Capstone confusion.. help!

zzbxdo · Jan 17, 2015

Roll the dice and consider stressing over something that matters more.. If you're open to all of the choices.

SierraBravo · Jan 18, 2015

Here's my opinion... unless you are deadset on working in OB or the OR after school, don't waste your time picking either of those locations for a capstone experience because neither will give you the experience you need to pull it all together (as you said).

Pick a location that you are interested in working in. Plain and simple. Capstone students sometimes get hired onto the unit where they did their capstone placement because it is essentially a job interview that lasts for weeks. The other thing you have to consider is what areas of the hospital are hiring right now.

PaigeAlayne · Jan 18, 2015

I know you're right, and I am not deadset on working in any specialty yet. Honestly, I have most enjoyed my clinicals outside the hospital. I really liked community, hospice, and am most looking forward to my short mental health rotation this semester. That's my fear, I really am not cut out for med/surg and worry that I will be boxing myself in if that's what I choose for my capstone. My irrational anxiety right now is telling me that I won't even make it through my practicum if I do it in med/surg. I have the option to choose PACU/Ambulatory as well. I liked Peds and would choose that but cencus is low on peds (sometimes only 1 pt) and clinicals were VERY slow up there. I am just at a loss!

Esme12, ASN, BSN, RN · Jan 18, 2015

First....BREATHE!

Your capstone will not define you. Your classmates who want ER or the ICU are going to be disappointed for may of them will not get hired into those specialties. I agree with students not being allowed to start IV's on the little ones....it is a skill that must be mastered first then you go to the little ones. I am surprised however that you are in your last semester and have never inserted a foley. What the hell are schools teaching these days....sigh.

I think med-surg is fine. It will give you these opportunities to refine some of these skills even if it isn't where you want to be.

PaigeAlayne · Jan 18, 2015

Thank you! MANY of my classmates have inserted foleys and IV's. I really have had some unlucky days where either the opportunities weren't available, or I was giving a bed bath only to walk out and see my nurse had started an IV on another pt. And yes, I need to breathe. I have to remind myself of that! I am currently in a doom and gloom mindset and need to get out of it!

Bbett, MSN, NP · Jan 18, 2015

I have a question, what is capstone? I graduate in three months and have never heard this word.

PaigeAlayne · Jan 18, 2015

Some people call it their practicum or preceptorship? Basically we pick one unit, and are paired with 1 nurse for 90 hours. It is like our final clinical!

SierraBravo · Jan 18, 2015

Despite the fact that you may not want to work in med/surg after school, doing med/surg for your capstone might allow you to learn more skills (like foleys, etc...) as school is winding down for you. I don't know your timeline, but can you shadow in a few different places before you choose your capstone location? That might give you a better idea of which you would prefer, and also where you might want to work eventually.

PaigeAlayne · Jan 18, 2015

Unfortunately, they handed us the sheet Friday to pick and said to have it back to them by 5, so I am definitely cutting it close if I decide to change, if that is still a possibility. After sleeping on it, having a panic attack, and waking up feeling better, I really do think med/surg is where I will do it. I requested a floor where the nurses have 4-5 pts rather than the standard 7-8 and think this will make it less over whelming for me so that I am able to learn. I honestly don't know why I am struggling so much. We have only ever had 1 pt so the thought of having 4 or 5 terrifies me. I have been on the honor role every semester here with a difficult grading scale (92, 84, 76, etc.) and have never had a single complaint from a preceptor. I am just really lacking in confidence right now and my ability to finish this semester. We don't do our ED, ICU, or psych rotation until this semester, so I have no idea if any of those are for me. I am really excited about psych (can't do our capstone there, though). I just need to keep reminding myself that no matter where my placement is, I CAN handle it and it won't define my future as a nurse. Now I am just waiting for a reply from my teacher about the panicked email I sent her last night. Haha, I figure everyone is entitled to 1 break down right?!

nurseprnRN, BSN, RN · Jan 18, 2015

I have yet to start an IV, insert a foley, and a variety of other small tasks, and we aren't aloud to insert IV's in infants and children. I KNOW these skills are important.

Don't confuse or conflate these tasks with learning to be and think like a nurse. "Ooooh, you're so lucky, you got to do ..... and I never even saw one of those when I was in school! The nurses will think I'm a total loser!" is something we see here a lot. Never confuse them with nursing skills; we teach those tasks, and more, to lay people all the time. Because a mother manages her child's ventilator and suctions his tracheostomy or runs his home hemodialysis doesn't make her a nurse. By the time you have been in practice for a year, all these once-exciting and daunting tasks will be boringly routine. I promise this is true. They only look all-important and critical because, as a student, you don't have a better perspective on them yet. Nobody will care if you say, "I never had a chance to do this as a student, can you walk me through it and come watch me?" We have ALL been there. As a brief example, my first 10+ years after school were in critical care. great experience, but I didn't start ONE IV in all that time. All my patients rolled in the door with central lines, so I never needed to. They mostly all had Foleys and NGs in, although I have always been a sort of idiot savant for both of those and can do them on just about anybody, male or female... but I learned a few tricks along the way, as you will. And so forth.

