would not let this one off of orientation.

[Altra, BSN, RN]

Agree with the post above. The issues you have identified do not bode well for her independent management of patients.

[icuRNmaggie, BSN, RN]

I have known two Med Surg RNs who transferred to ICU, but to this day, do minimal to no assessment and remain focused on tasks. They had bad work habits and no desire to grow. The desire to learn ICU nursing was never there. I think that the only draw was the ratio. They do not collaborate with others. They don't ask questions. They are not interested in continuing education. They rarely do oral care or turn their patients. They never update a physician of a change unless prompted to do so. ABGs are for other people to deal with. They are sitting down reading a book within an hour of starting their shifts. These two do not have "it" whatever "it" is and they never did.

The orientee the OP has is going to be one of those nurses who fakes it. It is impossible to teach someone who is indifferent. It sounds like this orientee was passed on to her for that reason.

Being a teaching hospital, the professional development department should be administering the BKAT ( Jean Toth's Basic Knowledge Assessment Test) for critical care prior to letting this nurse off orientation. Given the attitude of the orientee, I would request that it be given now to identify learning needs, as well as at the end of orientation.

[Codeblue1982]

icuRNmaggie you have perfectly described this person and her overall work ethic. I have spoken to the leadership team and let them know the specific concerns. I also suggested that she take the BKAT and be put through our critical care "boot camp" as well as have an orientation extension. I fear for the safety of her patients especially since I don't believe that she really cares about the care she is providing. I think she wants to say she is an ICU nurse and have the title but not put in the work. I have never met anyone like this who thinks they have it all down after a few weeks of taking fairly easy patients. She hasn't even scratched the surface of the acuity of our patient population and when I suggested ways that she could brush up and prepare for some of the things she will encounter I got the response that " it is just whatever, I will figure it out". Maybe I am unrealistic but I think when nurses are on orientation especially in the ICU, their baseline level of nursing knowledge and critical thinking should be evaluated first and then their orientation should be tailored based those results and then reevaluated to see how they are progressing and to see if they should even be in an ICU before it is too late and they are on their own.

[icuRNmaggie, BSN, RN]

The indifferent attitude is a huge red flag that you may be dealing with a diverter.

[AnthonyD]

Just based on your brief description, I'd be hard pressed to say there's a lot you can do to help this person succeed in the ICU. You can only do so much as preceptor, and changing someone's work ethic/attitude is a probably just on the far side of difficult to impossible.

I think any nurse that's new to the ICU, whether GN or experienced, should arrive somewhat nervous, hyper-vigilant and ready at the same time to impress and be humble. My advice is to give reminders as much as possible and document when and what you are teaching. Weekly email updates to your unit educator or preceptor coordinator will help them have a paper trail if they have to part ways with this nurse prior to completing orientation.

[ScrappytheCoco]

Uhh, working with critical pts is the definition of "put on the spot and stressful." :/

[Codeblue1982]

Uhh, working with critical pts is the definition of "put on the spot and stressful." :/

Yes it is! And I explained to her that we have had simultaneous codes occurring while whoever is in charge is off the unit at an rapid response or code so she needs to know her stuff because she may not have someone there to tell her what to do. Not to mention working at a teaching hospital if there is not a strong resident covering night shift they often look to the nurses to take the lead.

[Greenclip]

Maybe I am unrealistic but I think when nurses are on orientation especially in the ICU, their baseline level of nursing knowledge and critical thinking should be evaluated first and then their orientation should be tailored based those results and then reevaluated to see how they are progressing and to see if they should even be in an ICU before it is too late and they are on their own.

Agree 100%.

[Here.I.Stand, BSN, RN]

She is beyond scary!! I agree that you need to include all of this in her feedback, and were right to speak with the leadership team. If she's this blase and making false documentation when she is on orientation, what is she doing to do when she doesn't have 1:1 supervision??? I mean, you'd think she'd be on her best behavior, right? She can't be unleashed on the critically ill public like that

[dah doh, BSN, RN]

My approach to your orientee if I was training them: this is what I see you doing (give specific examples), this is what I need to see you doing (give examples), or these are the consequences! Also give a specific time frame for these changes to be made and give daily feedback on their how their day went. Ask how their day went and give your opinion of it...bet you it's different then their perspective. I've seen orientees change their behavior by the next shift and others very slow to change.

Management needs to be in the loop about the orientee's progress or lack of progress.

I've trained people for over a decade and I've never had an orientee NOT respond well to the above approach. It's not as harsh as it sounds as my opinions are very matter of fact and they know I really want them to succeed. I think it's realistic and expectations and progress is known. I think they come to appreciate that.