Class smart vs. clinic smart

sandi1743 · Sep 26, 2011

it gets easier - IMHO yes people want nurses that know their stuff medically but they are also looking for people that are comfortable with others and the situation as often patients are already nervous enough. it gets easier - you just have to do a bunch of times.

*hugs*

AOx1 · Sep 27, 2011

Yes, it gets better. Some things you can consider to help it along:

1. ask questions, and constantly look up information. Understand the pathophysiology, the expected labs and medications and treatments.

2. Every time you encounter a patient, think "What needs can I probably anticipate?", "What is the worst case scenario for this patient, and how can I prevent or recognize it?" Consider every area of the nursing process. For example:

Assessment- what should I pay particular attention to on this patient? What assessment findings would indicate that the patient is getting better or worse? When should I reassess?

Diagnosis- for this, in real life we mainly use computerized plans of care. Learn how to customize one on a computer, and learn what their medical and nursing diagnoses mean for the patient.

Planning- Which diagnosis takes the highest priority and why? Which problem is most likely to cause harm to your patient, and how can you address it? How do you plan to measure progress?

Implementing- how will you carry out all the many things the patient needs? Which has highest priority, and how do you know? If you can only accomplish two things today for this patient, what would they be? Be specific. Don't just say educate the patient- say how. Will you demonstrate? Will you use a model? A handout?

Evaluating- did your plan work? How do you know (be specific and measurable)? What will you do now?

In terms of confidence, try to gain experience by working a minimal number of hours as a tech/extern/intern (whatever your facility calls it!) or even as a volunteer. Sometimes just being around patients can really help. I've seen students improve significantly between 1st and 2nd year just from externships.

Most importantly: you are supposed to know some things, material you have previously covered, for example. You are not supposed to know ALL things!! The most dangerous nurse on the floor is the one that thinks they know it all. You will never know it all. You are a student, there to learn. Just because you graduate, doesn't mean you stop being a student. I've practiced for years and learn something new nearly every day. Don't be afraid to say "I don't know, but I can find out." Guess what? I'm an instructor, and I say it often!

QuarterLife88, MSN, RN, NP · Sep 27, 2011

I'm the same as you - book smart, hands on...not so much. I'm so worried about looking like an idiot that I become one! I compensate by living in our open lab. Even making a bed imperfectly can send my confidence plummeting.

I'm only an ickle firstie, but for me it's like driving; I sucked at it when I was 14, 15, 16, and learning and novice. Made a lot of driving errors even after I got my license. Now I feel like I could drive in my sleep and it's just become an unconscious skill.

It will get better! I sucked at blood pressure at first, now it's my BEST event! :cool:

meltnpointofwax · Oct 1, 2011

i'm in my last semester and there are still some days where i feel swamped. it's normal, but it deff gets easier! i was a nervous wreck in my first semester. what really helped me feel confident in clinicals was during my 2nd semester when i got a tech job at a hospital. it taught me how to be comfortable around patients, nurses, family members, and even doctors.

get to the floor early, introduce yourself to the nurses, smile, don't be afraid to ask questions but always be prepared (drug book, lab book, whatever you think you'll need). i got a pocket drug guide and it's saved my butt tons of times when nurses quiz me.

good luck. i believe in you! :nurse:

SeeTheMoon · Oct 1, 2011

Yes, it gets better. Some things you can consider to help it along:
1. ask questions, and constantly look up information. Understand the pathophysiology, the expected labs and medications and treatments.
2. Every time you encounter a patient, think "What needs can I probably anticipate?", "What is the worst case scenario for this patient, and how can I prevent or recognize it?" Consider every area of the nursing process. For example:
Assessment- what should I pay particular attention to on this patient? What assessment findings would indicate that the patient is getting better or worse? When should I reassess?
Diagnosis- for this, in real life we mainly use computerized plans of care. Learn how to customize one on a computer, and learn what their medical and nursing diagnoses mean for the patient.
Planning- Which diagnosis takes the highest priority atnd why? Which problem is most likely to cause harm to your patient, and how can you address it? How do you plan to measure progress?
Implementing- how will you carry out all the many things the patient needs? Which has highest priority, and how do you know? If you can only accomplish two things today for this patient, what would they be? Be specific. Don't just say educate the patient- say how. Will you demonstrate? Will you use a model? A handout?
Evaluating- did your plan work? How do you know (be specific and measurable)? What will you do now?
In terms of confidence, try to gain experience by working a minimal number of hours as a tech/extern/intern (whatever your facility calls it!) or even as a volunteer. Sometimes just being around patients can really help. I've seen students improve significantly between 1st and 2nd year just from externships.
Most importantly: you are supposed to know some things, material you have previously covered, for example. You are not supposed to know ALL things!! The most dangerous nurse on the floor is the one that thinks they know it all. You will never know it all. You are a student, there to learn. Just because you graduate, doesn't mean you stop being a student. I've practiced for years and learn something new nearly every day. Don't be afraid to say "I don't know, but I can find out." Guess what? I'm an instructor, and I say it often!

Thank you so much for this thoughtful and guiding answer. It's very refreshing! :)

CBsMommy · Oct 1, 2011

I had this issue in the same spot in school that you are at now. I had an ER RN tell me, just take a breath and OWN IT. You can do this. So, before I did the procedure, which was a NG insertion, I took a deep breath, went into the patient's room confident and owned it! It was a fantastic insertion and boosted my confidence x10.

Now, when I am doing a new procedure to me, I tell myself that I will get ___ done and I can do it. I take a deep breath and I do it. Of course, I still ask questions if I need to, or look up the procedure prior, if I need to, but this has really helped my confidence.

Also, I agree with A&Ox1. I got an externship between my junior and senior years and it helped me so much with getting the feel of the hospital down, I got to work on my skills, I learned great tips from great nurses and was exposed to things that I have never been exposed to in my clinical rotations before. I also got to work on time management, which is really hard for students and new grads.

Good luck to you and know that you are not the only one going through this! You will become more confident with practice! Now, go out there and OWN IT!

Alismom · Nov 22, 2011

I'm glad I found this thread because this is exactly how I feel. I am in my first semester of school and pulling straight As. But when I get to clinical I feel as though I know NOTHING. Hoping that the other semesters get better.

sandyfeet · Nov 22, 2011

Every time you encounter a patient, think "What needs can I probably anticipate?", "What is the worst case scenario for this patient, and how can I prevent or recognize it?"

This is SO TRUE and completely awesome advice. I have found that a mentality such as this can really help you in clinical because you are asking the right questions, and demonstrating your knowledge and preparation. Thinking about the worst case scenario will also assure you check your basics like oxygen, suction, correct dates on IV lines, etc.

classicdame, MSN, EdD · Nov 22, 2011

you have to have the knowledge before you get the license. That is why your license hinges on one major test. HOWEVER, once you begin to work you will do many of the same tasks on a regular basis. Eventually they will become routine and you will be able to concentrate on other issues. Good luck

aachavez · Nov 23, 2011

Im glad I found this threat, Im worried about the same thing. I know i can handle the material, but so scared that once I get on the floor, I'll be sooo nervous about making mistakes I'll end up being a wreck. Practice makes perfect right? lol I Know it really comes down to confidence. Work it girl!

tokyoROSE, BSN, RN · Nov 23, 2011

Building confidence takes time. Remember, we are students and still learning. Don't feel bad if you don't know something, just keep asking questions. Don't be so hard on yourself. It was only until my last semester in my preceptorship that I felt I could really be on my own as a nurse.