Struggling in current clinical - feeling really depressed about it - Advice?

[Philly85]

So, first of all, just want to say thanks for listening to anyone who reads this VERY long post. I just really need to get this off my chest, as it is really negatively affecting me.

I'm currently in my 2nd to last quarter in my program and my clinical instructor just completely dressed me down today after post-conference after everyone else had left.

Today was only our second time together and I already did not get off to a good start with her last time. She is of the mind-set of being very self-sufficient and taking charge and not asking lots of "obvious" questions, since we are "seniors" (I'm not in a traditional 4 year program, it's a 2nd degree accelerated program).

We have clinical pretty infrequently (one or two 12 hour shifts every OTHER weekend, depending on the quarter), as it is for working adults.

I'm a very detail-oriented, conscientious person, and I really need to do something about 5 times and on an consistent basis before I feel really comfortable with it. The problem is that we have clinical in such short, condensed bursts and then a two-week break in between that I never really ever get truly comfortable with anything. Not to mention the fact that we only have 5 total clinical days at any one site in the entire quarter, so I never really get comfortable with the staff, the layout, their equipment, etc.

That leads me to ask lots of questions, just to make sure I'm doing everything right. Certain things, like vitals, bed baths, bed-making, Accuchecks, etc I'm good with, but certain other skills like IM or subq injections, foleys, trach suctioning, I've done maybe a handful of times, and trach suctioning not until my most recent clinical the other week.

I could already tell our first day together the other week that she is not a fan of my questions and I can kind of see where she is coming from, but I just don't want to make a mistake and I want to make sure that I'm truly learning the correct way to do something or not placing a certain thing down the wrong way, etc. I'm very detail-oriented and I want to do things the way they are supposed to be done, so...I dunno, some people can't handle me sometimes. But when I DO learn it the correct way and have it down, I'm amazing at it and never ask the question again.

Well, anyway, so I'm already off to a bad start last time and I've been dreading this clinical today for the past 2 weeks b/c I can tell she is just not feeling me. But I tell myself to make the best of it and make it work and just do my best.

Of course, I get there 10 minutes late (supposed to be there at 6:30 am, got there at 6:40 am b/c they were doing construction around my train station and I had to walk the long way around). I was so anxious to get to the desk that I forgot to stop at the locker room and drop my back-pack off. "Are you supposed to have your back-pack in here?" Totally my bad, I should have left home a little sooner and, yeah, I forgot to stop at the locker room. No big deal.

Then we had a combative patient and they wanted to get mittens for him, but he had since calmed down b/c we gave him a sedative. Anyway, I still went and got them from another floor (our floor was out) and I asked if she wanted me to put them on right now when I got back. "When else would you put them on, he's combative, right?" Well, yes, but calmed down some, but I can see your point, he might become combative again, OK, I'll go put them on, makes sense. Pt was very cooperative and even held out his hands perfectly for me to put them on. Smart thinking b/c he WAS combative a few hours later. Lesson learned.

Then, I was in with my pt with my nurse and my instructor called in and told me to go on break when I was done. In my head, I honestly heard the word "lunch" b/c in all of my previous clinicals, "break" meant our 1 hour lunch. We never really took 15 minute breaks, just the 1 hour lunch. It was 11:15 am, a little early, but whatever, I was hungry, wasn't gonna argue.

Go to lunch and come back at 12:15, chilling for a little bit on the computer trying to fill out our worksheets we have to fill out for the day and she comes by and asks me where I've been and that I missed the 12 noon med pass (she had wanted me to do the insulin injection on the 1 patient).

****, I totally forgot that she wanted me to do that, and I totally OWN that, that was my bad. I tried to explain that I could have sworn she said lunch and that I didn't even realize we were supposed to be taking 15 minute breaks (she apparently did say this the first day, but I don't remember - again, my bad, I'm working against a year and a half of usually just taking 1 hour lunches during clinical, so I forgot). It was literally the most HONEST mistake I've ever made in my life.

I then asked my nurse I was with a bit later what she remembers our clinical instructor saying about break vs lunch, not because I thought she was wrong, but because I really thought I heard the word "lunch" and wanted to make sure I wasn't going crazy. She told me she heard the word "break" and I said "OK, thanks, I must be going crazy, lol", like didn't make a big deal. Well, this nurse apparently told the instructor and that did not go over well.

