Problem Learners

When Problem Learners Aren’t the Problem: How to Help New Nurses Succeed

You know the type. The novice nurses who make ICU or PCU staff say, “They don’t pick up material quickly enough. I’ve been trying to teach them, but they aren’t learning.” We strive to find the ideal ways to approach and support these so-called problem learners. We want to help them succeed. If they remain uneducated long enough, they can be a burden on unit resources and a risk to patient health and safety.

But what if the problem learner isn’t really the problem? Their failure to learn or showcase their knowledge could actually be a symptom of a larger issue, one that’s burning out nurses and preventing them from succeeding at the bedside.

Before assuming that your struggling nurse isn’t fit for the ICU or PCU, let’s explore what could be the real problem — and how to fix it.

‘Problem Learner’ Is a Symptom, These Are the Causes

In my experience, the majority of problem learners are sadly mislabeled. These nurses can learn complex critical care material and apply it successfully, but they don’t get the opportunity. Here are four common reasons.

• Bullying
  When I say “bullying,” what I’m talking about are judgements and behaviors that experienced nurses may think or do, such as:
  • Assuming that the novice nurse doesn’t fit in and then badmouthing them to others
  • Disliking the new nurse and then gossiping about them and their nursing care throughout the unit
  • Not giving the new nurse the benefit of the doubt or lending emotional support during their transition into the unit
  • Voicing only negative criticism instead of constructive feedback and then expecting the nurse to magically improve

  Novice nurses are often treated unfairly — they aren’t given the time and tools needed to succeed — and then to add insult to injury, they are blamed for not thriving in an unfair environment. They are labeled problem learners when they’re actually victims of bullying and haven’t been given a chance to learn, prove themselves or show that they fit in.

  How common is it? According to a 2017 survey, 45% of nurses have been verbally harassed or bullied by other nurses. This exact thing happened to me when I started as a nurse in my first ICU. I was once labeled a “problem learner.” My preceptor was too busy with her own patients to answer my questions or provide feedback, so I didn’t learn things I should have learned. Before I knew it, there were rumors around the unit that I was stupid and shouldn’t be an ICU nurse.

  Fortunately, that only lit a fire under me to pursue certification rather than leave, but that’s not always the case. According to the 2019 National Health Care Retention & RN Staffing Report, 22.9% of all new RNs leave within their first year, and over 25% of all RNs leave their job during the first year. After many years as a nurse educator, I’m not surprised. When nurses do leave, it’s usually because an unsupportive environment pushed them out the door rather than any lack of skills or knowledge.

• Not Understanding How the Nurse Learns
  In other cases, the new nurse starts struggling because preceptors or experienced nurses don’t understand how new nurses learn. Everyone is a little different. Some people are visual learners; others are hands-on learners. Some prefer e-learning modules that they can complete at their own pace. Some succeed in classroom environments, and others do better with one-on-one mentoring where they can ask specific questions. For ideas to help you create learning environments for different learning styles, read my blogs on the flipped classroom and goal creation for novice nurses.

  A colleague I know uses the tools and resources from VARK to assess learning styles. Assessing learning styles could provide valuable insight about your learner and also help you.

• No Actionable Feedback
  As I mentioned in my personal story, constructive feedback is essential. Think of it like novice nurse food! They need it to survive and thrive. How are they supposed to learn and improve without feedback? Well, I should say without actionable feedback. Generic feedback for the nurse that doesn’t provide specific next steps isn’t very helpful. Here are examples of feedback that is too broad:
  • You need to develop critical thinking
  • You need to learn to advocate
  • You need to learn to communicate

  These comments have no specific, actionable points. When the new nurse hears that, it probably goes in one ear and out the other, and then they’ll make the same mistakes over and over. Frustrating for them and frustrating for the unit; not to mention an easy way for the nurse to be labeled unfit for the unit.

• Infrequent Check-Ins
  Check-ins between new nurses and their preceptors achieve a lot of the same things as good feedback: They reinforce good behavior and accurate knowledge, stop incorrect knowledge and clinical care practices, and provide some time to discuss how the nurse is adjusting.

