Clinical instructor feels I'm not competent?

  1. So I have always had anxiety. It's followed me my whole life, including ADD and I feel it's possible for some sort of slight autism... long story short I am in my second year of nursing school, currently in med-surg. I get slightly anxious when passing meds specifically heparin injections, mostly because my clinical instructor can be so intimidating. I didn't think I was doing so bad until my instructor pulled me aside today and told me how horrible I'm doing and how she will not be giving me the opportunity to visit the OR like she is allowing my other classmates to do this clinical. She told me she doesn't trust me because I have no confidence. I am very concerned that this issue will follow me throughout my career and that I'll either be a horrible nurse or be terminated for making mistakes and being so nervous all the time. Am I alone in this, is there anyone else who has made mistakes and felt this way or am I just really stupid.... 😔 Please no harsh comments I'm feeling low enough, hoping it's not just me.
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  2. 16 Comments

  3. by   caliotter3
    While the instructor's criticisms may be valid, there are ways to constructively criticize and ways not to talk to a student. Using the word "horrible" is not specific or measurable, making this less than a good teaching moment. If her goal was to upset you and throw you off your mark, it seems she succeeded. Turn the critique into a positive by not allowing this to derail you. And BTW, worry about your performance on the job when the time comes. You have enough on your plate now.
  4. by   shibaowner
    I'm so sorry you are going through this. I went through the same thing during the ABSN program - kept being told I lacked confidence, which made me feel less confident - a vicious cycle. However, I graduated and am now a nurse practitioner. Oddly, I got nothing but praise for my clinical skills during the MSN program and I did feel confident!

    Here's my advice:
    1. Talk to your clinical instructor. Suck up big time. Ask them for a plan with specific things you can do to improve your skills. Your goal is to pass. Make sure the plan includes regular dates to get feedback from the instructor - you don't want to reach the end of the semester and get failed.

    2. Talk to your advisor and ask for suggestions as well. They may be able to find a tutor for you.

    3. Try to get a tutor if you need one - it could be a fellow student who has great skills who could use a little money from tutoring.

    4. Most nursing students do feel nervous, but can usually hide it. What are you doing/saying that makes your instructor feel you lack confidence? For example, if a patient asked me a question and I didn't have the answer on the tip of my tongue, I would think and then answer. For some reason, the instructor hated this. A friend suggested that when in this situation, I respond, "That is a great question! Give me a second to make sure I give you the information you need (or something similar)" That gave me a few seconds to compose myself w/o having the "deer in the headlights look"

    Good luck!
  5. by   HermioneG
    Quote from studentnursemorgan
    So I have always had anxiety. It's followed me my whole life, including ADD and I feel it's possible for some sort of slight autism... long story short I am in my second year of nursing school, currently in med-surg. I get slightly anxious when passing meds specifically heparin injections, mostly because my clinical instructor can be so intimidating. I didn't think I was doing so bad until my instructor pulled me aside today and told me how horrible I'm doing and how she will not be giving me the opportunity to visit the OR like she is allowing my other classmates to do this clinical. She told me she doesn't trust me because I have no confidence. I am very concerned that this issue will follow me throughout my career and that I'll either be a horrible nurse or be terminated for making mistakes and being so nervous all the time. Am I alone in this, is there anyone else who has made mistakes and felt this way or am I just really stupid.... ������ Please no harsh comments I'm feeling low enough, hoping it's not just me.
    Hi studentnursemorgan,

    I'm really sorry that you're having this anxiety. I, myself, have ADD and struggled tremendously in the beginning. With that being said, repetition and practice should steady you. The problem here might be that you simply haven't had enough practice yet.

    Here are some suggestions that hopefully can help:

    1) You've identified a weak spot, such as passing medication and giving heparin. Great! Now you must practice doing this at home. I struggled with this, so I had my husband lay in bed and pretend to be a patient. I would get random things (peanuts, m&ms, raisins, etc) and pretend he was my patient. I would simulate the introduction, checking full name and DOB, scanning the patient, checking the "MAR", explaining which pretend medication was which, and basic patient education. I would do this over and over and over and over and over again until it started to click better. Part of getting confidence is practicing it!

    2) I noticed that you said that you were particularly stressed about giving a heparin shot. Do you think this could possibly be because you know you're going to cause discomfort for the patient? I personally figured out that I was struggling with injections because I knew I would cause my patient slight pain/discomfort and I myself wasn't comfortable with that. It helped me to remember that I'm causing some discomfort for a very important purpose, and the patient allowing me to give them the shot means that they know that you're going to cause them some discomfort but is letting you do it anyways. You know its going to cause them discomfort, the patient knows it will cause them discomfort, and you're both doing what is necessary to help them avoid much more uncomfortable things in the long run. The patient understands this is going to hurt and yet is still okay with it. That helped me be more confident.

    3) I would also suggest watching videos on giving shots and meds. Watch the techniques. Something else that was really helpful that a nurse told me one time was to not be flamboyant and stab the patient with the needle. Be gentle and chill while you're doing it. Talk to the patient while you're doing it if you can.

