I feel so incompetent as a student nurse..

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Today in clinicals. I was assigned a patient with a nurse. This is a orthro flow. My patient has a heart condition and hypertension. During med pass. I got my patient vitals. Her bp was 176/62. I got the meds. The CNA went back and got vitals and it was 98/65. I told the nurse ok so we should hold the BP meds because that's low. He said no we can't because it's a risk for rebound hypertension. I listened to him. I then asked what are the parameters. He told me

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

You're supposed to be incompetent; you're a student. Competence is something you develop gradually. A difference in systolic BP from 172 to 98 is huge. It makes me think at least one of you didn't get an accurate measurement. The nurse told you to give the meds and so was on the hook for the result. If I had been the nurse, I would have checked it a third time myself before deciding whether to hold the med or give it.

Sounds like the patient is fine; no one is mad at you. Take a breath. Review your technique for taking a blood pressure so you can feel confident in your accuracy. Continue to run anything questionable by the nurse. What you're describing is standard nursing student stuff. We've all been there.

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Specializes in Emergency Nursing.

Hi mzsuccess!

I agree with TriciaJ.. You're a student and so being incompetent is kind of your MO right now. And thats okay! It won't stay that way forever and you're asking great questions! I also agree that the nurse should've gone and personally checked the BP since there was such a huge discrepancy between you and the CNA. Chances are one of you guys was incorrect.

One thing I would like to point out for the future though is that if you're going to be giving the meds, you need to check the MAR yourself for the parameters. Antihypertensive meds should have parameters on them in the MAR as written by the Healthcare Provider. The nurse just telling you

Also, I'm a New Grad so I also don't know my head from my tail yet... but it sounds like the nurse was just talking generally that you shouldn't give the antihypertensive if the patient's systolic is in the 90s etc. I've always heard that the general rule of thumb is SBP

If it was written in the orders as 90/60 and the patient was 98/65 but you're still unsure you can always assess other factors (BP trends, heart rate, s/s hypotension) and if you're still uncomfortable with giving the medication you can discuss with the nurse possibly clarifying the orders with the physician. But you shouldn't hold the medication on an asymptomatic patient if the blood pressure is within the parameters because of the risk of rebound hypertension. If, say, the patient was borderline but symptomatic you'd need to clarify with the HCP to hold. Blood pressure meds are important because a lot of the time they're a "maintenance" med. Stop or hold them too much and you could be playing with fire as the patient may go into rebound hypertension. So you wouldn't hold without communicating with your team. But don't beat yourself up! You will get more comfortable with all of these things as you grow and learn. It can be overwhelming sometimes *hug*

Something that I've learned recently is that there is very rarely a "one size fits all" in nursing. What is prescribed for one patient may not work for another. Blood pressure parameters for patient A may not be the same as patient B etc etc. I can still remember in my last quarter of nursing school ER practicum I had a complex patient with active liver disease. One of the first medications on the MAR was an off the wall med which when I looked it up it said in bold letters "contraindicated in patients with active liver disease." I asked my nurse and he wasn't sure either, so I ended up having to go and clarify with the physician. He was very kind and explained to me that while thats true, the benefits far outweigh the potential risks as the medication was needed to treat an even more serious aspect of the patient's disease. Thats why its critical to know why you're giving a medication and ALWAYS clarify when you're not sure!

I'm so glad you're coming here to ask questions and talk about it. We've all been there! You're still a student and everyone has slip ups. The patient is okay and just learn from this! Don't let it get you down!

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Thanks you both. My instructor has no clue this happened. We can fail because of clinicals. He passed me yesterday. He already told me to my face he thinks I'm kinda incompetent because I'm quiet. I just feel like they'll find out the med was given and BP was low. I did look in her chart and it is a trend for her bp to run low and some of her systolic numbers have been high and diastolic low. I took her bp two hours later and got the 136/45 and asked him he said it's ok. O said do you want me to continue to monitor bo he said no. I just think it should've dawned on me to not give it. I did look in her Mar and there were no parameters. Later, that day I saw a nurse give a book when bo was similar. Should I say something to my instructor?

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Thanks you both. My instructor has no clue this happened. We can fail because of clinicals. He passed me yesterday. He already told me to my face he thinks I'm kinda incompetent because I'm quiet. I just feel like they'll find out the med was given and BP was low. I did look in her chart and it is a trend for her bp to run low and some of her systolic numbers have been high and diastolic low. I took her bp two hours later and got the 136/45 and asked him he said it's ok. O said do you want me to continue to monitor bo he said no. I just think it should've dawned on me to not give it. I did look in her Mar and there were no parameters. Later, that day I saw a nurse give a book when bo was similar. Should I say something to my instructor?

I don't know how "quiet" equals "incompetent". Do you tend to not be assertive? Are you afraid to ask questions because it might tick someone off? Do you not speak up when something doesn't look right? Please ask your instructor to clarify and ask for some specific behaviours he'd like to see to demonstrate your competence.

By the way, any time you're criticized for any reason, it's a good strategy to ask for more specific information. If the criticism is constructive you can learn from it. If the criticism is just to cut you down, the criticizer will have nothing more to say. Win-win.

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I don't know how "quiet" equals "incompetent". Do you tend to not be assertive? Are you afraid to ask questions because it might tick someone off? Do you not speak up when something doesn't look right? Please ask your instructor to clarify and ask for some specific behaviours he'd like to see to demonstrate your competence.

By the way, any time you're criticized for any reason, it's a good strategy to ask for more specific information. If the criticism is constructive you can learn from it. If the criticism is just to cut you down, the criticizer will have nothing more to say. Win-win.

I speak up on things concerning the patient. It's just out of my colleagues. I'm less talkative and don't have small talk with him and somehow he thinks that's reflects how I am with the patients. I admit I'm not fully assertive and I'm working on that I am. Today was our last day at that hospital. I just feel as if what if I should've told me instructor about that situation when it could've indeed made me fail this term and I have two months left. I communicated only with the nurse whom I was working with.

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If the nurse(s) you were assigned to thought it was worth bringing up to your instructor, they would have done so. Don't go looking for trouble.

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BEING SHY DOES NOT MEAN ANYTHING ABOUT YOU AS A STUDENT NURSE/NURSE! I am a quiet person. I was shy up until a year ago. I'm great at communicating with patients and families but with nurses, I need to pop the bubble. I listen for a few days then I'll start opening up. Being shy does not make you incompetent. You're asking questions and you seem to care about your patient.

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BEING SHY DOES NOT MEAN ANYTHING ABOUT YOU AS A STUDENT NURSE/NURSE! I am a quiet person. I was shy up until a year ago. I'm great at communicating with patients and families but with nurses, I need to pop the bubble. I listen for a few days then I'll start opening up. Being shy does not make you incompetent. You're asking questions and you seem to care about your patient.

You are right. Personally I think he just didn't like that I didn't hold small talk with him if it was about anything other than school. I just couldn't believe he would say that. Sure I've had teachers say I need to be more confident in myself and skills but incompetent?

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Specializes in Stepdown . Telemetry.

If there is a specific BP parameter that is hold for sbp

Only thing would be stop and consider, if you are unsure. Also, when NO parameter is there, i am holding to clarify before giving generally if

But bp 130s / 48 is fine. That is probably a typical response for the pt.

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