Clinical despairs

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I just came back from my first clinical and my instructor told me I did not pass. It's discouraging, it's as if everything from class somehow doesn't process in my mind when I care for the patient. I usually even get pretty decent grades for my tests too from 80's to 90's. I just lack common sense...or even critical thinking.

A) I'm super shy. I can speak with the patient, but all the assessment questions to ask flew out of my head, even COLDSPA and ADPIE. It's completely different from the lab. There are times the patient just wanted to rest, and I didn't want to disturb the patient. I couldn't even get enough vitals out because I didn't want to disturb the patient's rest or breakfast.

B) I have trouble organizing my thoughts and presenting them for some odd reason for post discussion too. My clinical instructor said something like, "If that's the way you talk, you're just a CNA." Any tips on how to tell which pieces of information are definitely essential? I need to have a certain structure or way of organization down, or else I will be lost.

C) I have the caring portion down. I tried to work in such a way the patient could get the least discomfort. I'm told my patient actually liked me a lot too, but I've depended too much on the clinical instructor and primary nurse for what to do. Pulling out the old IV for the first was an acceptable thing for me to ask for assistance, was it not?

D) Also, what types of things do you report to the primary nurse for? Just so I don't make the mistake of reporting the wrong information again.....

I almost think it would be better if I had a partner to work with for the beginning. However, my shyness is may have been so visible that my clinical instructor decided to make me work alone. Some people got to work with partners too. The experience of working alone is probably meant to be beneficial, but I'm not too comfortable with the hospital environment yet.

It didn't help that the clinical instructor told me that I had the easiest patient to work with and that I'm just not up to par. She doesn't know how I can improve myself. She even said I should maybe reconsider not taking the path of nursing, but I truly do want to help patients as a nurse. If clinicals are in the way, I at least want some tips on how to improve so I can help better.

I don't know why what I've studied in class and lab isn't being applied very well in the field. Everything I've learned becomes jumbled in practice. How do I consolidate everything in my mind and mentally prepare myself so my nerves don't get the best of me next clinical?

I apologize if I sound like I am ranting or whining too much, but any tips are appreciated. My mistakes have been too many.

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Specializes in Maternal - Child Health.

Take a deep breath! Reading your post left me winded!

It's obvious that you are a conscientious and caring person and you want to do well for your patient, the staff and yourself.

Please make an appointment with your instructor ASAP and ask for her assistance in formulating a plan to help you prepare for your next clinical. Is it possible to find out the evening before who your patient will be so that you can research his condition and prepare a tentative care plan in advance? How does she suggest you organize yourself at the beginning of your shift once yo have received report? What specific skills are you expected to have mastered for this clinical session? What are the guidelines for reporting off to the staff nurse? What are your limitations on skills that you can perform independently? How can you work on becoming more assertive? (This can be tough to balance. You are right that patients need uninterrupted rest, but they are in the hospital because they require monitoring by a professional nurse. You can't provide that monitoring if you are unable to obtain vs and assessments. Is there an assessment sheet that you can copy and take into the patient's room with you? Even with years of experience, I don't always remember to assess everything unless I have my sheet with me.

Discuss these things with your instructor. She is in the best position to guide you.

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i think you're just nervous. write down on index cards what you plan to say to your pt and study. practice on loved ones at home. talk to your instructor again about having a partner so you observe what they r doing. i'm sure it's not helping that your instructor is not being encouraging. i urge u 2 seek some help, maybe from someone n the nursing department, talk 2 your fellow clinical students, they may prove 2 b very helpful and by all means do not listen to negative advice from your instructor!!! you've made it this far, u just need a little push n the right direction.:nuke:

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Hopefully, you will have a different instructor.

That's great that you achieve very well on your exams.

Why would a partner be useful?

Keep practicing. Keep organizing. Keep focused.

About the shyness - remind yourself about the reasons for

you being there for the patients.

If that instructor suggested that you should not take the path

of nursing - ask yourself what YOU want to do with your life -

and follow your chosen direction.

Sounds like SHE could be more helpful.

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Specializes in Trauma, Teaching.

First off, remember the pt. is there for nursing care. If they were well enough to ignore and let sleep all morning, they wouldn't be there, on the whole.

That means you get your baseline assessment and VS at the beginning, so if any changes occur, you have something to compare to.

