Advice from RNs to a senior nursing student, please

[JMG2207]

Hello all,

Thanks for taking the time to read my (long) post. I would love to hear from experienced RNs who can give me some advice as to whether or not my worries are valid, or if I'm making a big deal out of nothing.

I'm currently in my 5th semester in a BSN program which is 8 semesters long. We are finishing up our Med-Surg 3 rotation. Over the summer I'll do an internship as well as Peds, then the fall and spring semesters will consist of paid externships as well as community health and leadership classes. Right now clinicals consist of working on a tele floor, as well as a few days in the ER and the ICU. I really love what I'm doing, but after last week, any self-confidence I had managed to muster up has really plummeted. I was responsible for only two patients, and it felt like no matter how hard I tried, I couldn't get things done on time. My clinical instructor tells me I'm doing very well, but that I'm not "aggressive" enough with the staff. I also notice that when I get overwhelmed, I forget how to do the simplest of things. One of my patients had a trach with a T-piece and needed to be suctioned. Afterwards, RT asked me to grab the Yankauer and suction her mouth. It suddenly dawned on me that I had had very little experience with suctioning, and in my anxiety attack, I couldn't even figure out how to attach the yank to the suction. I felt like a complete failure. I'm supposed to be an "advanced" med-surg student, and here I can't even figure out how to set up a simple suction device. I later had my instructor come in and help me learn the in's and out's of my pt's respiratory care set-up, but I felt so bad.

My question is...little things like this keep happening to me, and it makes me feel terrible. I hate all the "little things" that I forget and/or take me forever to figure out. Generally speaking, I have good experiences during clinical, but sometimes I get a nurse or pt who obviously thinks I'm a complete idiot and it destroys my confidence. (I'm 24, but I look about 16, so that doesn't always help, either!) I'm a great student, but I feel I'm lacking in the clinical area. I've struggled with depression and anxiety and extreme shyness my whole life, so the transition to nursing school has been a real accomplishment for me. I love my patients and work hard to communicate well with the staff and to offer my help when needed. If I need to perform a skill, I ask for it. If I feel my pt needs something he or she isn't getting, I advocate for him/her. Unfortunately, I still feel that my organization, prioritization, and overall timidity really holds me back. I would try to get a job as a student tech but honestly I don't have any time, the program is very demanding and if I worked, I think my grades (and my marriage) would suffer. Am I asking for trouble when I step out next year as a new grad, or will the upcoming internship and (hopefully, if I get hired) externships provide me with the experience I need to patch up any holes?

Thank you in advance!

[JB2007, ASN, RN]

Let me start by telling you, everyone is lacking clinically when they are a new grad. You learn enough in nursing school to be minimally compentent. In other words, you will know the basics and have to do most of your learning on the job. Every new grad is at this level, even the ones that seem to have it all together. All of the skills and procedures take time to learn and in the mean time you will be slow. Personally, I would rather someone be slow and safe rather than quick and hurt someone. I have been an RN for just over 2 years now and I am just now getting the time management and confidence thing down fairly well. They both take time to develope. Until they develope pretend that you are confident and that you know what you are doing. However, ask questions when you do not know what you are doing.

Just remember every nurse was where you are at when they first graduated. Do not let somebody else run you down (they may try). Learn all you can in nursing school and the rest will come with time.

Good luck, you will make a good nurse!

[jane85]

Hang in there, you will be fine. I can tell from your post that you are a conscientious and hard working person. I really agree with the previous poster: act like you are confident and eventually you will be there. I've been working as a nurse for 25 years and I still really love what I do. Keep seeking out new experiences. The organizational skills will come. I would recommend seeking employment at a teaching hospital because I have found overall that the environment in those hospitals is much more open to those who are new and learning. I remember when I first started in critical care. I was terrified! Our orientation method was really trial by fire. They threw you in the room with the sickest patient and told you to call them if you needed any help. I'm still grateful for it. Start by assessing your patient first and work your way out to all the machines and all the lines and all the stuff. If your patient is stable, you can figure out the other stuff later. Flattery is a great ice breaker. If you work with someone who has great assessment skills, ask them to teach you, even if they are old and crusty. Don't give up-- we need you!!!

[whipping girl in 07, RN]

You will hone the skills you need in the area you work in. If you work in the ER, you will likely get great IV skills, because you start so many. If you work in SICU, you will learn all the equipment and drips but may forget how to put in a foley or not be great with IVs, since most of your patients come with them (from ER or OR).

If your clinical instructor says you are doing fine, then you probably are. You may be being too hard on yourself. Seek out experiences, learn as much as you can, research your patients' diagnoses. Carry yourself with confidence, but don't be afraid to ask for help if you don't know.

