"just" a student nurse: feeling ineffective/inadequate (for a few reasons)

  1. Hi,

    I'm a first-year nursing student in a part-time program and a first-time poster. Gotta say first that I love this website. It's so informative and supportive. Now if I could just tear myself away from it long enough to study for that next exam...

    Anyway, we just started a L&D/postpartum rotation. I LOVE it so far, and I'm thinking that this is the way I want to go, or eventually to some related field like the NICU. This is the first time EVER that I've had a long-term goal in mind for my career, so I'm really excited and I want to do this right. The problem is where I seem to stand as a "student nurse" in relation to the moms and families that I'm trying to care for and educate.

    From talking to my instructor, being a postpartum nurse is a challenge anyway because it's hard to work your tasks around family visiting time or mom/baby time. But I find it a bit harder because as someone who is "just" a student nurse, and who is perceived as such by the mom, I have much less authority in the mom's and family's eyes to come in and do my tasks as needed. They are far more receptive to their assigned nurse than to me. This has been true of my other rotations to some degree (mostly in elder care up to now), but it seems more obvious now because there are so many more people affected by a baby's arrival......more emotions that I need to keep in mind (privacy, family bonding, mom's protectiveness and emotional lability postpartum, etc.)...and so many more people who are protective of mom and baby. What I'm finding is that on the mom/family side of things, I feel like an INTRUDER. I hate walking in on a mom's bonding with her baby, or on a family visit, so I can try to get my assessments done. Usually what I find is that when mom is alone and I walk in to do what I need to do, she is pretty open and receptive. But when she's with baby and/or family in the room, the mom gets irritated and annoyed (and sometimes the family does too). It makes assessments and teaching very difficult for me, because I hate being given the hairy eyeball by mom and family despite the fact that I'm doing everything as correctly and gently as I can, and explaining the whole time what I am doing. (The fact that the hospital doesn't really enforce postpartum visiting hours doesn't help much, but oh well.)

    Of course, taking care of the babies is easy...they can't really resist your care or assessments or procedures, and they certainly can't talk back! :wink2:

    I realize that part of it is my problem. As a first-year, I am still learning to prioritize and juggle (especially with 2 patients now -- mom and baby -- instead of just one), and I could better arrange my tasks so that I get as much done as I can while mom is alone, or at least before the whole family comes to visit. I did better this week, but also didn't expect the baby to be rooming in...which meant a lot less time assessing either mom OR baby because mom or family seemed suspicious that I didn't know what I was doing. I tried to time things around the baby's feedings and periods of alertness; around family visiting; around mom's willingness to be assessed; around the baby's circumcision; and around my boundaries as a student nurse. I know, you're all probably either rolling your eyes or laughing at me ...after all, welcome to nursing!! I have said this before and I'll say it again: I don't know how nurses do it. I missed so many things in the process of juggling, though I tried not to. I tried to find my instructor several times so she could observe certain things that I was doing (also giving me more "clout" at the same time with her in the room), but with 5 other students to tend to, she couldn't always be there when I needed her... So that just made it harder to get things done.

    This past week was the second week in a row that I didn't get all my assessments done because family was visiting way before regular visiting hours. I talked to my instructor about this, and she did concede that as a student nurse, I have to walk a fine line. If I was mom's regular nurse, I could push harder to get things accomplished. But as a student nurse, not only do I not have that kind of authority, but I also don't want to piss off the patients and families, who would then complain to the hospital about the student nurse who is a pain in the behind, and then my instructor would have to defend me AND the nursing program, etc. etc. etc.

    I'm not really sure what I'm looking for here. I mostly need some assurance that THINGS WILL GET BETTER WITH TIME!! I only have a couple more days for this rotation, then it's on to Pedi, where I'm sure similar clashes between my "student" status and parents and family will arise. I definitely need more experience juggling tasks, and being assertive enough to get things done, but with tact and finesse (and without overstepping my bounds as a student). Any tips, experiences, etc. that anyone has would be greatly appreciated!! A friend of mine (a med/surg nurse for 5 years) says that once I'm an RN, I'll be able to go in and do what I need to do with more authority...but I don't know if I can wait that long, I do have to pass clinical

    Thanks
    Last edit by nightingale1969 on Oct 2, '06
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  2. 13 Comments

