First Day of Clinicals....Disaster

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Hi everyone,

I just wanted to share about my first day of clinicals. It was awful. :crying2: We had partners to take care of one patient. Our patient was 95 and her daughter was glued to her side. I was to start vitals. The daughter insisted on BP first. I was afraid because she was frail. Then after two tries I couldn't hear ANYTHING. My instructor had to do it. Then after that we were to do a full head to toe assessment and a bed bath. The daughter would not let us do it because the patient was tired.

Finally after two hours my instructor assigned us to another patient. We performed the full assessment and helped her to the commode. She really wanted her bath. She smelled like feces. I felt so sorry for her. But, no. We had to then hand in some nurse's notes to our instructor by 10:30 so we had to wait on the bath. In lecture, we learned about fidelity. If you tell your patient you're going to give her a bath, give her a bath. So about an hour and a half later......We started her bath. We didn't have much time and were rushed because we HAD to meet for lunch by 12:30.

We were unorganized because someone had taken our bath supplies and linens out of the room and we had to go hunt down more. How does that happen? Only to me, right? LOL So we gave that sweet lady a bath. And we started to get her out of bed and to the chair to give her lunch and change her linens. I had the foley bag to make sure it stayed where it was supposed to. I looked up on my partner's side where the iv was and it had come out. NIGHTMARE. I hung the foley bag back on the bed (but too high. I was panicking about the iv) I went and told my instructor and the nurse. The instructor was furious about the bag. It was on the side rail. I WILL NEVER DO THAT AGAIN. Sucks when you learn from mistakes sometimes. The nurse was so sweet to us. The patient was so appreciative.

After lunch, we met with our instructor and had a little conference about the day. Everyone but us had a good day and did great. I said, "I feel bad because of the mistakes that were made." My instructor said, "You should." I guess I should expect that. She said if it happens again she will fail us. I'm definitely not used to that. I have been doing so well in the lab and in lecture. She pulled me aside and said I wasn't aggressive enough and I needed to not shuffle around so much. I was running my butt off, not shuffling. She yelled at my partner and said she was making excuses.

I went home last night and felt like a complete FAILURE. My instructor told my parter after I left that "we need to figure it out." Next week I will be by myself and I know it will be better. I can organize a little better and we will hopefully have a patient from start to finish. All night I tried to make sense of the day and how I could have done it differently. And I learned some things from it. It still feels REALLY bad. Up until yesterday I thought I was doing so well. One day can just shatter my confidence.

Sorry this was so long. It feels better to get it off my chest.

Specializes in ED.

I go to the same school as the OP and physical assessment is one of the first things we learn in lecture and campus lab. We have several campus lab days, then check off and then we start in the hospital. By the time we actually get to start in the hospital, there are only like 4 clinical days left (these are 8hr days, not 12hr).

Also, the OP did say they were starting vitals first, and that's when the daughter insisted on the BP being done first, not that they were going to start the bath or assessment first.

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Specializes in ER, ICU, Education.

Can I just be frank? You are not the failure, your instructor is. I am a nursing instructor, and would never in a million years treat a student in this way. It would be one thing if you were a student who was well advanced in the program and still didn't understand where to place the foley bag. However, this was your first day. I can't understand how this is teaching you anything. Yes, you should have been corrected, in a private manner, with compassion.

The only time I would ever become this angry is if a student isn't trying (ex- reading a book instead of working, etc). You were trying. Everyone has bad days, and if this experience had been treated properly (as a learning experience) it still could have taught you what not to do without completely undermining your confidence. It is possible to have extremely tough standards without resorting to humiliation and unkindness to enforce them.

You are on track as much as one would expect at this point. I would ask experienced staff about developing a routine, and as you mentioned, begin to find a plan that works for you in organizing your day. It will get easier. That said, even the best laid plans go awry, and we all have horrible, terrible days from time to time. Brush yourself off, and realize that the problem is primarily the manner in which your instructor handled things. I will say one thing: the best thing I see coming from this so far is that you easily admit mistakes. There is nothing more dangerous than a nurse who either does not admit or does not realize more mistakes (in other words, a "know it all"). Clearly you are not this type of student. This is a good thing.

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Can I just be frank? You are not the failure, your instructor is. I am a nursing instructor, and would never in a million years treat a student in this way. It would be one thing if you were a student who was well advanced in the program and still didn't understand where to place the foley bag. However, this was your first day. I can't understand how this is teaching you anything. Yes, you should have been corrected, in a private manner, with compassion.

