down in the dumps

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    Hey all!


    This may be a little long but I'll try to just get what I need to say out. This last week's clinical was really hard/stressful/draining. I know clinicals are supposed to be challenging but something is not right here. I feel lifeless after clinicals. After Thursday (my first clinical day), I felt like a failure, and I had to come home and work on a care plan that I knew would suck. I stayed up all night and then went to an all day clinical the next day.
    My patient was a pitiful, COPDer, 300+ lbs (female) and not friendly. She had diabetes so I checked her glucose and gave her insulin with an instructor's supervision. I gave meds which was sorta traumatic just because of how MANY pills she took. There's a million things I want to ask my teacher about my patient but she has 10 students to look after on two different floors.
    She had a small BP cuff so I got a larger one and had a hell of a time getting it on, because it was like as big as her whole humerus. I took respirations but she breaths REALLY funny and counted 10 when the other CNAs had been counting 20. I mean I couldn't even do a simple think like count respirations. She would breathe in, and then breathe out, breathe in and then her adbomen would collapse. Anyone know if there is a name for this kind of respiration? Alternating breaths happened so that's why I only counted 10 at first. I still don't feel really confident that it was 20 times per minute but my teacher didn't think that a COPDer would have a low RR of 10. I thought since she has sleep apnea, that that might make it low. Of course what do I know? I do well in theory but I realize how much I don't know and how bad I do in clinical.
    During the weekend I should unwind right? I can't. I just become a zombie so upset with clinicals and feeling useless. I don't know what to do. I really want to be a nurse, and I think if I could just finish school, I could get into a sector of the profession where I could use my compassion and skills (if I have have any by then.) OK I have some skills and I have learned a lot. But hello I should be able to take a simple respiration. Of course I wanted to validate it with my instructor but she was no where to be found.
    What doesn't help is my parents get mad at me if I show that I felt bad about clinical. They also make comments like I should go work at McDonald's. It just makes it worse (((.
    I'm sorry this is kind of a depressing message. But I have to get this out or I'll explode.

    Zach
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  4. 12 Comments so far...

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    Don't feel bad Zach. My instructor just recently said to us that anytime you see a CNA or nurse that just keeps charting 20 for resps, you know they're lying....lol. I have actually had patients before where it was difficult to get an accurate resp rate on them for various reasons. At those times I just get out my trusty stethoscope and listen to the breath sounds, counting as I'm listening.

    Now, as far as you being concerned that you were wrong, I believe you were probably right. COPD patients often exhibit slower than normal resp rates. And as for her breathing pattern, it sounds like you might be describing Cheyne-Stokes respirations.
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    You are definitely not alone on the whole respirations thing. I have counted many times, only to discover that my count didn't match the PCA's count. 20 seems to be the magic number for many of the PCAs at my hospital. There was one situation that helped me to have faith in myself...I was in a patient's room while the PCA was taking pulse and resp rate. She counted both in MAYBE 20 seconds. After she left, I re-checked everything...she was way off. Another thing that helps me is using my stethoscope to listen and count. It makes it much easier for patients with shallow or irregular breathing.
    Don't discount yourself so quickly. You were probably right. I think that too many people are in a hurry to get the job done. A lot of times, I feel that nursing students are there to help get the job done right.
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    Oh Zach..Welcome to nursing...To try and give this a positive spin at least you were learning something..even if it's the field you would prefer over another...and Instructors are only that..just people trying to educate..not saints or even particularly "Good" nurses..Please don't give up just because it's hard..But remember this time in your training. This is why there are nurses are freaking out about people who aren't REAL NURSES acting like they are...Im sure anyone will have some wicked memories of their clinicals....That 's one of the reasons we're proud of our titles..We really worked hard for them and have to stay on our toes to hold on to them, too...It will all click one day and not be the struggle it is now..I hope........and remember these people are patients..not actors..they're gonna be fat, smelly, rude,ugly, stupid, gross and mean..and every once in awhile one is gonna crawl into your heart and you'd do anything to help them..and then you find out there is nothing you can do..Because no matter how smart or fast or skilled or sincere or compassionate you are..God calls the shots..Everyone does not have a desire or a calling to become a nurse..It is a very special and humble postion(THAT DOES"T MEAN YOU CAN"T GET PAID WELL). There is a reason why you find yourself in nursing school..Follow your inner voice and strive on through the swamps..Hold your head up high and know there is a purpose to your life..A growing of your spirit...Stay with it ..If you can, find the beauty and humor in it..And take with you the firm knowledge that at least you are helping whats left of humankind..Tell anyone who says you should get a job at McDonalds to kiss your Big Mac..Besides nusring has better uniforms!!!
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    Oh Zach~
    Honey, you are definitely gonna have days like that. Shoot! Sometimes weeks like that! As a student, you will feel unsure and like you know absolutely nothing, but it's coming.
    We have a conference after our clinicals where we can ask questions or make comments. Do you have such a thing with your schooling? And, yes, although your teacher may have ten students under her to see to, if you ask, I'm sure she will take time out to answer any questions you may have.
    You hang in there. You're not the only one in the "I don't know" boat. We all are for awhile.
    Julie
    PS My thing that gets to me is that it takes me a minute to figure out the answer to something, and by the time I have figured out a question that my instructor asks me, 5 other people have answered it, making me look like I haven't learned a thing!
    Don't be so hard on your self. You're going to be a great nurse!!!
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    ZACH, HANG IN THERE DO NOT GIVE UP. I am sending you hugs your way. You can do this. It is obvious that you want to become a nurse and just from reading what you write and say about school and nursing and general you would make good nurse. Zach, I am going to tell you what I know you already know and what I have been told over and over again and what I have to keep reminding myself of. WE are just students. We are learning so much, in so little time, and we cannot be expected to become proficient at everything at once. Our instructors know that. We are expected to learn the fundamentals and TRY our best. Your instructors know that you have what it takes to be a good nurse or else they would have weeded you on out.

