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, MSN
145 Articles; 4,504 Posts
Yikes! A little off-topic, but what was their issue?