The only time I would ever become this angry is if a student isn't trying (ex- reading a book instead of working, etc). You were trying. Everyone has bad days, and if this experience had been treated properly (as a learning experience) it still could have taught you what not to do without completely undermining your confidence. It is possible to have extremely tough standards without resorting to humiliation and unkindness to enforce them.

You are on track as much as one would expect at this point. I would ask experienced staff about developing a routine, and as you mentioned, begin to find a plan that works for you in organizing your day. It will get easier. That said, even the best laid plans go awry, and we all have horrible, terrible days from time to time. Brush yourself off, and realize that the problem is primarily the manner in which your instructor handled things. I will say one thing: the best thing I see coming from this so far is that you easily admit mistakes. There is nothing more dangerous than a nurse who either does not admit or does not realize more mistakes (in other words, a "know it all"). Clearly you are not this type of student. This is a good thing.

Perfectly said!!!!! I just want to add, with experience you will learn how to walk into a room quickly assess everything you need to grab to get your morning started and go. Also You will learn to multi task in a way of doing much of your physical assessment while doing other things such as your bed bath! Perfect time to do it. You're going over the whole body, and you can talk and ask questions as you go as to keep it comfortable and not awkward small talk.

And as you're instructor said, you should be upset, well not nicely said.. but it's good that you were upset because it means you care! You care and want to fix your mistakes, that is a POSITIVE thing!

Hang in there :):) Keep your head high and walk in there next week with a smile on your face and just do your best :):)

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Willbeanrn,

Don't sweat it. Come up with a game plan on the order of how you want to do things. Go in, get your report from your nurse, introduce yourself to your patient, do your vitals and then your assessment. Try to get that done before breakfast. Then, you can write your notes while they are eating and when they are done, you can do your bath and linens. You will have patients who can wash themselves at times, so bring them their stuff and go in and change their sheets. It will get easier. After running behind that first day even though I had another student WITH me, I never thought I would be on time on my own. But I've been on my own since, and I have been doing just fine. .

May I just say THANK YOU for writing this out? I'm a first-year, first-semester student, with no previous hospital working experience and this information is EXACTLY what I need to know. It may sound dumb, but just knowing what is going to be expected, what kind of day I may have, that makes it a little easier to breathe and prepare. Thanks again.

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Specializes in Cardiology, Cardiothoracic Surgical.

Ahhhh....I remember my first med-surg clinical last year. We were on a busy renal/pulmonary/GI floor

with pretty sick patients. My clinical instructor came out of retirement to teach, and watched us like

a hawk. I remember thinking "I'm going to die and so will the patient" the first time I was on my own.

There were definitely a few meltdowns between the students and the CI over trivial things (baths, feeding, Foley care),

but we all survived.

+1 to the above game plan. Figure out when important stuff like when meds are passed, meals, and procedures occur

(like PT comes at 10) and organize around that. I found the day went best if I knocked everything out of the way as soon

as I could. Plan your stuff like baths, linen changes, ROM exercises after you medicate for pain. I also invite the patients and family

to be involved in care, because most of the time the family members are anxious to do anything to help their loved one.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
May I just say THANK YOU for writing this out? I'm a first-year, first-semester student, with no previous hospital working experience and this information is EXACTLY what I need to know. It may sound dumb, but just knowing what is going to be expected, what kind of day I may have, that makes it a little easier to breathe and prepare. Thanks again.

This thread is two years old but it is always good to hear you aren't the only one. Organization is key....

take a look at these brain sheets you may find one to help

doc.gif mtp med surg.doc doc.gif 1 patient float.doc‎

doc.gif 5 pt. shift.doc‎

doc.gif final graduate shift report.doc‎

doc.gif horshiftsheet.doc‎

doc.gif report sheet.doc‎

doc.gif day sheet 2 doc.doc

‎critical thinking flow sheet for nursing students

student clinical report sheet for one patient

i made some for nursing students and some other an members (daytonite)have made these for others.....adapt them way you want. i hope they help

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Specializes in ER, ICU, Education.

I have been a nursing instructor for a long time, and would never do what your instructor chose to do. Brand new students are expected to be slow, clumsy, and unsure. I have extremely high expectations for professionalism and preparation for my new students from day 1, but that is about it! They have to learn the rest when we are at the clinical site. One of the first things I have them do is to go in to a patient's room, introduce themselves, look about, then report back. I will then ask them a series of questions. Does your patient have an arm band? Any allergies? Where is the IV site? Is there a foley? Any guests in the room? Who are they? What does the general survey tell you?

