Feeling like an idiot during sims lab... Normal?

Nursing Students General Students

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Specializes in Critical care.

Hi everyone,

I'm a first semester student in an accelerated 2nd degree program. So far I've taken nursing basics/CNA type classes and a history of nursing class. I'm also finishing up a pharmacology class and this class involves simulation labs in our robotic simulation center.

We have had two of these and I just generally feel soooo slow! And stupid! The first sim, the "doctor" told us to give our "patient" a 30mg IV dose or morphine. I thought it was high but was prepared to administer it, and then another peer of mine brought it up and we discussed it. She thought it was high too, so we called back and the doc said oops, 10mg not 30mg. So it was a good catch except it wasn't really my catch, since had it not been for my peer I probably would have administered the erroneous dose (I did look it up in the drug book to check dosages prior to my peer confirming though). So that was sim one.

Second sim, the "patient" was a type 1 diabetic and had just received humalog. It was lunch time and we were also prepping him for a blood transfusion. He kept complaining of being cold, tired and had chills/shakes... For some reason my whole group got hung up on the mind set that he just really needed the transfusion to make him "perk up" rather than the fact that he was experiencing symptoms of hypoglycemia from his rapid acting insulin and having refused his lunch! We eventually figured it out and pushed sugars but again, I just felt so slow and stupid. I know the symptoms of hypoglycemia perfectly well and yet I did not connect them, clinically, to my patient.

Should I be concerned that I am being slow and missing something, or is it supposed to take awhile to make clinical connections like this? Any advice or encouragement?

I feel like I also get nervous because of the one way mirrors and the professors watching us, I don't want to look stupid, but then I end up missing things. Gah. Advice?

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Don't be too hard on yourself--you've only had two! This is why we're students and we do simulations before they set us out on real patients. I'm still a student too but after my first whole semester of clinicals it's amazing how much more confident I feel (though I know I still have a ton to learn!). It definitely does take a while to start being able to connect what you know from the textbook to what you know from interacting with your patients. You're going to do fine!

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I'm a first semester student in an accelerated 2nd degree program.

So what we're saying is that you're a beginner... a newbie... green as an estate lawn... Each and every one of us starts out at the beginning and that's where you are.

OK, now that we have some context...

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I just generally feel soooo slow!

Well, you're a nursing toddler... you shouldn't be expecting yourself to be Usain Bolt at this point...

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And stupid!

OK, I'll be the first to tag someone with the "stupid" label... there are plenty of stupid people running around but two classes into nursing school is hardly a sufficient sample size to make that determination.

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The first sim, the "doctor" told us to give our "patient" a 30mg IV dose or morphine. I thought it was high but was prepared to administer it, and then another peer of mine brought it up and we discussed it. She thought it was high too, so we called back and the doc said oops, 10mg not 30mg. So it was a good catch except it wasn't really my catch, since had it not been for my peer I probably would have administered the erroneous dose

Hmm... do you suppose that's why they're having you learn on a SIM? So you have the freedom to make mistakes without hurting anybody? Of course.

I'm willing to be that you'll never in real life be ready to give a morphine dose like that.

SIM goal accomplished.

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Second sim, the "patient" was a type 1 diabetic and had just received humalog. It was lunch time and we were also prepping him for a blood transfusion. He kept complaining of being cold, tired and had chills/shakes... For some reason my whole group got hung up on the mind set that he just really needed the transfusion to make him "perk up" rather than the fact that he was experiencing symptoms of hypoglycemia from his rapid acting insulin and having refused his lunch! We eventually figured it out and pushed sugars but again, I just felt so slow and stupid. I know the symptoms of hypoglycemia perfectly well and yet I did not connect them, clinically, to my patient.

Hummm... well maybe it's a good thing that you're in a SIM lab rather than taking your own assignment next to me in the ED... What did I say about SIMs being a safe place to learn?

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Should I be concerned that I am being slow and missing something

No... but you should be concerned that you're undermining yourself by calling yourself "stupid" and thinking that, as a newbie student nurse, you should be knocking this stuff down.

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is it supposed to take awhile to make clinical connections like this?

