Letting A New Graduate Go

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Letting a new graduate go during probation is a difficult topic that we rarely discuss but has come up in several leadership development sessions recently. A nurse manager related the following story:

It is hard to even talk about this as I still feel guilty, although I know I should not. I just terminated one of our new graduates during her probationary period. She was friendly, and this was not about calling in sick or having a bad attitude. She could not do what was asked of her in the RN role. Her clinical skills, judgment, and ability to prioritize were so weak. We extended her residency, changed preceptors, and even moved her to a different unit. We did not see progress. I feel that in the past – this nurse would probably not have successfully finished a nursing program if the faculty were observing her behavior in clinical. On paper, she seemed okay but not in practice. She was unsafe and had challenges managing care even with extensive help and supervision. I would not feel right if I overlooked this, as it was a patient safety issue.

Once the manager told her story – others joined the conversation with their own experiences. This story was not as unusual today as I might have thought. Yet this is something we rarely talk about in leadership development. I can remember the first time this happened to me many years ago. It was just so hard because I felt like we had tried everything. Telling a brand new graduate on their first job that you have concerns about their clinical abilities never gets easier. The best advice I can give when you see this happening is the following:

• Ask the new graduate about their perceptions of their transition and whether they enjoy what they are doing – a new graduate admitted to me during one of these conversations that she did not like nursing.
• Have a frank but respectful discussion with the new graduate about what you see in their performance that is problematic.
• Maintain your expectations and be clear.
• Check with HR to be sure you are following your health system protocol.
• Try another preceptor and another clinical area that might have a slower pace.
• Get assessments from unit educators about additional strategies for upskilling the new graduate.
• If things are not working out – be honest about it and take action before the probationary period is up.
• Don’t offer to give an employment recommendation.

Not everyone can be a nurse – I have learned that during my career. The situation is especially challenging right now because graduates have had less clinical time and oversight over the past two years. Some might not have made it through their programs if they had not happened remotely.

Your first responsibility as a leader is to ensure safe patient care. If you have deep concerns that a staff member cannot meet those standards – you have no choice.