Throughout the day, we are supposed to get done our 4 page worksheet/care-plan and myself and my whole cohort are used to not having to hand that in until the next clinical day, not the same day. So we're all kind of struggling throughout the day to get it done so we can hand it in at the end of the shift. I did take several 20 minute breaks to get portions of it done throughout the day.

However, I was definitely in my patients' rooms throughout the day, pitching in with everything, doing anything when asked. Well, I guess my one patient had multiple issues during a few of my downtimes, needed to be changed multiple times, was combative again and my partner (we worked in pairs) ended up having to deal with it all several times. Apparently, I was "nowhere to be found" (I was at the computer at the end of the hall b/c the other computers near my patient's room were taken). My partner is truly amazing and so helpful and I love her, so this is not anything against her at all.

My one nurse then asked me if I could make sure we definitely got the pt from his chair back into his bed before we left for the day, b/c she had a new admit and had to do q30 min assessments. Had to use a Hoyer lift to get him into and out of the chair, so it was a bit more time-consuming of a task. I assured her we would.

Well, we then got pulled into doing a bunch of stuff for our other combative patient so that got a bit delayed, but we still had about an hour left until we were leaving and we were just about to do it. But she came in anyway and started to do it herself and pulled in a few of my other classmates. I apologized and said I was about to start it, but she said it was fine. That was also relayed to the instructor. (Side-note b/c I just remembered, apparently, getting him into the chair earlier in the day also happened during one of my 20 min breaks when I was nowhere to be found, AKA down the hall).

Finally, while in the middle of heating up a heating pad in the microwave for a pt, one of the techs asked me to go put the leads back on a patient that had fallen off. I (stupidly) said "Oh, I don't quite remember how to do that" and DIDN'T follow it up with "but I'd be happy to get someone to refresh my memory and go do it", and she had kind of already drifted away before I realized my mistake. I found her about 1/2 hour later and apologized and said I was sorry, it just slipped my mind and that I wasn't trying to avoid doing work. But she had already told the instructor.

So anyway, very long story short, my instructor (in front of everyone) tells me to stay behind at the end of post-conference. Once we're alone, she tells me she is going to send a clinical communication to my course chair about me taking lunch early. She then said how she noticed I was slacking off and not being a team player and not wanting to chip in and then all of the other stuff the nurse/tech relayed, but wasn't going to relay THAT particular info in a clinical communication and wouldn't send me to remediation (though she could have) and would give me a second chance next time. I said thank you.

I was truly shocked, since I really felt I had pitched in and really tried to do a good, conscientious job today. I even became teary/emotional (damnit) and said I had always gotten really good feedback at previous clinicals (I have) and I was really surprised to hear this and that I had really tried to be helpful/a team player today.

I was so stressed about getting our worksheet done that maybe I could have spent more time in the room, but I really was only working on them for like 20 minute spurts (and not a whole lot of them throughout the day, maybe like 5 or 6 total). I truly didn't know how else I would have gotten it done otherwise. And not all of my classmates DID get theirs done. I suppose I should have made patient care a priority, but she basically said that the worksheet was just as important and I needed to figure out how to get that done in addition to not shirking my patient care responsibilities.

I KNOW that I made stupid mistakes today and I TOTALLY own up to that and I will absolutely be more conscientious next time, but it's just so disheartening to have someone have a certain opinion about you when you really did try your best and just made honest mistakes.

I am now so terrified of going back next time and getting the same feedback and having to go to remediation, etc. Maybe I'm just having a rough few weeks, but now I'm worried that this is going to be an ongoing issue and am feeling really disheartened, especially after usually doing so well in clinical.

Does anyone have any advice or words of wisdom? How can I get better at getting these worksheets done and not "disappearing" for 20 minutes when there is no available computer station near my patient's room?

I'm sorry if I sound like a huge complainer. I totally own up to my mistakes and I just want to get BETTER and help out as much as possible. I want to be an AMAZING nurse and I just feel so stressed about this right now.

Thanks for listening, you guys.

[canoehead, BSN, RN]

Well, you really didn't do a good job. Arrive early, not on time. Be CONSTANTLY available for your patients while on duty, not out of sight or hearing for any reason. Agree to help when asked to do tasks, even if you have to go recruit another student to assist.

The lunch issue, you said it was an honest mistake, so I imagine it wont happen again. If you aren't normally getting bad evaluations, it will blow over. Your instructor probably went home and reviewed your past performance and already knows if this is a pattern or a bad day.

