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.
Feb 24, '02
by NICU_Nurse, BSN
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
I remember in my clinicals,many years ago,that I also became disillusioned and questioned myself but, one-day in class (A&PII),I received a message to report to the Nursing Directors office. I was sure my number was up and as I entered her office, with eyes swollen and tears running down my face,she merely pointed over to a package that had been delivered for me.
I opened the box and inside was a small basket filled with Easter Grass,a rope about 15" wrapped around the handle and upon further digging,a quart size zip-lock bag.
I pulled the bag out of the basket and upon examination of its contents were the most unusual items; an eraser,penny,marble,rubber band,string, a candy that said hug and a chocolate kiss. I was bewildered until I noticed a note wrapped with a bow; upon opening,it read;
Feeling Great Kit
An Eraser, so you can make all your mistakes go away.
A Penny, so you will never have to say; "I'm broke".
A Marble, in case someone says you've lost all yours.
A rubber Band, to stretch yourself to the limits.
A String, to tie things together when it seems that everything falls apart.
A Hug and a Kiss, to remind you that someone cares about you.
Another small note wrapped with a bow, worded simply; "Open if All else Fails".
Upon opening it, I Bawled!!! Then I laughed; it said; "Betts, unwrap the rope and when you get to the end of it, tie a Knot and Hang On!"
Signed: No matter the outcome, I'm always here, by your side.
Love, Your Husband ...
I graduated with a GPA of 3.6
So, get a quart size baggie, fill it with the above items and remember to include a small length of rope. You will make it!
I still have the baggie with all its contents and the rope, hangs above my degree.
Last edit by betts on Feb 25, '02