  3. by   collegebound
    Well, I am not even a nurse yet BUT I have had two daughters so I can say: don't take it to heart that it is you in particular mom is annoyed at. New moms are tired from being up with baby, tired from being woken for vitals through the night, and slightly uncomfortable from all that has just happened. Thus you become a target when you walk in the room. Now I am not sure what kind of rules/regulations you have at your school regarding conversation with patients and family but I would suggest a huge friendly smile, make eye contact with everyone in the room and say sorry for the intrusion, I'll be out of your way as soon as I do my assesments followed with a thanks and congratulations on your way out the door. I always felt more comfortable myself when a nurse was so open and friendly and included my family. Anyway, hopefully someone with nursing experience can give some real advice and I wish you the best of luck!
  4. by   Tweety
    It's tough being a student, and your experience is definately not unique. Yes, it does get better with time.

    Words like "ineffective/inadequate" need not enter your vocabulary as you describe yourself. You're in learning situation, you're not supposed to be an expert nurse yet. Be kinder with how you talk to yourself.
  5. by   Daytonite
    Hi, nightingale1969!

    You know, if you go into any situation looking for, or expecting, a clash you will be sure to find it, Murphy's Law. You have to think positively. Negative thinking leaves people behind in the ruts and sides of the road, believe me. It also narrows thinking and inhibits the creative processes. I've been in nursing and management so long, I could tell you stories. One of the BIG things about being in nursing is that you have to learn to roll with the punches. Being good at multi-tasking isn't enough. Little fires need stamping out all the time. We have to be like sturdy work trucks that can shift gears, make sudden sharp turns and still keep all four wheels on the ground. The testament to an exceptionally good nurse is someone who can deal with and work around things like open and unenforced visiting hours. It is doable. You just need to find and correctly use the right skills to make it happen. I would like to offer some advice, however. That is, to remember to put yourself in the role of the patient and try to see things from their perspective. Being hospitalized for any reason is a very emotional and trying time for them. We are there to bring service to them. It is never going to be their responsibility to make our job easier for us. Things are always going to be changing, from minute to minute, hour to hour, week to week, so don't depend on regular routines. You can take a two week vacation and come back to find that a new charting form or some other new policy or procedure has just been mandated right after you finally mastered the last way it was supposed to be done. That's nursing. That's the profession you have chosen.

    Welcome to allnurses.
  6. by   nightingale1969
    Quote from Daytonite
    I would like to offer some advice, however. That is, to remember to put yourself in the role of the patient and try to see things from their perspective. Being hospitalized for any reason is a very emotional and trying time for them. We are there to bring service to them. It is never going to be their responsibility to make our job easier for us. Things are always going to be changing, from minute to minute, hour to hour, week to week, so don't depend on regular routines. You can take a two week vacation and come back to find that a new charting form or some other new policy or procedure has just been mandated right after you finally mastered the last way it was supposed to be done. That's nursing. That's the profession you have chosen.
    Tell me about it...it becomes more apparent as I get more clinical experience. I'm not expecting everything to be cut and dried, and that's part of the appeal and the challenge. Like I said...I don't know how you all do it. As for keeping the patient's perspective in mind...part of the appeal of working at this clinical site, in this unit, is that I was a patient there 5 years ago when I had my daughter...new mom + emergency C-section + post-partum blues = a big sniveling mess! I'm sure I wasn't easy to deal with either. I know moms are tired and sometimes overwhelmed (physically and emotionally) and I do try to respect that. As a student nurse, though, it is still hard to balance that empathy with the need to get tasks done. I am trying to roll with the punches...thanks for the advice and the reinforcement. :wink2:

    BTW, when I was a patient at this site, the nurses were PHENOMENAL and I hope I can be the same way.
  7. by   rpbear
    I don't work PP but I do work L&D, so the emotional/family/no visiting hours is something I deal with all the time. I have found that the best way to do things is to walk into the room, introduce yourself to everyone that is in the room, not just the pt, ask how their new family is adjusting, do a little small talk, then give a brief run down of the day, tell them you will be doing an assesment on mom and baby, what times you will be doing vital signs, any scheduled meds, meals etc. This lets them know what to expect from the day. Then leave the room, do no "nursing stuff" the first time you meet them. They don't feel like you are just jumping in and touching them or invading thier space. Let them know you will be back in a few minutes to get started. This gives everyone who needs to leave the room a chance to go. Go gather up what you need to do assesment and VS, or any meds due. Then the Pt is ready, the family has stepped out if they need to. It makes it much easier. Also, always end with a thank you and ask if there is anything else you can do before you leave and tell them when you will be back for your next task.