Enjoy all you see wherever you go, seek out new experiences, and stay curious. And always try hard to put it into the big picture-- why are we doing these? What do we find out about this patient? What should we observe, plan, teach, understand about them? Then you're really learning to be a nurse.

Several people have pointed out that your senior practicum/capstone will not define you. That means that it will not limit your professional choices forever and ever, and probably not even on your first job. Chill about that. It's not an issue.

As for your anxiety, some folks have heard me tell this story before. I was several years out of school and had been staff in this fabulous ICU for three, and I was actually pretty good at it. One day I was in the break room with Sarah, a nurse of more than a decade's experience in the unit, one who could take every kind of patient that rolled up the hall, who was never flustered, always expert, always willing to teach and explain. I asked her when I would stop feeling scared when I sat in report. She smiled and said that every day before report started she felt a pang of anxiety, but that it passed when she started working. She said that when that little stab of fear went away she would have to go somewhere else, because it's what keeps us awake and sharp. I never, ever forgot that (and here I am telling that story again, smumble-mumble years later), and I am happy to pass it along to you. A little anxiety is good: your senses are enhanced, your body is geared up for action, your liver kicks out some extra glucagon to feed your brain and muscles...all useful. Terror is a paralytic, not a functional approach to much of anything.

Lose the word "terrified" from your self-descriptive vocabulary. I mean it. Never use it again, and if you feel it coming on, immediately replace it with the word "challenged" or "excited!" Challenges you can rise to and meet, but terror is a paralytic. This is an exciting time! Embrace it!

PaigeAlayne · Jan 18, 2015

Don't confuse or conflate these tasks with learning to be and think like a nurse. "Ooooh, you're so lucky, you got to do ..... and I never even saw one of those when I was in school! The nurses will think I'm a total loser!" is something we see here a lot. Never confuse them with nursing skills; we teach those tasks, and more, to lay people all the time. Because a mother manages her child's ventilator and suctions his tracheostomy or runs his home hemodialysis doesn't make her a nurse. By the time you have been in practice for a year, all these once-exciting and daunting tasks will be boringly routine. I promise this is true. They only look all-important and critical because, as a student, you don't have a better perspective on them yet. Nobody will care if you say, "I never had a chance to do this as a student, can you walk me through it and come watch me?" We have ALL been there. As a brief example, my first 10+ years after school were in critical care. great experience, but I didn't start ONE IV in all that time. All my patients rolled in the door with central lines, so I never needed to. They mostly all had Foleys and NGs in, although I have always been a sort of idiot savant for both of those and can do them on just about anybody, male or female... but I learned a few tricks along the way, as you will. And so forth.

Enjoy all you see wherever you go, seek out new experiences, and stay curious. And always try hard to put it into the big picture-- why are we doing these? What do we find out about this patient? What should we observe, plan, teach, understand about them? Then you're really learning to be a nurse.

Several people have pointed out that your senior practicum/capstone will not define you. That means that it will not limit your professional choices forever and ever, and probably not even on your first job. Chill about that. It's not an issue.

As for your anxiety, some folks have heard me tell this story before. I was several years out of school and had been staff in this fabulous ICU for three, and I was actually pretty good at it. One day I was in the break room with Sarah, a nurse of more than a decade's experience in the unit, one who could take every kind of patient that rolled up the hall, who was never flustered, always expert, always willing to teach and explain. I asked her when I would stop feeling scared when I sat in report. She smiled and said that every day before report started she felt a pang of anxiety, but that it passed when she started working. She said that when that little stab of fear went away she would have to go somewhere else, because it's what keeps us awake and sharp. I never, ever forgot that (and here I am telling that story again, smumble-mumble years later), and I am happy to pass it along to you. A little anxiety is good: your senses are enhanced, your body is geared up for action, your liver kicks out some extra glucagon to feed your brain and muscles...all useful. Terror is a paralytic, not a functional approach to much of anything.

Lose the word "terrified" from your self-descriptive vocabulary. I mean it. Never use it again, and if you feel it coming on, immediately replace it with the word "challenged" or "excited!" Challenges you can rise to and meet, but terror is a paralytic. This is an exciting time! Embrace it!

Thank you for all of that. It was what I needed to hear. I emailed my instructor and told her to keep everything as is, but added that I would be willing to travel to a couple of rural hospitals that are also available. I'm sure she thinks I lost my mind, maybe I even did for a few hours, but I feel some clarity this morning. I KNOW I can get through this, learn from it, and come out better on the other side! I'm sure you're right about a little anxiety being a good thing. I need to stop comparing myself to other students. I have been really down on myself for not knowing what I want to specialize in like my fellow classmates, but I know this can also be a good thing. THANK YOU!