[Double-Helix, BSN, RN]

I think you already identified what you need to do to improve. Be on time, arrive on the floor ready to go when (or earlier than) expected. When you take a break or lunch, clarify with your instructor exactly when you are expected to return. Don't "disappear" or venture away from your patient's room without telling your instructor, partner, and the nurse where they can find you. To be more present- do as much of your care plan as possible on paper while sitting in sight of your patient's room. Use the computer only to look up information and type the care plan when it's complete. It sounds like you recognize your mistakes- correct them and you should be fine.

[Triddin]

Does the facility have an online techniques guide that you can review before doing certain skills so you don't have to ask your instructor as many question? Or can you bring your techniques textbook to clinical? I personally can't imagine gong through the program with so few clinical hours. We had clinical twice a week, every week for 4 months per level with a 4 month preceptorship working a full time schedule before graduating.

[peripateticRN, BSN, RN]

All I can say is.. I remember those days and clinicals suck. You're always struggling to find your way, while someone is watching over you, wanting for you to do it THEIR way. This can be a struggle for many.

I had a similar 'come to Jesus' talk with my clinical tutor in my one of my med clinicals. I was absolutely heartbroken with her assessment of me and literally cried for 24 hours. I, like you, like to ask questions. Many questions. Many many questions. It was my way of making sure I knew what I was doing - more looking for confirmation that I was heading in the right direction than not actually knowing what to do. My instructor apparently took this as utter incompetence and was worried about my ability to move forward. After sitting back and actually listening to what she said, I realized that, yes, the questions I was asking could make it seem like I didn't know what I was doing. I used that feedback and instead of asking questions I would regularly check in and say "This is what I am doing now"... not "what should I be doing now?". For example if I was giving an IM injection instead of asking "What angle should I use to inject?" I would say "I am going to inject it at a 90 degree angle" (and then look for confirmation). After a shift or two of this the instructor pulled me aside and said she was impressed at my 'suddenly found' confidence. I chuckled to myself that I wasn't anymore confident, I was just changing the way I approached the situation.

So I guess... all this to say: do what you are doing... keep reflecting on your practice and become aware of how your behaviour can be received by other staff. Be humble and take the crap that is heaped on you with humility and know that as long as you pass, clinical will soon be over. Once you are out of school you will have the freedom to practice the way that works for you.

.. and for the love of all things holy - never be late again!!

[neuron]

If you weren't there helping your partner with the combative patient, you knew he/she was combative, but your partner wast there doing it, sorry I wouldn't trust you. You HAVE to be available, not intermittently sorry it doesn't work that way. As for not knowing how to place leads, that's ok, you're learning.

[Apple-Core, ASN, BSN, RN]

I know it stings to read the above posts, but they are all being honest with you; your OP is littered with self-acknowledged issues/mistakes/"my bad" etc. It is especially important to CYA when you already feel your instructor and yourself aren't off to a good start. I would feel equally as upset, so I do understand that. However, give yourself time to feel hurt/annoyed/upset then do some self-analysis as to where you contributed to this situation. Imagine you were the instructor and you had a student who had done everything that you have mentioned above - would it frustrate you? At your next clinical, get there 10 minutes early, be present and available, carry a snack in your pocket, if offered breaks confirm the length of time, always follow through etc etc...

[City-Girl]

It isn't easy recovering from poor first impressions, but it can be done. I remember when I was working as a well-respected CNA and having a hard time in nursing school. One of the seasoned nurses that I worked with gave me some very helpful advice. She told me those instructors play a big part on who they decide get's to become a nurse and who does not. (That sounded awfully judgmental to me, but turned out to be true!) You're there to prove that you have learned or are capable of learning what they have taught you in the classroom and show that you can do this at the bedside. She also told me that sometimes instructors feel like you are challenging them when you ask what they perceive as too many questions. She kindly told me "You're not there to prove what you already know, you're there to learn what you don't know". She told me it's better to sit back and take it all in. If you're a wall-flower you're less likely to be the one person in the clinical group that the instructor makes an example of for all of the others in your class. If a question is important enough to be asked, many of your other classmates might. As far as being a team player, be available (get used to that now, it will come in handy once you're an RN). Keep snacks in your bag so they are easily accessible, better to get use to the fact that you will not have an hour long lunch (it can be difficult squeezing 30 minutes when you're actually practicing as an RN). Always, always get to work with at least 15 minutes before you have to punch in. That way you won't have to hit the ground running, but instead be ablt to ease into your day.