    This works well for me on most pt's (there are exceptions to everything) Good luck to you!
  8. by   jov
    Quote from nightingale1969
    (The fact that the hospital doesn't really enforce postpartum visiting hours doesn't help much, but oh well.)
    just a note, remember that the only reason the hospital is there (and therefore your job) is because of the patients. It ought to be terrific that the hospital doesn't enforce postpartum visiting hours. Who is the hospital to tell a husband he can't be with his wife and new baby anyway? Magnet hospitals now are having NO visiting hours, that is, family are welcome day and night. They are making patient's rooms bigger and including a day bed for a family member because after all, patients recover better and quicker with family around. And again, who are WE to tell a man that his wife of 20-some years now isn't ALLOWED to spend the night with him?

    Other than that, perhaps you could become part of the entire experience for the new mom and her baby. Are you asking her about her feelings about this experience? How her care has been? How her care experience could be improved? What does daddy think about the new little one? What are they worried most about? Are you ooing and aaing over the little one? If family is there, i.e. grandma, do you really MEET grandma, and spend a little time with her too, getting feedback? Seems to me this is a perfect opportunity for lots and lots of patient teaching, student nurse or not. I don't ever remember bristling at any nurse who came in to give me care in the L&D/Recovery rooms. It's a department that's mostly just happy all over!
  9. by   nightingale1969
    Quote from jov
    It ought to be terrific that the hospital doesn't enforce postpartum visiting hours....
    I know, I know...:imbar that really did come out wrong. I'm just frustrated right now, but certainly dads (or whoever the mother designates as her partner/primary support person) should have the right to visit whenever they want. I guess I'm just surprised to see a horde of family members descending on the PP unit way before visiting hours start...not my experience with previous rotations (like I said, we've done mostly elder care up to now).

    Quote from jov
    Other than that, perhaps you could become part of the entire experience for the new mom and her baby. Are you asking her about her feelings about this experience? How her care has been? How her care experience could be improved? What does daddy think about the new little one? What are they worried most about? Are you ooing and aaing over the little one? If family is there, i.e. grandma, do you really MEET grandma, and spend a little time with her too, getting feedback? Seems to me this is a perfect opportunity for lots and lots of patient teaching, student nurse or not. I don't ever remember bristling at any nurse who came in to give me care in the L&D/Recovery rooms. It's a department that's mostly just happy all over!
    I do try to go beyond the usual assessment and actually talk to the moms about their feelings, how well they are prepared for the new baby (emotionally; is the room ready at home; how does family feel about the new arrival; etc.) I'm still pretty new at this (plus not a great conversationalist in general) and when I do ask these kinds of questions, I find myself getting distracted from the physical assessment. I'm still at the point where there are questions I forget to ask on the first time around, and once I start juggling tasks, I never get back to the discussion I really do want to spend time with mom and family, getting their idea of the whole event, because I've been through childbirth myself, with all the excitement and change and some of the mixed emotions that come with it...and I think I can teach quite a bit. But honestly, once I get a vibe of "would you just leave us ALONE" from the family, that's it, it kind of scares me off. It shouldn't, and that's my problem, not the patient's...something I need to work on.
    Last edit by nightingale1969 on Oct 2, '06
  10. by   Daytonite
    As I was reading this last post you made, this caught my attention:
    Quote from nightingale1969
    I do try to go beyond the usual assessment and actually talk to the moms about their feelings. . . I'm still pretty new at this (plus not a great conversationalist in general) and when I do ask these kinds of questions, I find myself getting distracted from the physical assessment. I'm still at the point where there are questions I forget to ask on the first time around, and once I start juggling tasks, I never get back to the discussion. . .
    I just wanted to say that it sounds like you understand that conversation and exploration of feelings definitely is an important part of the assessment process. It takes some experience to be able to do it at the same time as a physical assessment. What helps is when you've done dozens of physical assessments and you have developed a kind of routine about them. When I went into my BSN completion program the focus was almost exclusively on that conversational and psychological aspect of the assessment. And, boy! were my horizons broadened. It made such a difference in the way I approached many things at my job. I came from a family where my mother was a authoritarian (very strict if you can imagine living with Judge Judy on a rampage every day). I took that attitude and strictness of adhering to rules into nursing with me. It got me into a lot a trouble in my beginning years. My BSN program knocked that attitude out of me and things have been so much better since. As I told another poster on another thread, it takes time to develop skills. They don't happen in the few years you are in nursing school. Nursing school only gives you a little taste of each kind of nursing specialty. Your real deep learning experiences will come after you graduate and get your first job. That is when you will hunker down and focus on a particular area. There will usually be a regular routine which helps. Don't be too dismayed at what you are not able to do at this time. You've only barely hit the tip of the iceberg!
  11. by   todell80
    nightingale1969, I just want to say I feel for you!! I am just starting out, and it is really hard to get everything done!!