Almost none of them can answer even the most basic questions on day one. I ask them if they feel a bit stupid, and they admit that they do. I then tell them that this is NORMAL. You are in a strange environment, learning new skills, a new language, where things are, and what the expectations will be. I expect errors in judgment and in performance. I am always near my first semester students, especially in the first few days. I model the assessment we have learned in lab. I then ask them to go perform a general survey and perform vitals. They slowly build their skills. Odd mistakes will happen. Students will upend bedpans on the patient or themselves. They will fail to unlock the wheelchair wheels and wonder why it won't move. They will be less efficient and less fluid at every skill than I am. This is NORMAL. It took me years to get where I am. They will not be nurses overnight.

I increase my expectations over time. I expect professionalism, kindness, and caring from the beginning. The rest will only come with practice. You made a small mistake. No one was harmed or died. I would bet that you learned from it and will not do the same again. You seem to care about your patient and want her to receive the best care. Work in the skills lab to practice vitals over and over until your proficiency increases. Don't let negativity burn out the caring side of you. Keep improving and keep challenging yourself. You can do it. You seem very thoughtful about the whole process and to want what is best for your patient. I would have enjoyed having a student with your motivation in clinicals.

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Esme, you are my new friend.:cool:

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Specializes in Prior military RN/current ICU RN..

Life is about challenge and rising up. If you never had bad days how would you know a good day? USE those days to learn. You will learn how to be organized, how to cluster your care, how to do assessments. The number one thing I got out of my 2 years med/surg was awesome assessment skills. I do psych now and have for 5 years, but those assessment skills STILL help me.

Use that day and learn from it. It is life. It is how you become a good nurse. Dealing with stress and intense situations builds you into a tougher person. I have walked into rooms with blood all over and had to deal with things THAT SECOND. You will appreciate these days and how it makes you stronger.

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It doesn't sound like your instructor did much instructing. I really do feel for you. Just make sure you try to keep a clear head, even when things go awry. I think that you ran into trouble when you panicked. Next time just try to stay calm and ask your instructor for help immediately. As far as the instructor saying you should feel bad for making mistakes, I think that is really unfair. You are a student, you are there to learn. You are not a well seasoned nurse. I do not understand how she does not expect you to make a few mistakes. Even nurses with lots of experience make mistakes sometimes, we are only human. Granted you did make an "uh oh" as I like to call them (you've got to keep some sort of humor during all this madness in my opinion. I do it by making corny jokes and calling my mistakes uh oh's, haha), but it was not a life threatening uh oh. You are not a failure, you are far from it. If anything, your instructor failed you, but you didn't fail her. Learn from your mistakes and try again. Please don't give up!

p.s. OP, I will pray for you, if you'd like. I've gotten a lot more religious during nursing school. I would highly suggest getting in touch with your spiritual side, whatever side that may be. I don't have one set religion, I'm kind of a drifter, but it gives me strength to feel like I'm connected to something greater than what I can comprehend. In those times when I feel hopeless, it helps to give me hope. I also make a point to pray during good times as well and reflect on my accomplishments. It's very humbling. Just a thought. I hope you find inner peace and the strength to meet all of your goals.

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I am sorry you had a rotten experience. Things will get better. You learned some valuable lessons today and you will not make those mistakes again :). I think your instructor was a bit harsh. She sounds like the "lay down the law type". Unfortunately, you will likely have to work with her, but if you encounter a serious problem, where she for example, was berating you on a daily basis no matter what you did to try and please her, do not hesitate to bring it up with your school.

Sometimes we have a blooper moment during clinical, and I think that was yours this semester. Put it behind you and go back to clinical excited. I was nervous when I first started as well. When I had a tough week, I reflected and then I went back the next week motivated to have a great shift! You will have good experiences that outshine this, and you will laugh at yourself for what happened on the first day of clinical in the future.

Best of luck future nurse!

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really liked this whole thread - especially the step by step explanation of the basics - which I know looking back seem maybe obvious (and they will later I promise) but at the time - oh my god the things I didn't realize, notice etc - but then that is what it means to learn right? I owe everything to my good compassionate, perceptive and constructive clinical instructors. To this day the one that I had for my first med surg - which I'm sure some would claim was helping me prepare???? (and seriously anyone able to show me a study linking abuse and humiliation to better outcomes for learning and better skills development - I am all ears) - well luckily she was the exception. I hope things are going better for you - and thank you to all who wrote such measured thoughtful responses...

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