When Your Preceptee is a Know-it-All

Here's some insights to help you and your preceptee.

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When Your Preceptee is a Know-it-All

By 0900 on the first day of orientation with her preceptee, Sheila knew, and groaned inwardly. Her preceptee, Kyle, was a know-it-all.

During rounds on their patient in the designated COVID-19 ICU unit, the intensivist musingly mentioned transfusion. Kyle spoke up excitedly, "Oh, you mean convalescent plasma transfusion? It looks promising. I read that it can be useful in the treatment of critically ill patients with COVID-19. I understand more than 6,000 patients have received...” Sandra jabbed him with her elbow and tried not to roll her eyes.

She knew for sure that Kyle had not so much as seen a blood transfusion, much less a convalescent plasma transfusion.

Everyone has encountered a know-it-all in the workplace, maybe a coworker or charge nurse, but what if you're the know-it-all's preceptor? A new grad who doesn't know anything but thinks they know everything is scary. They don't know what they don't know, they may not be appropriately cautious, and they may not even be teachable.

Variations

Some know-it-alls are posers and inwardly feel like fakes who haven't yet been outed.

Others genuinely feel superior to others.

They don't listen and they aren't concerned with what you have to say. They are busy thinking about the next smart thing they are going to say, and anticipating how impressed you'll be.

They monopolize conversations, like to hear themselves talk, and love to have the last word.

Know-it-alls want to be seen as the smartest person in the room. It's a driving need and it didn't start with their first nursing job.

Their need comes from a place of deep insecurity and their defense to feeling insecure is acting superior. Their insecurity is triggered by being in a new group and starting a new job because they must prove themselves. They crave attention and hate to be ignored or disregarded, often steering the conversation back to themselves and their accomplishments.

Choose Empathy

Be mindful of the dynamics between the 2 of you. Your job is to ensure a learning environment, which is built on mutual respect.

Watch that your preceptee doesn't trigger your defenses. If you have a very strong reaction, examine yourself. It's a sign that you also might also be a know-it-all.

Instead of anger, choose empathy. Find a connection. Above all else, your preceptee seeks acknowledgement. So give it to him. For example, you can give acknowledgement and respect by congratulating him on graduating at the top of his class. Sincere acknowledgement and genuine recognition may be all that's needed to reduce some of his anxiety, and help him listen to you.

Hold Them Accountable

Avoid asking yes or no questions because a know-it-all will not admit they don't know something and will not say "I don't know". Instead of asking "Have you read the Lippincott procedure on removing an arterial sheath?” or "Do you know how to remove a sheath?” ask "Tell me 3 complications of arterial sheath pulls and what your plan is for each one if they happen".

When your resident presents information as fact, ask them for their source so they know you are going to hold them accountable. Over time they will learn to be sure of their information before speaking up, at least around you.

Likewise, be sure of your facts. The surest way to lose respect with a know-it-all is to lose your credibility. When you say "it's policy to do thus and so",.…make sure it is policy.

Set Boundaries

Make it clear that they are not allowed to practice independently until you say so. Make sure they understand your facility's process around being validated on orientation competencies. Have them repeat the process back to you (teach back).

For example, you have to observe, validate and document them passing medication or starting an IV competently before they are deemed independent. Make sure they know that even when they get off orientation, they are to seek help when performing a procedure for the first time.

Constructive Feedback

Many know-it-alls lack self-awareness and cannot read social cues.

As their preceptor, you have an obligation to give them meaningful, constructive feedback.

When giving feedback, give specific examples. "I want to let you know how you come across to others. Today at lunch I looked around the table and watched when you were talking about taking the NCLEX. A couple of people tried to jump in the conversation but you interrupted. I'm concerned because it could prevent you from succeeding here, and I would hate to see that happen".

Summary

Think of it as a challenge to orient a know-it-all, but a satisfying one if you succeed. Most know-it-alls are actually smart people, some of whom go on to be leaders. The ones who are teachable can end up being good nurses, and you can be a part of their success.

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Nurse Beth

About Nurse Beth, MSN

Career Columnist / Author

Hi! Nice to meet you! I especially love helping new nurses. I am currently a nurse writer with a background in Staff Development, Telemetry and ICU.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

I was kind of a know it all, and still can be a bit of a know it all sometimes.

I agree with everything except for the advice about the social stuff. Stick to precepting on nursing stuff and let know it alls manage their social relationships themselves. You dont need to tell your preceptee what they are doing that will make people not like them and it might even be construed as bullying.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Empathizing with the know-it-all has limitations because they often have trouble empathizing with others. They will see your attempts at empathy as validation of their own behaviours. I shouldn't even know they graduated top of their class because it stopped being relevant on graduation day.

I would be constantly asking open-ended questions to shift the focus to empathizing with the patient. "If Mrs. Smith hadn't been forthright about her pain when we asked, what are some other clues that she was uncomfortable?" "How receptive do you think Mr. Jones was during his discharge teaching? What might have been getting in the way? Are there other things we could have done to make it more doable for him?"

