Orienting a Problem Orientee...the Know-it-All

Beth Hawkes MSN, RN-BC - 05/20/19

Joan is a seasoned ICU nurse who is precepting Sean, a new grad. Sean was hired because he graduated at the top of his class, interviewed well, and was president of his class. Joan doesn’t know it yet, but Sean is a problem orientee. 

Sean is bright, Sean is charming...and Sean is also a know-it-all.

Recognizing the  Know-it-All

Know-it-all nurses are easy to spot because they will tell you at the first opportunity that they do, in fact, know-it-all. Then they will tell you again and again.

They are not good listeners because when someone else is talking, they are nodding impatiently, waiting for them to take a breath so they can interject. It’s quite annoying to them when others keep talking. In their minds, whatever knowledge or experience they have is far more important that what others have to say. They believe that once others have heard what they have to say, they will be acknowledged and respected.

A new grad know-it-all, if unchecked, will grow into a domineering coworker. They become the nurse or charge nurse who never says, “I don’t know” and gives a wrong answer rather than admit they don’t have an answer. Know-it-alls go on to be opinionated nurses who issue knee-jerk responses without checking their facts.

Sean brushes off feedback from his preceptor, Joan, with his favorite response “I know that” while Brittany, also a new nurse, but experienced, dominates social and work conversations.  Typically she starts with “Where I came from…. we did thus-and-so in such-and-such a manner,”

Oblivious to Feedback

The know-it-all does not pick up on subtle feedback, such as people’s eyes glazing over, or downward looks in a meeting. Their competitive drive and urgency to speak blinds them to others’ reactions. They are 100% convinced they are right and being right is what matters.

After his first day in ICU, Sean went home and told his wife how impressed his preceptor was that he could explain the coagulation cascade in his patient with a bleeding disorder. He said he believed even the doctor was impressed.

Sean does not realize that his preceptor was not impressed, she was exasperated. Sean has book learning but book learning without experience is like owning a cookbook without cooking.

After Brittany’s first day, her preceptor went to their manager “She doesn’t listen to a thing I say. She’s simply intent on telling me what she knows”.

Smart People

Know-it-alls like Sean and Brittany are usually very smart people, with lightning-fast intellect. Very often, they are right, although some know-it-alls are bluffers. 

Successful know-it-alls have initiative and go on to become leaders and subject matter experts.

At the same time, know-it-alls are at risk for making errors. They do not know what they do not know and may feel entitled to take shortcuts or work outside of their scope of practice.

How to Deal

New grad know-it-alls are insecure and triggered by starting their first job as a nurse. Having been comfortable as high-achieving students, they don’t know how to manage being uncomfortable in their new work setting. Experienced new hires, such as Brittany, want to make their mark in their new job.

Understand the know-it-all’s needs. Everyone has a deep need to be understood, and the know-it-all needs recognition. They feel both insecure and superior. So first and foremost, give them respect and recognition. This must take place before they can listen. Acknowledge their accomplishments and skills.

As a preceptor, aim for a collegial and not a student-teacher relationship. Never talk down to new grads or inquisition them in an old-school manner, know-it-all or not. Come alongside as a peer and help them learn their role. In a few months, this is the nurse you will ask to switch shifts with you.

Ask questions instead of suggesting. “Tell me how you know this”, “What is the worst thing that could happen during a sheath pull?’ and “What is your rationale for that answer?”

Assign them challenging tasks, and ask them to reference their assertions.

Call bluffers on their facts (actually, their opinions stated as facts) and let them know you expect them to be credible just as you will be credible.

Remind your new hire that they cannot practice until they have been verified as competent. A key phrase to use with new hires is “This is how the organization expects us to do it here” which after all, is the definition of orientation.”

You may gently tell a know-it-all they are alienating people, framing it as a help to them. “It would help you succeed here if you ask others for help”, but it may not be successful.

It may take a sharper reprimand or a mistake before they listen and change their behavior. They change when they feel uncomfortable, not comfortable. Be firm.

Maintain your own credibility. Know-it-alls will not respect you if you are inconsistent or do not base your own instruction and practice on policies and facts.

Channeled properly, know-it-alls can go on to be top performers and outstanding nurses.  Know-it-alls who can be reined in have a lot to offer.