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How can I coach my new graduates through bad patient outcomes?


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Among the many challenges new graduates will face—and obstacles to the development of their critical thinking—are the patients in their care who have bad outcomes and the providers who are unwilling to collaborate with them. The first year after graduation is a time for education, and care must be taken that new graduates are not frightened to make a decision or feel constantly indecisive in the care they provide.

  • Allow them to grieve through their error or omission. Whether patients are in their care for one hour or one week, in their minds, they are still "my patient."
  • As nurses we tend to beat ourselves up when we make a medication or other error. New graduate nurses need time to go through a process where they review what happened and how they would approach it differently next time. Our job is to coach them away from the blame and move them toward learning experiences.
  • Provide them with more than one opportunity to sit with supportive mentors or preceptors to review the scenario that led to the patient outcome.
  • Make sure you are the person who debriefs the nurse. Don't expose them to the nurse who says, "I told you this would happen if you let the new grads in here."
  • Even if the bad outcome was not related to something they did or did not do, they still may feel like it was their fault. Coach them that a guilt trip will not change the outcome of the scenario.
  • If they are not willing to take responsibility or accountability for something they did or did not do for the patient, recognize this as a patient safety warning. These nurses will require further assessment of their critical-thinking capabilities and ongoing involvement with the nurse manager.

—Shelley Cohen, RN, BS, CEN