    I have also been in your patient's shoes, the day after having my second baby, I was told by my regular nurse (who I didn't see again for the rest of the day), "Lucky you, you get a student nurse to baby you today!!" I knew that in a few years, that student nurse would be me, so I was excited to talk to them about their experience. About 10 minutes later, to my suprise, in walks a 55 year old man who introduces himself as my student nurse. Talk about uncomfortable!! I thought I had lost all modesty in the childbirth process, but it turned out I was so not okay with a student my dad's age looking at my hoo-hah to see if things were okay down there. Right before I put my foot down with a "No way, Jose, get me my regular nurse STAT!!!" I realized it would be me someday and decided to suck it up. It turned out okay, he was very nice, but I can give you some pointers from my experience watching him. First off, don't act nervous/uncomfortable. Go in, take charge, be assertive. If you act like you aren't in control, it makes your patient very uncomfortable. Also, do talk to everyone in the room. My student nurse was embarrassed when my husband was in the room, and didn't say much of anything to me and nothing to my husband. It came off as being rude, when I'm sure that was not his intention at all. Lastly, if you do bring your instructor in, don't rely on her to take over. It will make it that much harder the next time you go to do anything to your patient.

    I'm not saying you do any of those things, that is just what I noticed w/ my student nurse. If you take nothing else from my little rant, remember this: at least you aren't a 55 year old man trying to take care of crazy postpartum ladies. Unless you are, in which case, my student nurse got through it, and I know you will too!!
    ~t
  12. by   nightingale1969
    Thanks for all the responses. I guess my thread topic was misleading then...it's not so much being "just" a student nurse and not having much knowledge or authority in the patient's eyes, but it's also my inexperience with juggling tasks and being assertive and confident (or at least appearing so). I still wonder how we're going to do all those things that the nursing books say we should do...I mean, besides all the "technical" tasks of nursing, being able to actually SIT with a patient and discuss the emotional/psychological/social issues of their condition. If you all have any other suggestions for juggling tasks and stamping out fires, while still getting most if not everything done, I'd appreciate it Thanks again.
  13. by   Tweety
    There is a "reality shock" phase in nursing when you realize you actually can't do textbook nursing in the real world. Somehow we survive.

    Good luck.
  14. by   rnsrgr8t
    Greetings Nightingale! What a great post! It sounds to me like you are doing a great job! It is tough being a student and the more experience you get the better you will be. Multitasking is an art that you will learn and it will get easier down the road. Get into a routine with everything you do and make it a habit so you do not have to think about it (this will come with time). When doing assessments, always do it head to toe and that will help you remember everything. I used to make a notecard and visualize my assessment at home. I would go through it step by step in my head over and over and that helped a lot. Relax and remember you are a student and noone expects you to multitask and put out fires like a seasoned nurse. Really watch the other nurses so you can learn all the little tricks they use. Also, when dealing with families, after working in peds for almost 10 years, the more you ooh and aah over the baby, the better you get a long with the family. I love kids, so this comes easy to me. I always try to find one thing I can point out (they have great eyes, eyeleashes, cute outfit etc). I have had some really stand offish, upset families that warmed up to me after I really gushed (sincerely) over their child. Good Luck!

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