    AS far as the patient not being so friendly I have learned not to let that bother me at first it REALLY bothered me I thought that meant I can not do this but now I just realize that they are often sick, and they hate being in the hospital and feel like they have hardly any room at all to do what they want, I think about the conditions some of the patients I had and I say to myself well, gee if I was like that I probably would be like that too.

    Also it has been my experience, that some NOT ALL CNA's do NOT count respirations right. So if you are in doubt and you get a totally different number from the CNA then go to your instructor or find the RN for your patient and talk to them about it. I have found that sometimes the CNA was way off and I was either on the right or on the right track and much closer than the CNA. I also have found that sometimes the CNA was right and I was wayyyy wrong. You just have to get a second opinion from someone else when ever you are in doubt of something. That is just my personal opinion and what I do in situations like that.

    As far as your parents, I can relate sometimes my parents are the same way. Sometimes they get tired of hearing me talk and say well, are you sure you are really cut out for nursing maybe you should go into computers or teaching or why not become a lawyer. One day I sat them down and told them that I really love them but it does not help me when I feel as though I am not being supported. Sometimes, I get stressed and nursing school gets hard and stressful at times and sometimes all I may need is a little boost or motivation and someone to say, Yes it is tough but you can do it if you really set your mind to it. That is what I told my parents and they are much, much better about it now. Do you feel as though you can do that with yours without making matters worse?

    Like others said as a student you will be unsure and my clinical instructor told me last semester she usually do not worry about the unsure students. IT is the students who don't come to her, don't appear worried, or don't ask much questions that TRULY worries her. In other words it is those who think they know it all that often get themselves into trouble.

    You are still in your second quarter if I am not mistaking. Also if I am not mistaking you are getting into more clinicals than you did last semester. The confidence will grow zach, I GUARANTEE IT. I know I was a nervous wreck and was totally going to lose it my first two semesters as well. Now this is my third semester and wow I still feel like a nervous wreck and I feel like there is SO MUCH I DO NOT KNOW YET. The confidence grows more and more each and every time. It will grow with you. It is natural. We will learn more and we will do more, it takes time, it does not happen overnight, when it does happen it will be a good feeling and it will be the feeling that I did it because I kept telling myself I could and I knew that with time I would be able to do this and know this. If we already knew it then we wouldn't be spending money and time in school right?

    Keep, going Zach, this time next year you will look back and you will say gee, I still may have a LOT to learn but at least I feel better. Also take some time out for yourself. I know with busy schedules that is hard but I encourage you to take out at least 10-20 minutes each day if you are Not already doing so and do something you enjoy most. I have to do that now and it is helping a GREAT deal.

    Take care
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    Know what, I'm an RN and sometimes I have trouble counting Pulse or respers.

    Some things you can do is lay the back of your hand on her chest, or just under the abd. or put a hand on her back or shoulder. Yes if she is sleeping and she get apneic she might go that low. If you were counting for a full minute and the CNA counted for 15 or 30 sec. the cna may have missed the period of apnea. Remember irregular respers or pulse need a full minute of counting.

    Let your instructor know you need desperately to talk. Ask questions. Ask the staff nurses the doctors the therapist questions. Let them know you want very much to learn.

    Do you have a guidance counselor or some such at school? make an appointment and talk out your feelings.

    You will be amazed how much you will learn and how quickly. No nurse has all the answers the good ones know this. You will always have others to ask and support you. This is not a solotary sport. I ask questions all the time.

