Advice needed. I don't know how to fix this.

[wifeandmomoftwo]

I'm a half way through my LPN course. I've got the best grades in my class. I have some serious anxiety issues that are causing me problems in clinical. I have done ok until this last week. It was my turn to pass meds. I knew this would be hard for me because the instructor would be looking over my shoulder the whole time. I was right. I passed but my instructor all but told me she was disappointed in my performance. She said she thought I would do better because of my grades. I feel like someone has kicked me in the stomach. I want this so much but don't know how to get passed this. When she is watching me I'm like a dear in headlights. All I can think about is that she is watching. My mind is not where it should be (on what I'm doing). I don't know why this was so much more evident when I was passing meds. I've done ok with the other skills I did in front of her.

Any suggestions would be greatly appreciated.

[DolceVita, ADN, BSN, RN]

I have had such great instructors the first two clinicals but some of my colleagues have not. I can only hope my luck holds out.

Some anxiety is good too much makes a brain fart.

If you have time between data collection and actual clinical you could try miming your skills (including med passes) or you could just do a run-through with a visualization. That got me through skills lab. Given that I wanted to puke before every check off I needed a strategy.

As for negative feedback, however badly phrased, consider the "truth of it" and make changes if needed. If you knew it all you wouldn't be in clinicals -- so learn all you can.

Also, some of the best feedback I have had has been the negative feedback. It helped me learn or change a behavior that I didn't realize was working for me.

Good Luck!!!!!!!

[dudette10, MSN, RN]

Some anxiety is good too much makes a brain fart.

I love this--actually the whole post--because it is so sweetly, succinctly true.

It's your anxiety, and I go through the same damn thing.

I've forced myself to walk more slowly during clinical. I've forced myself to spend an extra moment at the med cart before I call my instructor over for approval. When I feel the anxiety start to build, I STOP. In my tracks. Take a deep breath and just SLOW MY MIND DOWN.

You can feel it happening...I know you can. It's more than just your stomach, it's also your face. You can feel your upper eyelids lift just a little. You can feel your breathing get shallower. You can feel your facial muscles tighten up.

It really works to provide resistance to those sympathetic responses. Blink purposefully and slightly more slowly than normal. Wiggle your jaw around to loosen your facial muscles. Take a deep breath (sounds cliche, but it works because you sympathetic response doesn't want you to take a deep breath). Doing all these things will get your parasympathetic response to override the other one, and you'll begin to calm down.

And, your brain will magically start working again!

Then, once you have been able to survive it--with your brain working just as you wanted it to--it becomes EASIER! You'll eventually be able to do an entire clinical day with your mind at ease.

Good luck, and many, many hugs to you!

[Nurse-One]

I love this--actually the whole post--because it is so sweetly, succinctly true.

It's your anxiety, and I go through the same damn thing.

I've forced myself to walk more slowly during clinical. I've forced myself to spend an extra moment at the med cart before I call my instructor over for approval. When I feel the anxiety start to build, I STOP. In my tracks. Take a deep breath and just SLOW MY MIND DOWN.

You can feel it happening...I know you can. It's more than just your stomach, it's also your face. You can feel your upper eyelids lift just a little. You can feel your breathing get shallower. You can feel your facial muscles tighten up.

It really works to provide resistance to those sympathetic responses. Blink purposefully and slightly more slowly than normal. Wiggle your jaw around to loosen your facial muscles. Take a deep breath (sounds cliche, but it works because you sympathetic response doesn't want you to take a deep breath). Doing all these things will get your parasympathetic response to override the other one, and you'll begin to calm down.

And, your brain will magically start working again!

Then, once you have been able to survive it--with your brain working just as you wanted it to--it becomes EASIER! You'll eventually be able to do an entire clinical day with your mind at ease.

Good luck, and many, many hugs to you!

I like this response, especially the practically things to do concerning the sympathetic and parasympathetic response. I felt like I was in nursing school again for a minute:lol2:

Everyone is right on. First off I wasn't all that great in the textbook part but good in the clinical part. Everyone is different. I had a clinical instruction who was like a drill Sargent EVERYONE DREADED HER. I wasn't "scared" of her but just didn't want to be bothered with her complex issues. I remember one time during our after clinical conferences, she was asking me some questions about my patient and the meds he was on and why, etc. and she asked me specifically about aspirin and some things I should be aware of...well I may not have gotten A's all the time when testing but I did know my stuff. So I eventually answered her question and her response was "OH, YOU NOT AS DUMB AS I THOUGH YOU WERE":eek: ... (having fun with the smilies:)) Well, she said this in front of our group. I wasn't embarrassed It just showed how unprofessional she was as an instructor and her character was flawed just like us everyone else in this darn world! Instructors would say crap that anyone else (in their right mind) would know to be unprofessional and some of those instructors come to school or at clinical WITH ISSUES.

Anxiety (mild) is actually good for us by the way. It helps us perform better and helps us focus etc, its the side effects that suck.

My suggestion:

~Speak to the instructor when not in that environment Not just about anxiety but about other nursing related things. Talk about how you feel, he or she might say "yeah, everyone feels that one" but at least he or she is aware. And if their criticism is NOT CONSTRUCTIVE, let them know that too in a respectful manner. Again, depending on the instructor, this might soften a little towards you.

~Know the basics of passing meds (if no yet completely familiar)

~Volunteer to get on the med cart as often as possible (familiarity will lessen anxiety with some people)

~ASK questions. (even though some instructors will just tell you look in the book or will throw the ques back on you)

~ And sometimes "showing you want to learn more" attitude might get you that passing grade, if you are really having a hard time at clinical. (I've seen student's pass that way)

I hated clincals sometime because the nursing homes we went to just gave a few of us access to patients. Most of the time we where in the patent's chart. The hospitals were MUCH better.

B-t-w, I wanted tell that my clinical instructor about her comment to me at school the next day, but she wasn't there. Instead I spoke to her boss and told her about her rude and unneeded comment. She told me she was aware of this instructors mouth and many student AND HER OWN COWORKERs complained about her. Her advice was to not let it get to me and that I was here to get that paper and be out.

On a good note that same instructor taught me something, I'd never forget...even though she did it, again in a rude way. I did my morning rounds on my patients and she asked me "did I do my rounds and introduce myself to my patients" and I said "yes, but some where sleeping and I didn't want to wake them" She got sooo loud with me and took me to do my rounds again with me saying "how do you know if they are sleeping or if they are dead":confused:

Long story short depending on what type of patient I have, I'll either wake them up if sleeping or watch long enough to see their chest move up and down, then, I'm on to the next patient. So like one of the comments mentioned. Take the good from what they say and improve from it.

[wifeandmomoftwo]

Thanks for all the additional replies! Since this happened I had my end of the trimester evaluation with both of my instructors. This really helped. They gave me a lot of reassurance. The instructor that made the comment said it was meant to encourage me. I didn't take it that way but she did tell me at that time "You're going to be fine. You're going to make it." So I just keep repeating this to myself. I'm thankful she was willing to offer me some reassurance.

I'm still working on functioning when I'm nervous. As we get closer to graduation I get more afraid of how I'll do on my own. One day at a time.....

[mb1949]

I went through the same thing, you know what, it depended on the clinical instructor, I could be great if they just stood back and let me do my thing, but if they pushed at me or intimidated me in any way , I was a mess, it is very hard to change, what I did was practice, practice, yes but believe it or not I took up yoga, and practice breathing before med pass, relaxing breaths, worked for me, just an idea, anyway, I got through it. hope it works for you, you don't have to go to a class, just buy a book, or dvd works wonders.