Am I an idiot? Should I give up?

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In my 2nd year of clinicals & I have not come across any patients with irregular heart beats until today. My patient had atrial fibrillation and it was difficult for me to count the apical correctly. The beats were so irregular and fast. I got it wrong - twice.

1. how do you count an apical in this situation?

2. am I an idiot and should I give up nursing?

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A-fib by nature is irregularly irregular making it hard to follow.. and if you had a tacy rate to that it may not be a surprise that you could not get an exact count. Question is how do you know that you got it wrong twice?? did another nurse or someone else count the heart rate and tell you for a fact that you were wrong??

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Specializes in Pediatrics/Developmental Pediatrics/Research/psych.
A-fib by nature is irregularly irregular making it hard to follow.. and if you had a tacy rate to that it may not be a surprise that you could not get an exact count. Question is how do you know that you got it wrong twice?? did another nurse or someone else count the heart rate and tell you for a fact that you were wrong??

Especially because a fib is irregular, it's very possible to take it numerous times with different results. Only way to tell if you got it is to have two people count simultaneously

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Yes, my instructor listed with her stethoscope at the same time. Afterward, she just looked at me blankly like I was mentally challenged and did not discuss it further for the rest of the day.

Two of my fellow students also listened to the same patient and got around the same apical pulse # as me, so their count was also off by 20 bpm. It was important because the pt was getting digoxin. I understand it's something I should be able to do but having never heard that kind of heart beat before, I haven't really been able to practice.

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Don't give up! Next time just really focus! Turn off pts tv if necessary ect. Take your time count a full minute

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Sounds like your instructor may not know what is going on??? This seems like a little thing to get upset over. Your learning! Don't give up every time you do not know something, that is part of the medical field. Learn from your mistakes and move on.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Unfortunately these days schools are flunking these students and not teaching them.

OP did you count for a full minuet?

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Specializes in Critical Care, Education.

A cardiologist taught me to tap my foot in time with the beats when I'm counting an apical pulse. Just focusing on moving my foot helped me to catch each pulse more accurately.... try it, it may work for you also.

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Specializes in Hospital Education Coordinator.

I had real difficulty counting respirations and HR on infants for what seemed like TOO LONG. Finally got the hang of it, with advice from friends. THe instructor should have offered advice on how to do it.

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My instructor taught me to close my eyes and tap my foot while taking it. It helped me so much.

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I wouldn't even try to count a rapid a-fib. The rate varies so greatly from minute to minute, it's not going to be accurate. If the patient is being digitalized, they are on a cardiac monitor. Look at the telemetry strip

The instructor gave you that look because... he/she couldn't count it either.

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Of course you shouldn't give up!! Maybe your instructor was the one who was wrong if you and two other students got the same number of beats and it was 20 beats off according to your instructor. I was taught to close your eyes, tap your foot with the beats and count for a full minute. You can even count it twice if you are unsure. It takes some practice to count a fib accurately. Have another student count with you with a double eared stethoscope if you have access to one. Practice makes perfect!! Something so simple is no reason to quit nursing school and its unfortunate that your instructor did not educate you when you got the count wrong...some instructors are more focused on weeding students out that teaching them and it really does take its toll. You're only as good as your teacher but, in nursing you must be proactive about learning the profession. Get as much clinical experience as you can. When you have some downtime in clinicals, which is rare but sometimes happen. Go take several patient's pulses apically and just practice counting. It will come to you. Don't give up!!

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