    OP, honestly, if you had seen me my first year and then saw me again as I prepared to graduate you would've never believed I was the same person. I used to get so scared and stressed, my hands would shake badly whenever I tried to give someone a shot, and I was just generally a nervous person. But keep your head high and try to project confidence. I know its hard, I had many patients comment early on about how badly my hands shook and I would force myself to laugh and tell them that I just needed to lay off the coffee. The key is to be safe and also be confident. You CAN do it.

    I went from thinking I sucked and feeling like I would never make it to doing my capstone in the ER and now I'm starting in a New Grad program at a level 1 trauma center at the ER of my dreams. You will NOT be a horrible nurse because you care enough to post here and ask for help, so clearly you want to fix this. And you will. It takes time and practice. Maybe your confidence won't blossom this quarter since your clinical instructor seems to be hurting rather than helping, but practice and keep pushing through and it will blossom. As you enter into the nursing field as a new grad you'll look back and marvel at how far you have come throughout nursing school. And as you finish out your bumpy first year as a nurse and start getting into the groove of things you'll look back and really REALLY see how far you've come.

    Have faith and keep asking for help. Its definitely NOT just you.

    -HermioneG
  6. by   ilovebirds
    I'm a fellow nursing student and I know how nerve-wracking it can be - especially if you feel intimidated and anxious.
    I *personally* do not feel that your instructor's comments were tactful at all. That being said, you will need to work on (at least) appearing confident. Patients can and will get scared if you look and sound like you don't know what you're doing (I had that happen once during my med-surg clinical).
    Practice these tasks in your head - not just the administration of the shot itself, but what you will say to the patient and how you will say it. Prepare for questions - including questions you may not immediately be able to answer.
    Additionally, talk to your instructor and ask specifically what they expect from you and how you can meet those expectations throughout the duration of your clinical.
    Good luck!
  7. by   marples
    I'm not a nurse as of yet, just a student but i hope you take what I have to say to heart. I really don't think you should be projecting into the future the way that you are. Just because you get nervous and anxious, doesn't mean you are stupid or incompetent. I too have anxiety and it can be debilitating so I get it. It also seems like there may be an underlining self-esteem issue going on. I'm not saying that to be judgmental, i'm saying it because you sound a lot like me at times, and I know that it has to do with my self-esteem not being as good as it could or should be. I really really think you need to take a step back and assess all the things you ARE good at. You got into nursing school because you're smart. If you need to write out and say affirmations to yourself in the mirror everyday do it. For me, I know when I'm getting in my head and feeling less than or not good enough, I need to reach out to the people in my life who know and love me and tell them how i'm feeling and whats going on. I get feedback and advice from the people who have my back and know how my soul ticks. F**k what that teacher had to say. She doesn't know you, nor is what she said supportive or positive. So chin up. Be proactive in your own confidence and success. There is no shame in admitting you are having a hard time and need help/love/advice/pep talk whatever. Just be willing to put in the work to get your head back in a good place, whatever that may look like for you.
  8. by   BBboy
    Don't listen to your instructor. During my first hospital rotation my instructor pulled me aside and made me redo an additional clinical day by myself because she wasn't so sure about me as I was taking on a higher patient load than she wanted and wasn't too knowledgeable about medications at the time. Flash forward to now and I'm an LPN after finishing the NCLEX in 40 minutes in the minimum and will sit for my RN boards this December after graduation. I will say that I'm a completely different student and nurse from where I was at that time but it just shows with time that you can prove anybody wrong
  9. by   fibroblast
    Quote from studentnursemorgan
    So I have always had anxiety. It's followed me my whole life, including ADD and I feel it's possible for some sort of slight autism... long story short I am in my second year of nursing school, currently in med-surg. I get slightly anxious when passing meds specifically heparin injections, mostly because my clinical instructor can be so intimidating. I didn't think I was doing so bad until my instructor pulled me aside today and told me how horrible I'm doing and how she will not be giving me the opportunity to visit the OR like she is allowing my other classmates to do this clinical. She told me she doesn't trust me because I have no confidence. I am very concerned that this issue will follow me throughout my career and that I'll either be a horrible nurse or be terminated for making mistakes and being so nervous all the time. Am I alone in this, is there anyone else who has made mistakes and felt this way or am I just really stupid.... Please no harsh comments I'm feeling low enough, hoping it's not just me.
    Your mistakes are your own and so is your anxiety as far as your practice goes. Do you only get nervous in front of others when evaluated? Don't let these darned clinical instructors tell you that you are a horrible.
  10. by   meanmaryjean
    Quote from BBboy
    Don't listen to your instructor. During my first hospital rotation my instructor pulled me aside and made me redo an additional clinical day by myself because she wasn't so sure about me as I was taking on a higher patient load than she wanted and wasn't too knowledgeable about medications at the time. Flash forward to now and I'm an LPN after finishing the NCLEX in 40 minutes in the minimum and will sit for my RN boards this December after graduation. I will say that I'm a completely different student and nurse from where I was at that time but it just shows with time that you can prove anybody wrong
    Worst advice EVER!