The new nurse needs to learn that nursing is not about oneself. I would be constantly redirecting their focus back to the patient and asking questions that require critical and empathic thinking.

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I agree asking about their patient observations is very good. Focusing on the patient is a good lesson for all of us, as we are often quick to mentally go off in the wrong direction as soon as we hear something familiar ("Oh, chest pain? I know about that!"). With the insecure/know-it-alls, the same phenomenon comes into play all the more--they're not really paying attention but rather mentally soothing themselves with the fact that the patient has said something familiar e.g. patient mentions chest pain and the nurse just knows that heart attacks cause chest pain so the patient is probably having a heart attack.

The main problem here is interference with the development of critical thinking.

Best to realize it's often an emotional difficulty such as insecurity and just help the person re-focus. It isn't really an interpersonal issue as much as it appears to be, so it's best to not make it personal.

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Specializes in Adult Internal Medicine.

Maybe I am an outlier here, but am I the only one that the "case" isn't a great example of "know-it-allism"? I generally don't have a problem with peceptees being well read about a topic and eager to engage on it; in fact I've always felt it is a good time to engage them on applying their theoretical knowledge to practice.

In my own self-reflection, I can admit that most of the time I have a problem with "know-it-all" comments is when they are on a topic that I don't feel I have a mastery of (and the preceptee may even be better read than I am). I think as preceptors we need to be OK with the fact a student might actually know more than us on a given topic.

As I write this, I keep thinking maybe I am being the know-it-all by posting. I don't mean to be.

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Specializes in Tele, ICU, Staff Development.
On 6/4/2020 at 9:51 AM, FolksBtrippin said:

I was kind of a know it all, and still can be a bit of a know it all sometimes.

I agree with everything except for the advice about the social stuff. Stick to precepting on nursing stuff and let know it all manage their social relationships themselves. You don't need to tell your preceptee what they are doing that will make people not like them and it might even be construed as bullying.

One of the roles of the preceptor is Socializer. The others are Educator, Role Model and Protector. Not all preceptors have great coaching skills, but it is their job to help their preceptee be a success

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Specializes in Tele, ICU, Staff Development.
On 6/4/2020 at 11:26 AM, BostonFNP said:

Maybe I am an outlier here, but am I the only one that the "case" isn't a great example of "know-it-allism"? I generally don't have a problem with peceptees being well read about a topic and eager to engage on it; in fact I've always felt it is a good time to engage them on applying their theoretical knowledge to practice.

Good point. I was trying to convey an example of someone clearly drawing attention to themselves as their main motivation for speaking up.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
47 minutes ago, BostonFNP said:

Maybe I am an outlier here, but am I the only one that the "case" isn't a great example of "know-it-allism"? I generally don't have a problem with peceptees being well read about a topic and eager to engage on it; in fact I've always felt it is a good time to engage them on applying their theoretical knowledge to practice.

In my own self-reflection, I can admit that most of the time I have a problem with "know-it-all" comments is when they are on a topic that I don't feel I have a mastery of (and the preceptee may even be better read than I am). I think as preceptors we need to be OK with the fact a student might actually know more than us on a given topic.

As I write this, I keep thinking maybe I am being the know-it-all by posting. I don't mean to be.

I don't think it's a problem when the preceptee actually knows something and can discuss it. Rather than going by the example I was referring to my own experience with preceptees who are already perfect and won't be taught.

If they want to discuss something they're knowledgeable in, great. A place to start. I think the article was referring to a high level of self-absorption and the challenge of redirecting it.

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Specializes in ICU, LTACH, Internal Medicine.

I am really sorry to ask, but can anyone for just one time imagine that there are REAL know-it-all people? Novice nurses or even students who, for one reason or another, really know things, and more than many other nurses?

I am one of just such people and was treated atrociously just because of this, by nurses who were supposed to be preceptors, protectors, role models and overall moral pillars of society. While treating me into PTSD, there was at least two cases when patients died because these nurses completely ignored what I tried to tell them to do and why.

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Specializes in Tele, ICU, Staff Development.
19 minutes ago, KatieMI said:

I am really sorry to ask, but anyone for just one time imagine that there are REAL know-it-all people? Novice nurses or even students who, for one reason or another, really know things?

I am one of just such people and was treated atrociously just because of this, by nurses who were supposed to be preceptors, protectors, role models and overall moral pillars of society. While treating me into PTSD, there was at least two cases when patients died because these nurses completely ignored what I tried to tell them to do and why.

Could it be that the nurses who disregarded you were know-it-alls?

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Specializes in ICU, LTACH, Internal Medicine.
9 minutes ago, Nurse Beth said:

Could it be that the nurses who disregarded you were know-it-alls?

Sorry, no. They were not. With all honesty.

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? ... Most of the Preceptors simply roll their eyes and sigh! LOL

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