Make a schedule for yourself. What are you going to do every hour of your day? Make a 3x5 card to keep in your pocket with what you are looking for (VS, head, lungs, gut, feet). Start at the top and go down.

7 - 8: get report, assess pt.

8-9 assist with breakfast, start ADLs. Check the chart for new/changed orders. Write your inital assessment note.

Go on from there. Put the rest of your assessment questions on the other side of your card, so you always have your cheat sheet with you.

I've never had students work in pairs. You need to be able to do your own stuff, without being led by the hand.

Report: name, age, diagnosis, diet, IV site and solution, ABNORMAL findings with breath sounds or anything else, pain/comfort measures, treatments/procedures that happened or still need to. Short, concise, to the point.

ie "49 yo male, A&Ox4, post op chole, started clear liqs and tolerated well, patent IV to right forearm, D5&1/2w/20KCL at 125, lungs crackles in bases, did I/S well, Dilaudid IV once with relief at noon, needs JP drained and dressing change at hs, wound looked good with morning dressing change."

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Ack, sorry Jolie. Didn't mean to overwhelm you. I had no idea how to work the formatting for a while, but hopefully I changed it for the better. We weren't really given an assessment sheet. Is that normal?

We were just told to bring notebooks and document. My class was provided with concept maps and nursing preconference maps, but the clinical instructor insisted that we only look at the chart and complete the plans at the end of the day. We didn't even get the patient information until the day of the first clinical, so I was flustered about how to even plan everything if I was to finish it at the end of the clinical rather than before.

I am assuming my class is using the same assignment as last week, so hopefully I may be more prepared. Thank you for providing questions so I may reflect and improve the care I provide to patients. It's very appreciated.

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Thanks for the advice and encouragement lunden, I'll seek some help from the lab instructor, she seemed much more receptive and offered useful tips. I'll be making those index cards to be prepared!

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Thank you for the advice Gingersue, I don't believe my instructor will change anytime soon, so I have to adjust and deal with it at least for this semester. I kind of thought a partner would help because we could cover each other's memory deficiencies for care, but I suppose it is better to learn how to care collaboratively and alone. I hope I learn this soon.

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Thank you so much JBudd! I was pretty fuzzy about what to focus on for reports because my class never really went over it. Now I have direction. Your example illustrates what's needed so much more clearly. Hopefully I will have much more prepared next week.

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And oh my, I've sprinkled this message with so many thank-you's. I'm sorry if it bothers anyone. I'm just very appreciative of any advice I can get.

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I don't understand if you didn't pass just one day of clinical, or if you didn't pass a whole clinical rotation? It takes practice to figure out how to approach patients, do assessments, etc. How many days have you been on the floor? We follow a flowchart when doing assessments, are you supposed to just walk in the room and do an assessment from memory and write it down without a form?

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I received the fail for that one day of clinical. There are only seven more clinicals left as far as I know. There still is hope, so I want to nip any major problems in the bud.

It seemed what was suggested for my class was a much more informal for assessment. My instructor pretty much said to observe the room & patient, provide am care, then deal with what's there via critical thinking. My problem was that a) I had no idea how exactly to arrange my focus and b)forms were not available. I think I need more structure to function better.

What was provided were nursing plan forms, but only to be looked at and finished after the clinical day was over.

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Bubble tea, what a traumatic first clinical experience for you. I remember my first clinical day and I was so discouraged. I had a patient that I was supposed to take vitals on and I couldn't even find her pulse. I had no previous healthcare experience and several people in my class did. I was seriously thinking maybe I wasn't cut out to be a nurse. I have just completed my first rotation of my second year, and my clinical instructor told me that she can tell that I am very careful and caring and that I put the patient's safety as my highest priority. She said I was an excellent student and gave me an all positive rating. I was very happy, and whenever I get down on myself I am going to pull out this review and remind myself that I can do this.

Now as for what your clinical instructor has said, don't let it sow the seeds of self doubt. You got into nursing school and you will find a way to conquer clinicals. Now we have several teachers who split up our class and serve as clinical instructors. Is it possible to talk to another instructor about what areas your instructor has a problem with and get their opinion on what you can do to fix them? Another avenue may be to find someone from the previously graduated classes who can advise you on the personality of your clinical instructor. What they are looking for and things like that. I am very sorry you had such a crappy first clinical experience. I know that first time clinicals are stressful enough without having your clinical instructor not supporting you. Take care and hugs.

Jean

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