Training a new RN

1 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.
If it all went as you say I don't see anything wrongly her than she has the chip of "I'm an RN and you're and LVN, why should I listen to you?!?!" However lets watch for her "this LVN was so mean, she thought she was better than me" post.Posting from my phone, ease forgive my fat thumbs!

Sounds to me like you did a good job!It also sounds like she needs to sloooooow down, listen and pay attention!You can only do so much and if she keeps going the way she is going, she'll surely find herself in a mess.Surely, you can speak to your manager about your concerns?I would think that if you are training her that the higher-ups would want some feedback on how their new nurse is doing and you would be the one to provide that.It's not about causing trouble... what you mentioned are real safety concerns.

Do you have paper MARs or EMAR? With EMAR there is no excuse for a mistake, with MARs is it another story entirely.Anyway, she is on her own now? I would suggest to your manager that she needs a few days and explain why.

I think you could go ahead and show her the door. So to speak.

I'm shocked at her level of disrespect. I'm also shocked at the level of mistakes she is attempting to make. I'd be very concerned to precept someone like that. If it were me I'd speak to the manager about finding her a new preceptor. I wouldn't want to be any part of it. Frankly those are big mistakes in my opinion, and it seems like there have been several in a short period of time. I'd worry about her safety on the floor... GL with this situation.

Yeah, in thinking more about this- remove the mistakes, forget about that for a minute. I'm focusing on the way she is disrespecting you. It shows that she has no fear of authority. She forgets that they didn't have to hire her for this job, and that there's probably a few handfuls of qualified RN's out there who would just LOVE to have her job. She's an RN and you're an LPN- big stinkin deal! When I was an LPN, my preceptor was a Medical Assistant, and she had been a peds CMA since I myself was a kid, she knew her stuff! Just like you know yours but she has no fear of you. She doesn't get that all you have to do is say the word and she's lost herself a job and won't be getting a real kind reference. I myself am shy and I hate confrontations, so I'm sorry you're going through this. Were it me, I would be up in arms, but since I'm removed from this, I can clearly see someone who, even on their own isn't going to fare so well I think. Add in the careless mistakes and half hearted work and I'm just thinking she's going to have problems- big ones.

Oh, for heaven's sake. Tell your nurse manager everything you said in your first post, and suggest that this person be oriented by an RN. That way the newbie won't be able to discount everything you say because you're not at her licensure level, you're off the hook, and whoever takes over from here will be able to reinforce to your manager all you say. Or perhaps she'll get religion and start doing a better job. Either way, this is off your plate.

Quote from itsnoworneverIf it all went as you say I don't see anything wrongly her than she has the chip of "I'm an RN and you're and LVN, why should I listen to you?!?!" However lets watch for her "this LVN was so mean, she thought she was better than me" post.Posting from my phone, ease forgive my fat thumbs!

Thanks for the support. I really don't care about her disrespect - my skin is pretty thick - but I do care passionately about patients and keeping my license. I rarely see our manager (I work second shift, part time, and any time that I raised a concern with her, she has blown it off), so I told the evening supervisor what happened, and that in my opinion she needs more time on orientation. I'm a pretty quiet person and don't really fit into this facility very well; they do things "differently" if you catch my drift, and I suspect that she'll fit in just fine. It isn't quite organized enough that we have preceptors/mentors (although they pay lip service to it), and I feel pretty sure that she'll insist on not spending another shift with me. I've been off for five glorious days, and just want to end my time there peacefully. Six more shifts for me, and then I'm done.

The new RN sounds like a snot. I would never say anything like that to someone who was orienting me. It's just rude.

In the end, patient safety is priority and this nurse risks that. When I started orienting on a Progressive Care floor, there was another new grad nurse that was a little behind on her skills and frankly, a little lazy. Her preceptor brought it to the attention of the nurse manager, who extended her orientation. This meant a lag in her rate of pay to rise once off orientation and threats of longer training on the med/surg before returning to PCU. She turned her act around pretty quickly and ended up getting along fine with her preceptor. I was grateful to have preceptors that stopped me when I was new so that these basics were deeply engrained, if that helps!

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