  When preceptors get really busy, though, the first thing to fall by the wayside is check-ins. The nurse doesn’t get the attention they need, so they flounder and think “maybe I’m just not cut out for this unit.” Hello, turnover. I recommend a check-in every two weeks, for consistency.

What Can You Do to Prevent ‘Problem Learner Syndrome’ in Your Unit?

The good news about ‘problem learners’ is that you’ll probably see far fewer of them in your unit after making some simple changes.

• Learn How to Create a Healthy Work Environment
  Much of the time, an unsupportive environment pushes new nurses out the door. On the other hand, a healthy work environment (HWE) allows nurses and other staff to be their best for each other and patients. There are six AACN HWE standards:
  • Skilled communication
  • True collaboration
  • Effective decision making
  • Appropriate staffing
  • Meaningful recognition
  • Authentic leadership

  Use the free HWE assessment tool to see where your unit stands, and find resources to help you resolve identified problems.

• Have Everyone Commit to Positivity
  Speaking of tools, I’ve had great experiences using a commitment tool I created to promote buy-in from both the preceptor and new nurse. The tool is basically a one-page sheet that outlines some HWE behaviors, such as avoiding gossip and promoting positive communication. When I was a nurse educator, I sat down with preceptor and nurse pairs and asked them to commit to creating a positive learning experience for the nurse.

  They signed the commitment tool, and it became a mission statement that guided their interactions from there on. It’s so simple, but I was always surprised how well this tool worked to get everyone on board right from the beginning.

  I outlined a commitment process in chapter 22, application of the Synergy Model to orientation, page 182, in the book “Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care, 2nd ed.”(2017).

• Create a Goal Tracker
  You can also encourage preceptors and nurses to start their orientation by filling out a goal sheet. I recommend the preceptor tool we developed, which is included in Chapter 22, pages 183-190, of “Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care, 2nd ed.”(2017). This sheet could cover categories such as:
  • Clinical care knowledge
  • Patient and family interaction
  • Team communication
  • Confidence and job satisfaction

  Once they fill out the sheet, it’s easy to check in every two weeks and mark their progress. The preceptor can see where they need to provide a little more help, and the novice nurse has a sense of accomplishment.

• Schedule Regular Feedback and Check-In Sessions
  Give new nurses the opportunity to ask questions by setting up feedback meetings with their preceptor and experienced nurses. These can be as short as five to 10 minutes every week. The point is to set aside some time to ask specific questions, share suggestions and identify strengths and areas for improvement. Preceptors will also understand how the new nurse learns best, which can be very helpful.

  If you get pushback from nurses and other staff along the lines of, “I don’t have time,” remind them that feedback is one of the best and fastest ways to get a new nurse up to speed so they need less help later. Plus, if a five- or 10-minute check-in session could make a big difference in the quality of patient care in the ICU or PCU, wouldn’t they want to do it?

  Nurse educators, don’t forget that you’re also part of this check-in chain. Try to meet with new nurses every two weeks, whether in a meeting or rounding in the unit. Noticing how well nurses are applying their knowledge will help gauge their progress and improve your program in the future. Create a recurring appointment on the calendar ensures the time is set aside.

• Give Preceptors the Resources to Succeed
  Like you, preceptors are busy people. If it takes too much time, they probably won’t do it. Be sure to give them all the tools and resources they’ll need in one easy packet. This includes:
  • HWE Information
  • The commitment process and goal-tracking sheets in the book “Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care, 2nd ed.”(2017)
  • Information to join the ECCO Community of Practice ListServ to connect with and share best practices with educators.
  • Explanations of specific, actionable feedback
  • Your time and attention

If preceptors succeed, the nurse will succeed. And if the nurses succeed, you succeed.

We all became educators to help make the system better — better for nurses and better for patients. By doing these simple things, we can prevent people from mislabeling new nurses as problem learners in the first place, create an HWE and build teams of knowledgeable and passionate nurses who provide better patient care.

I want to know: What are some of your tried-and-true solutions for ‘problem’ learners?