    OP: Did your instructor use the word 'horrible' or is that your interpretation of her conversation with you? Can you not see that she is trying to HELP you? That she recognizes your deficiency and is trying to help you overcome it?

    I get that anxiety can color the words you hear in these crucial conversations. My advice is to look for the truth in what the instructor tells you, own it, and - with the instructor -formulate a plan to improve.
  11. by   shibaowner
    To OP: Hope you have received the support you need here! I really feel for you.

    In my previous post, I forgot to suggest that you see a psychiatrist or psychologist. You need to find out if you do have ADHD, general anxiety, or autism. If you don't, that will be a relief. If you do, then you can be properly treated, which will greatly help you.

    Best wishes.
  12. by   HermioneG
    Quote from BBboy
    Don't listen to your instructor. During my first hospital rotation my instructor pulled me aside and made me redo an additional clinical day by myself because she wasn't so sure about me as I was taking on a higher patient load than she wanted and wasn't too knowledgeable about medications at the time. Flash forward to now and I'm an LPN after finishing the NCLEX in 40 minutes in the minimum and will sit for my RN boards this December after graduation. I will say that I'm a completely different student and nurse from where I was at that time but it just shows with time that you can prove anybody wrong
    Sometimes our harshest critics can shine light on some uncomfortable truths. There's no help in being surrounded by a bunch of people who just tell you what you want to hear. The struggle is not letting it cut your confidence, but rather taking it in stride.

    My favorite nurse of all time (and my senior capstone preceptor, who will also *hopefully* be my New Grad preceptor) raked me through the coals sometimes when discussing my weaknesses. He was never mean about it, but he was very up front. It hurts to hear, but its absolutely necessary in order to get better.

    The OP should push through in spite of the clinical instructor but she should never ignore their observations. You'd better believe that my preceptor's constructive criticism stung, but I worked my butt off and eventually earned both his respect and a letter of recommendation from him for the New Grad program. Don't let the criticisms crush you, but make sure to listen to them because they can help you get better.
  13. by   operations
    I don't think what the instructor said was constructive.

    I think it's normal for student nurses to have some anxiety and hesitate to make decisions during school, that shouldn't mean you don't get OR exposure.

    Making you nervous and doubt yourself was wrong (unless you were not trying to focus, distracted by friends or something, didn't sound like that).

    I have panic disorder and I have worked with a surgeon doing liposuction and tummy tuck in clinic before nursing school with no nurse above me (just other assistants and a director of surgery). In nursing school now for rn

    Though I had panic and had to really take care of myself with meds, the job was great. I gained the respect of my surgeon and the staff and it was a great experience

    1. Take care of your anxiety. Plenty of people work in jobs like these on the anxiety meds. But if some counseling or other method works for you do that certainly.

    2.Study very hard and be sure of your answers. This is what I have to do to minimize anxiety, and is the best thing imo. You said you were unsure of yourself. Why? Are your afraid because you don't trust your knowledge, or don't trust your memory? You need to study so that you don't worry about knowledge, then practice so you don't worry about errors. You may need more practice than others.

    3. Ask the professors (not just that one) for advice. This is their job and thats what you are paying them for. Ask exactly what is expected of you and what you need to do to get there. Do you need more knowledge (about how heparin should be given? ) or, practice?( Do you need to practice with the technique or verifying Rs or something else?)

    4. If you are not working hard or are distracted, they do have reason to keep you out of OR. Be honest with yourself and you may have to change your habits if that's the case.

    5. Talk to others with experience and see what things they did. Some have trouble communicating with doctors. Some are afraid of a mistake. Figure out what they do to build your confidence

    6. OR is supposed to be routine, at its very best, not full of drama and unknowns (though you should be prepared for those). This is a common misconception which leads to anxiety. You don't have to worry about that as much as you may think but you do need to be prepared because you'll have less "stage fright" as I call it.

    I am just in nursing school, I'm not in any rotation, but when I worked for the surgeon I made sure I was really prepared for cases by watching videos if we did something different, also reading about the procedures in journals and what are some common issues that happen or different variations.
    Last edit by operations on Sep 1
  14. by   aflahe00
    u can definitely relate when you talk about your anxiety and having no confidence. I had the same problem during my synthesis clinical which was the final clinical I took before I graduated. I was terrified of my instructor she was so intimidating! she could sense my lack of self confidence that's for sure. one day during clinical me and 2 other students were shawdowing a nurse on the telemetry unit. The desk phone
    Rings and it's my instructor summoning me to the icu. I get there and she quickly tells me I'm going to insert a foley in a female and she says this right in front of the patient. I stupidly said "I've never done this before " which she snapped back at me that I should never say that in front of a patient. I don't think I got it in on the first try but eventually I got it in. After wards in group she asked me how I thought I did to which I replied "terrible ". She seemed shocked by my answer.

    Looking back she made me realize that the only thing standing in my way is me.

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