There's no set template... everybody gets up to speed at their own rate (and yes, some never do... but you're at the very beginning... give yourself some time.

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I feel like I also get nervous because of the one way mirrors and the professors watching us

I work at an academic medical center and volunteer to work with the med students and residents (that is, MDs who are learning their specialties). I recently volunteered in the SIM lab as a bedside nurse for a doc who was running an ACLS code. Before I went to the bedside, I spent awhile watching her through the "looking glass"... so here's this lady who's just finishing her second year of training as an MD and she looked like a nervous nursing school newbie...

The point is, most people don't like SIMs and almost nobody likes to be watched and judged. However, SIMs are supposed to be a safe place to learn... and to make mistakes... all with the "no harm, no foul" caveat.

Practice relaxing and enjoying it... and look for the simple answers before you get hung up in the complicated ones.

Be nice to yourself and stop using the "stupid" moniker anywhere near yourself. I'll make you a deal... you agree to never call yourself stupid and I'll agree to do it for you if it's justified... 'K?

Chill out, go forth, and conquer.

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You are a student. You'll become much more familiar with normal doses of medications when you actually start working and administering them on a regular basis. Until then, just check and double check!

And with diabetics, always suspect hypoglycemia when they're acting or feeling strange. Some people get cold and clammy, but I've had a few who just started screaming and crying for no apparent reason.

Always look at the big picture, too. I remember one question in school about a man who came into the ER with a femur fracture and started experiencing chest pain. A priority intervention needed to be selected, and almost half the class chose an intervention related to the fracture instead of the chest pain ...presumably since he came to the ER for treatment of the fracture. Instructors and real patients will "trick" you on occasion by distracting you with less relevant information. Learn to see around it (which it sounds like you are doing).

:alien:

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Specializes in ICU/ Surgery/ Nursing Education.

At this point you will make mistakes! If you didn't then you would show up for work with me in about an hour.

Let me pass something along..... You learn much more from your mistakes than you do when you do interventions perfectly. I usually tell people that when they are learning IV's, but it works here as well. Relax, you can do it, we were all there at one point! Some may say they were confident in simulation lab but most have been right where you are.

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rob4546 said:

Let me pass something along..... You learn much more from your mistakes than you do when you do interventions perfectly. I usually tell people that when they are learning IV's, but it works here as well.

This is so true!

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Hang in there! Great advice here. ? it does come together in clinical! And even then, your instructor is there to guide you if need be- trust yourself. If you work hard, you will "get it" ?

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Specializes in public health, women's health, reproductive health.

Simulation lab keeps you humble, lol. That's a good thing. I think you will find that many people leave simulation lab feeling a bit like a dunce. I am finished with all of our scenarios, but if I were to do it over again (God forbid!), I would keep a journal about each one, what happened, what my thoughts and feelings were, etc. to review and learn. Sim lab is a learning experience. Just keep remembering that. You will improve as time goes on.

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Specializes in Childbirth Educator, Birth Doula.

In my program, we're told all the time that simulation is where it's SAFE to make mistakes!! Don't internalize them too much. Who is a perfect nurse right out the gate?? You're learning! Be good to yourself, take the opportunities to learn, and apply them later. I think the people who are willing to make the most mistakes while they still can are the ones who learn the most.

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Specializes in ICU, ED.
chwcbesteph said:
In my program, we're told all the time that simulation is where it's SAFE to make mistakes!!

This!

If you didn't feel stupid leaving SIM, I would be concerned. Don't be too hard on yourself and don't be afraid of looking stupid. Take advantage of the safe haven that is SIM lab.

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Bleh. I hated SIM all the way through the program. To me it has all the appeal of public speaking and a pop quiz all rolled into one! Don't worry too much if you don't feel comfortable, I would get so freaked out I probably could not have told you the names of my children much less an appropriate med dose! It will all come together in clinicals, have a little faith!

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Specializes in Critical care.

Thanks everyone. I do realize I'm not stupid but boy, SIMS sure made me feel like it! I ended up getting above average reviews on my clinical evaluation though, so apparently my mistakes were above average? Who knows. Looking forward to seeing what the next semester brings, thanks for all the great words of wisdom here.

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