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Clinical Advice Needed

Posted
by violet_2 violet_2 (New) New Student

Has 2 years experience.

Hi All!

I'm am currently in my first clinical on an IMC unit and let me tell you I. am. struggling. I'm a very shy and reserved person and I feel like that is affecting my clinical experience. My preceptor hasn't given me very many chances to interact with a patient on my own and she always does the assessment before I get the chance. My clinical instructor has emailed me telling me that I need to be more active during clinical but I'm not sure how if my preceptor is doing everything. She basically "assigns" me a patient for me to do my paperwork on and lets me draw up meds or prepare meds but other than that I'm just following her around and watching. I'm also so nervous that whenever she asks me questions I freeze and forget everything that I know.  It's gotten to the point where I am questioning whether or not I'm in the right profession. I'm not sure if I'm posting in the right place but I'm really just looking for some helpful advice. Thank you!

NICU Guy, BSN, RN

Specializes in NICU. Has 6 years experience.

15 hours ago, violet_2 said:

My clinical instructor has emailed me telling me that I need to be more active during clinical but I'm not sure how if my preceptor is doing everything. She basically "assigns" me a patient for me to do my paperwork on and lets me draw up meds or prepare meds but other than that I'm just following her around and watching. I'm also so nervous that whenever she asks me questions I freeze and forget everything that I know.

It is your responsibility to be more active in the care of the patient, not the preceptor's. During the assessment, the preceptor listens to the lungs, ask the preceptor "Can I listen to the lungs?" Ask questions if you hear abnormal lung sounds. Your instructor should involve you in bedside procedures. If she doesn't, ask them if you can go watch the procedure. Yesterday, I was helping with a circumcision. A co-worker had a student, so I asked the student as I was passing by on the way to the procedure room if she wanted to come and observe. You need to be proactive in getting the most out of your clinical experience. At the beginning of your clinical, when you come across another nurse (other than your preceptor) ask them if they are going to do anything you can practice your skills on (like inserting a foley), let you know.

Next clinical, take the bull by the horns. Immediately ask your preceptor for OK to do assessment yourself while she observes. She can critique you during and/or after. Same with everything else, meds, procedures, AM care, anything. If you don’t grab onto that bull’s horns now you might find yourself failing clinical. Sure preceptors just go in and start doing without two or three words. But those pushy preceptors will be the first to tell your instructor that you did not take initiative, or do the minimum expected, or even show interest. At the end of each clinical day write yourself a little summary emphasizing that you told Mary Preceptor you would do assessment, meds, AM care, assigned procedures. If possible write the time that you made each and every interaction with Mary Preceptor and if there were any witnesses to it. Be one step ahead of any preceptor that might want to express doubts about your performance. That is how a timid student passes clinical.

RN-to- BSN, ADN, RN

Specializes in SCRN. Has 7 years experience.

Hi, you have some good advice by previous posters.  Speak up at clinicals!

9kidsmomRN

Specializes in Cardiac. Has 30 years experience.

I feel your pain. I,too, was painfully shy. At the beginning I would stand outside my patient’s room for a moment to psych myself up to go in and introduce myself. I felt like no one would want a student even with a real nurse following up. In those days we prepped the night before and knew history, meds, scheduled tests before meeting the patient. I was never “over-stepped” by the patient’s assigned nurse. They were glad to have us for the most part, though some seemed to feel that we were in the way. The good news is that you can overcome shyness, but it takes work. You will be respected if you calmly assert yourself. This takes a lot of positive self talk. You deserve to be there(you got into the school) but make sure that you have done whatever prep work you can. This will help you feel more confident. Then approach the nurse/situation with a positive and cheerful demeanor. Introduce yourself and state that you would like to do the assessment and don’t be surprised/offended if the nurse also assesses the patients. As the nurse responsible I would....after all, you are still LEARNING and the experienced nurse may pick up on nuances that you missed-and you will learn from. If the patient’s nurse has already assessed the patient, go ahead and do your own assessment. No sim lab will be ever be able to give you that experience! When the instructor checks in on you during the shift/at recap be sure to report what you saw and heard, what you discussed with the nurse/ancillary staff,  as well as tasks that you performed, and how the patient tolerated the interventions. Speak up for yourself, chances are no one else will. If this is something you want it is worth fighting for!! Don’t let your fear paralyze you. 

I get it! I'm not shy, I get what I call 'anxiety Alzheimer's'. It'll be things I know without a doubt, but when anxious can't remember a thing. It further increases anxiety. Don't beat yourself up too bad, it will get better as you become more accustomed to clinical. As for being more active, ask your preceptor if you could have more hands-on experience to reinforce you learning the process. And if something else is going on, like a bedside procedure, try to be present if possible. It will help you get an overall view of how the field and will expand your professional social circle. I used to try to see every bedside procedure, code, whatever! Learned a lot by watching and participating.