[Tweety, BSN, RN]

Your post expreses the feelings that almost all of us have had.

During clinicals and beyond there are dozens of experiences almost daily that make us feel like we're total dorks and we wonder why we ever got into nursing in the first place. That's entirely normal. Eventually things fall into place and we become competent and confident practioners. This doesn't come overnight.

When we're fumbling around and feeling horrible about ourselves, it's very easy to project that onto others and go away with the feeling "that I get a nurse or patient that feels I'm a complete idiot...". I promise you this, 99.99999% of the nurses and patients don't think you're a complete idiot and you're projecting. I know the other day I was teaching a couple of students how to set up a chest tube, and one of them said "shouldn't you do such and such........" and I felt like "they must think I'm a complete idiot....". It's an easy thing to do, but stop it.

I think you're doing a fantastic job.

[BelleKat, BSN, RN]

You sound just like I did in nursing school,my hands shook so much when I was trying to insert a foley in a woman I that it was impossible for me to get it in (LOL?) but my instructor was very understanding,in a stage whisper she just said "relax,you're doing fine".

I also looked very young,I was 22 and looked 18 or so. I had experience as a CNA and started work on a busy surgical floor where once the staff there knew I could pull my own weight, they supported and helped me.That helped give me confidence because I was just sure that I didn't know anything.

I also lost 40 pounds in nursing school,it was/is rough.

You sound like a very conscientious and caring person we need you. Welcome!!

[Vito Andolini]

I think you'll be fine. You've got Studentosis. Don't stew about it. Just keep on plugging away. It takes time to feel confident, so don't give up. We all have been where you are and, in a short while, you'll be here advising a student to keep her chin up and not give in to discouragement or embarrassment or fear or other emotion.

Look at it this way - you now know how to assemble and use the Yankauer suction, do you not? Focus on your successes and believe your Instructor when she says you're doing well. I'm so glad you have a good one, not some egomaniacal nut case.

OK now, Mrs. Future RN?

[JMG2207]

:wink2: Yes, I think I'll be ok....thank you everyone for your replies, it makes me feel better and it means a lot to me!

I'm just under a ton of pressure right now and sometimes I need a little reassurance. I think last week was especially hard because the nurse I worked with was...well, interesting. She was all over the place and instead of helping me give my meds she left me in the pt's room with a cup of Dilantin, in full PPE, with a leaking G-tube so she could go flirt with the doctor...even though I was calling to her...to ANYONE... for 15 minutes straight....eventually she came back with the physician and a smile on her face. I couldn't leave because the pt was in distress and was attempting to pull out her trach. Anyway, this genuis of a nurse told me that I better make mistakes now, because otherwise I will be eaten alive when I graduate. I was baffled. She followed this up by telling me, "The good news is, I think I got a date with Dr. So and So"...

Anyway, I really appreciate all of your replies, any other advice you can give is greatly welcomed!

[JMG2207]

Haha..."genuis"....

Ah well....

[SteffersRN87, BSN, RN]

Oh dear! You can't be perfect from the start. If you don't do the same thing day after day (very boring), you are going to have to look at it for a minute before proceeding. It takes time to feel comfortable and confident. Utilize your instructors and their expertise for advice and guidance. And, I feel there is no such thing as an "advanced" med/surg student. You are a student. You are still learning. Do not label yourself to the title of the course you are taking. Good luck in all that you do!

[firstyearstudent]

Frankly, it sounds like you are doing great! Most of your nursing skills will be picked up during orientation once you have a job. You are being way too hard on yourself. Beating yourself up like this and being a perfectionist is actually counterproductive to being a good student and a good nurse and not a good idea in general.

I had a pretty hard time with nervousness/shyness, etc., while a nursing student so I went on Celexa. It really helped!

[crossds]

You will learn how to really be a nurse when you graduate. We all did. Time management is the one thing we ALL needed when we graduated, and you, too, will get that with experience. Done stress over it. It does eventually come. You will get a job as a new grad and your manager will place you with a preceptor and he/she will teach you more than you learned in the 8 semesters of nursing school.

The other thing....you may have stumbled with the yank and suction thing....we have all done that....don't sweat it. I give you HUGE kudos that you went to the instructor afterwards and went over the equipment. That says a lot about you as a person and a nurse. The one thing someone told me years ago, was to "always know what you don't know".....the only thing I add to that is "and once you know you don't know it, learn it!!" Always strive to learn something new, and when you find something you don't know, go home a look it up. The internet is a wonderful source, or your co-workers are awesome too!

Good luck.....and don;t beat yourself up. You are not supposed to be able to keep up with seasoned nurses yet.....or the nursing program would not be 8 semesters long.....it would stop at 5!!!!