    It's tough in school but remember thousands have gone before you and suceeded and so can you. Please, never give up.
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    I TOTALLY agree with the poster who said to count for a full minute!!!!!!!!! I cannot tell you how many times the CNA or tech has just half-assed the vital signs for my patients. I'm not criticizing all CNA's/Techs, but it would be ridiculous to suggest that every single one is as concerned about accuracy as you are!! I've even known NURSING STUDENTS who faked vital signs because they forgot to do them, and I don't doubt that there are nurses out there who do the same thing sometimes. The only person you can count on 100% is yourself, harsh but true. I never go by what the CNA's say if I have even the slightest doubt that they are being honest in their reports. If my patients were even slightly unstable, I just did all my own vital signs or re-checked pertinent ones that had already been taken. For the respirations, I find that the surest way to get them is to count for 60 full seconds. If your patient is disagreeable (remember, there are few bad patients and many unhappy ones!) to having you actually place your hand on them, use your stethoscope and pretend to be listening to bowel sounds while you count the breaths. Don't ever tell the patient you're checking their breathing because they will, subconsciously or otherwise, try to moderate their own rate. If you can't get near the abdomen, pretend to be taking their pulse and look down at their tummy for movement to count the rate. Or, if they're visibly breathing, and you can see their chest rising, or their gown rustling, or whatever, from a bit of a distance, hold your chart and pretend to be writing something while you discreetly watch them. If they don't think you're watching, you could count their rate from a few feet away and you wouldn't have to touch or disrupt them. I've been known, in our ICU rotation in school, to stand in the doorway or sit outside of the glass windowed walls at the nursing table and simply watch them from outside the room. There is always a way, sweetie, and you shouldn't get down if one doesn't work for you. Furthermore, patients change status from minute to minute, so while she may have been breathing at about 20 for one person doesn't mean that she will be doing that for you. I assessed a HepLock at seven twenty this morning that was healthy and fine and flushed easily; by seven thirty eight, when it was time to give a dose of Lasix and I had it drawn up, the HepLock wouldn't flush. My preceptor said, gosh, you just charted that it flushed fine! I said, yes, but you know damn well it takes less than a minute for an occlusion to occur, and I charted that eighteen minutes ago!!!!!! :>P Anyone who will criticize you because your V/S don't match someone else's is executing poor nursing judgement! And that includes your instructor! You may very well have assessed a new complication that wasn't present before. This morning on my other baby (I work NICU) the MD was at the bedside before I could get there. She did her assessment and charted everything in her notes. I went to the warmer after she was done and began mine and quickly noticed several things, including that the baby had an undetected heart murmur (it had been hidden somewhat by the ventilator noise) and that the baby had been on OG feeds for almost four days with no bowel movement and now had a grossly swollen and tense stomach!! No big deal- told the MD, she double checked me, and we went from there when both of those things turned out to be true. On the other subject, tell your parents to kiss your butt if they EVER try to demean or belittle you because you had a bad day. Having a bad day doesn't mean that you chose the wrong profession- name a profession that DOESN'T have a bad day!!!!!!!! I'm sure that includes your parents!!! God love parents, but if they can't be supportive then they don't deserve to take part in that part of your life. The fact that you posted here at all shows how much you care about what you're doing. Please, please keep at it, and know this: There are many, many people here who care about you and what you are doing. We support you and we AAAAAAAAAAAALLLLLLLLL KNOW what it's like to have a day that will send you running for a bottle of tequila and a fistful of Versed!! Ultimately, none of us are doing as bad as we think we are, and while that's little comfort now, in the long run it might help a bit. Come work on my unit! I promise never to criticize you for being unsure. Well, you know, except every now and then...hafta keep you on your toes. ;>P

    -Me, a brand new, but strangely optimistic, nursing grad
    Last edit by NICU_Nurse on Aug 28, '03
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    PS. Am I mistaken or did I not reply to a post of yours at least six months ago when you were BRAND, SPANKING NEW? I vaguely remember you (I could have the wrong person here, who knows...) not understanding how to do an initial assessment and all that stuff? And now look at you!!!!!!!! You're working with pitiful, obese, diabetic COPD'ers!!!!!!!!!!! RECOGNIZE what you've accomplished. Even the MD's started out not knowing crap about their jobs, and trust me on this one. We get a new batch of em' every thirty days and they don't know a thing about these preemies and sick babies. We all start at the beginning. When you were one year old, you had a vocabulary of what....a hundred words? Fifty? Thirty? Two? Now look how well you speak English! ;>P
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    Zac, don't get discouraged!! Just take a deep breath, you have made it this far, you can do it!! There is always someone who will try to make you feel down, don't let them, just have faith in your self and keep on going!!


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