Bad day in clinicals...

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*this is a vent post*

Today was the 6th clinical day of my med-surg II rotation (2nd year of a 3rd year program) and I'm starting to think that maybe i'm not good enough to be a nurse?? I really love learning about pathophysiology and I'm really good in theory, I even had the best grade of my class on the last exam. When it comes to clinicals it's a little bit different. I am not the best of course, but the comments I get are always good.

But today was just rough and I can't see myself being a good nurse in the future.

Today was our first day with a new clinical instructor (she is soo nice and calm but I found her very intimidating) so 4 students of our group of 6 (including me) only had one patient. Mine was admitted for hematuria (with a foley at home) and he also had chronic renal failure. Since it was our first day on this unit (with really heavy cases), we started at 10 instead of 8. The thing was that my patient was leaving for hemodialysis at 13h30, so I had to do everything I had to do before 12h30 (the time we're taking lunch break)

During those 2 hours I probably looked so dumb and incompetent.. At 10 I had to go change 2 dressings on the feet of my patient because he had two seriously infected wounds (probably caused by his diabetes). Anyway, I only bring 1 IV cath to plug on the syringes, but I needed to have 2. Also, I should have brought an extra pair of pliers to manipulate the sterile material with, so my instructor had to go get one. Okay, I forgot material it's one mistake, not so bad. The thing that is bothering the most is that one of the two wounds was on a heel and after cleaning it and applying silvadene, I tried to apply the dressing (which was like a sticker if I can say) and it wasn't adhering to the skin very well. So it ended up very ugly with a lot of little folds, and I even had to put some adhesive tape so it could stay in place :( It was basically the ugliest dressing I had ever seen.

After that, I started to make a lot of little mistakes : washing hand of the patient with soap and water instead of using an alcohol swab before a blood sugar??? (we've been teached both), in my meds, I forgot to check that I applied " dermabase " cream in my meds, I didn't wrote the right amount of Humalog units that I gave in my charting (I wrote the dose who depended on the blood sugar result, I didn't add the regular dose), I almost forgot to write about neurovascular signs in my dressing note, etc...

I thought I was A LOT more disorganized and slow today with one patient than 3 weeks ago with two. I always had more difficulties to be good with performing skills and I think i'm scared I'll never be good at IV's, blood samples, dressings, etc. Also, I

was always told my communication with my patients was my strenght but today I didn't felt it was so good, due to my stress. How am I supposed to be a good nurse someday if i'm running like everywhere like a headless chicken with only one??

I know this is probably a longer post than it should, but thanks to those who took the time to read :)

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I'm not in nursing school yet so I haven't been in your position. I just wanted to stop by and offer some supporting words and hopefully I will be able to receive the same when I get into my nursing program. Hugs!! Everyone in every profession has bad days. I'm sure your next clinical rotation will go much better for you. Stay positive! You can do this.

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It sounds like the dressing change was the start of what got you flustered. I think any good instructor will realize that you are learning and likely to forget things when you do a procedure for the first time. Do be mindful about your charting though, especially when it comes to meds and your assessment, as that has a huge effect on patient outcomes. If these mistakes come up later in a conversation with your instructor, own up to them and make sure you have a plan for preventing the same mistakes from happening again. Finally, Med-Surg is hard! I graduate soon and I feel overwhelmed sometimes in the same setting. Keep in mind that there are many avenues to explore! You sound very conscientious and caring, and you have a good knowledge base. The confidence part comes with time. Don't stress!

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Take a deep breath and try to put that day out of your mind so you can concentrate on your next tasks. I hope your next clinical goes very well.

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Thanks for the kinds words it's really encouraging :)

Today was a little better : I made some more little stupid mistakes concerning things I know, but I made a right call and it made me feel a bit less incompetent!

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Take a deep breath. Here's how you learn: You watch, you do, you teach. That's three times. If you are messing up after the third time then you need to evaluate your skills.

Before you do anything you should watch it being done, either from a video or someone actually doing it. Then you do it, preferably without being rushed, then you teach it...even if it to yourself. When you teach someone how to do something, you learn it even more.

I used to teach the patient, I'd explain everything I'm doing: "I'm going to check your blood sugar, I have to wipe the first drop with alcohol and get the next blood drop okay?" Explain everything, you are teaching yourself. "I have to go look at the sliding scale so I know how much insulin to give you" The patient might be like, "yeah, I know" Just keep talking through it.

You have two pockets on you scrub top, stuff them with everything; gloves, sterile caps, scissors, tape, flushes, hammer and screwdriver, whatever you think you will need, then double it! Then stuff your pants pockets, alcohol swabs, 2 pens (which you never lend out) temp dots, whatever. It's all there...and tape, can never have too much tape. When you do a wound care bring 3 times what you need because you will probably need it...and always bring TWO Foley's, you can put one back.

