Biggest Red Flag In A New Nurse: 3 Steps To Address It

A Lone Wolf is the biggest red flag for a dangerous new grad nurse because they NEVER ASK QUESTIONS! They push through orientation figuring stuff out as they go and sometimes make stuff up. Some feel the need to prove themselves as a nurse and some may not be used to relying on others. Regardless of the reason, the outcome is rebellious and a danger to patients. They make it almost impossible for even the best trainer to work with them. It is hard to know what a Lone Wolf is up to because they go off on their own without keeping their trainer informed and do not like answering their trainers’ questions.

  • Chloe was training a new grad nurse on a busy Telemetry unit. From the first day, the new nurse was quiet but Chloe chalked it up to nerves. However, as orientation progressed, the new nurse rarely initiated conversations with Chloe. She never asked questions and would go off and do tasks on her own without Chloe knowing. 

1. Have Hard Conversations

Being assigned to train a new grad not only requires good teaching and communication skills, but it also requires conflict management skills. You have to be able to address inappropriate and unsafe behaviours in a professional way. Ask them for their rationale behind the Lone Wolf behavior, see if there are any learning gaps with policy regarding preceptor-preceptor relationship, and try to get a better picture of why they are acting that way. Pull the new nurse aside and share your observations, concerns, and corrections in a private setting.

  • When Chloe would try to have a conversation with her, the new nurse’s responses were minimal and she would get upset with Chloe’s constructive criticism. With the lack of communication Chloe never knew the full extent of care the new nurse was giving patients and what orders she was or was not aware of.

2. Involve Your Chain of Command

The biggest mistake you can make when training a Lone Wolf is to become one yourself. Let your educator and/or manager know about the unsafe behaviours you are seeing and ask them for help. Sometimes a conversation from people in direct authority over their career can have more impact than you as a trainer. Sometimes the new nurse will be more open to share things they are struggling with and allow for clearer direction in how to help them learn better.

  • Chloe told management about the new nurse’s Lone Wolf behaviors and they had a meeting to discuss the safety issues and the need for change in behavior. The new nurse thought she was doing fine on her own, but agreed to communicate more and cooperate with Chloe’s oversight with tasks and medications. After the meeting, there was an increase in communication, but she was still very aloof. One day, Chloe noticed an order for an IV electrolyte for the new nurse’s patient. While looking for the new nurse to give the medication with her, she checked to see if the new nurse was in the patient room. The new nurse was not there, however Chloe saw the electrolyte IV hanging on the pole without a pump to control the rate of administration and the bag was empty. Chloe immediately did a complete assessment of the patient and her heart rhythm to ensure the patient was safe after the new nurse’s error.

3. Create Action Plan

The Lone Wolf behavior continued and could have caused significant harm by not including her trainer like she promised she would.

At this point, management should be taking further steps with an Action Plan and discipline. You, as the trainer, should not be involved in the disciplinary aspect, but you should be made aware of the Action Plan. In order to move forward with training, you need to know what the goals are and boundaries have been set by administration.

Part of the Action Plan may be transitioning to a different level of care or specialty in order to better fit their current time management skills, critical thinking ability, or required higher level of observation during training. If they are unable to uphold their commitments in the Action Plan, they may be fired.

Independence Vs Lone Wolf

The whole point of a new grad nurse’s orientation is to get them to be able to work independently. However, when they start out as a lone wolf it is very dangerous. A new grad does have enough clinical knowledge to act safely in solitude. It takes years of experience to reach Expert Level knowledge in your specialty and even then, expert nurses with Lone Wolf tendencies know that there are times when teamwork is absolutely necessary, when to ask for help, and when to offer it.