Charting takes time, it's not something you just get right away. Chart by exception, if something is good, leave it out, if it's bad, include it.Charting is probably the hardest part when it comes to time management.

Hurry up and tear things down, get the old dressing off quickly, then take time redressing. Get the old primary line off and out of the pump quickly, then take your time setting up the new one, NEVER rush a med, a carpenter's saying goes, "Measure twice, cut once." Once the wrong pill goes down there's no getting it back.

You are still a student, you have time, once you get in there you will be doing three Foley's a day, forget blood sugar...after day one you'll wish you never saw another glucometer again, insulin pens...make sure you prime with 2 units and MAKE SURE you crank that baby down to the dose, I've seen some nurses prime then forget to reset it. It's hard to feel it when you're injecting 4 units. And remember, some patients get a standard dose on top of the sliding scale. Check blood pressure manually, not with the stupid machine with the dead battery thats in the next hallway. The BP cuff will be on your med cart or in your pocket or around you neck, us it, it's quicker and more accurate when you get good at it.

The more you do it the better you get. I can see a Right Bundle Branch Block from down the hallway but in Med surge I couldn't tell a RBBB from a PVC, look at them 12 hours a day and you'll get it. You're going to see the same things day after day, everybody gets a cardiac med, almost every woman gets synthroid and I can count on one hand those who don't have diabetes. Flushing IVs is second nature and you'll get better at starting IVs as time goes on (it's one of my best skills). I was slow when I was in clinical, but I rarely made mistakes. These tricks I learned from other nurses and CNAs. (Note: make friends with the CNAs, they will bail you out of a lot of tough situations...CNAs are your friends, not your subordinates)

Good skill, because luck has nothing to do with it.

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I think everyone has felt like that at one point in nursing school. You had an off day. I had plenty of those during nursing school. I know when I felt that way, I would go to the bathroom for 30 secs and deep breathe. After that I felt good. You're a nursing student and you're going to make small mistakes. After clinicals try to relax for a bit (I know that seems impossible) but watch your fav show for 30 mins and then learn from you mistakes. I use to do a mini self evaluation and learn from mistakes and how to prevent them in the future.

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I will be happy to trade places with you! I am nearly the polar opposite, while the classroom/book work is my main struggle and I dominate in the clinical setting. Find the ME person in your class, suggest a trade... Have them help you with the hands on portion and you help them with the book stuff. While the NECLEX isn't a group effort the real world of nursing is, never be afraid to ask for help. Keep you chin up kiddo, it all comes in time.

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This!

i do well on exams but clinical is another world. I'd rather be comfortable in clinical, because that is actual nursing! I am so lucky to have 3 pcas in my clinics group and I always befriend the pca working that day. You had ONE bad day, it was bound to happen and now it's over and good news...you survived!:)

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Relax. And breathe. I assure you that nothing about your post screamed at me "She's going to make a terrible nurse!" What you sound like is what we all did in nursing school-tired, nervous, stressed, and frazzled. It's ok. You've gotten very good advice-take more than what you'll need, slow down and talk yourself through it, and load up those pockets! You're going to continue to have bad days. The next is always better. You're being watched and graded by someone who is watching your every move. That's enough to make anyone nervous! Some days I wish I still had someone to say "Wait before you do that, what are you forgetting?" Make your mistakes. You won't ever make them again. I was always a nervous wreck at clinicals. One time while giving meds I was so frazzled I couldn't even think of what kind of medicine cortisone is! My instructor looked at me like I had two heads. You're going to be fine. You're mindful of your strengths and weaknesses. That's a very good thing. Hang in there. It's just one day.

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Oh my goodness does this bring back the memories... Keep your chin up, clinicals are to learn from. We all go through them to gain experience and learn to be more organized and learn the ways of being a nurse. Nursing school is about teaching you the basics, the foundation to build your nursing career on. Its the clinical aspect and then once you are on RN and your working that you start to fine tune those nursing skills. Don't be so hard on yourself, its all a part of learning we ALL wanted to step onto the clinical floor and be a pro and know exactly what to do all the time but it just does not happen, it takes time, it will come with time. Clinicals can be brutal at times and as sad as it is often nurses on the floor are not the kindest to nursing students and that's a struggle in itself. One day at a time and it will all start to fall into place. Good luck and I am sorry you had a bad day, but continue to think about the good days vs the bad days. I bet there are some good days and some great successes you have had too. LIttle by little, step by step you will become a nurse that can handle all those things that went wrong. :))

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Specializes in Ortho.

You're doing fine. All nurses forget materials and have to go back and get more.

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