Failing Clinical

[knikkole]

Hi guys, I am a first semester nursing student and in need of some advice. I just had my first clinical last week and after getting my evaluations back have found out that I failed my first clinical. I am a bit frustrated and concerned to say the least.

In preparing for clinical we were told by our instructor that she would like us to take an evaluation on a chosen patient if we can but if not not to stress about it because it was our first day. Overall all though, by the end of this semester's clinical rotation we needed to successfully complete a head to toe assessment. Other than to follow our nurse we were not given much direction.

Getting to clinical my instructor had trouble locating my nurse so I missed report. Once I found her, my nurse immediatley began passing medications to her patients giving me little information and was short in answers to my questions. She continually mentioned that soon we would chart and go over the patients together. I assumed this meant that she wanted to choose my patient for me. After an hour or so my nurse disappeared to a meeting and told me she would be back. After a few minutes I found my instructor, feeling a bit lost without my nurse, I asked what I could be doing while I wait for her. She asked if I had done an assessment yet, and I told her no that my nurse had not done any assessments yet. She said she would go with me to get one done or I could wait on my nurse. I opted to wait on my nurse because I still had not chosen my patient yet. My nurse returned and continued to pass medications, after giving one medication she did do a partial assessment in which she assessed the abdomen, lungs, and heart sounds quickly. Asking the patient's permission, I did jump in after her and listen quickly as well. Soon after, my nurse took a break. My instructor found me again and helped me pull up this patient's chart so I could get a little background information. I told her that I was was able to listen to heart, lung, and bowel sounds and we discussed that I wasn't sure if what I had heard was normal or abnormal for her condition. She explained this to me. I asked if she would like me to listen to them again and she offered to watch me do my assessment. I admitted that I was nervous and she said that she would walk me through it. I agreed and we went to the patient's room. The patient was having a conversation with her daughter. My instructor and I hung back and went over what I knew about the patient and what we could see. After a few minutes of the the patient continuing to talk, my instructor told me that we would instead look at her chart because they were busy. I went back and got all the information I could without further instructions from my instructor.

When getting my results back today I was told that I made no attempt at taking an assessment and as a result I did not pass my clinical. Her notes also mentioned that she remembers a visual assessment but that I did not assess the areas I mentioned. Although I did not complete a full assessment I did assess several key areas on my patient as many of my classmates did the same. Can anyone give me tips on how to remedy this situation or what I could have done differently? I definitely need to work on communicating with my nurses but I am concerned about stepping on their toes if they are not completing assessments themselves.

[gM_2010, MSN, PhD, RN, NP]

I think you hit the nail on the head about communicating clearly about what, when, where why, how about expectations. A professional nurse on the floor will always do an assessment on his/her assigned patients independently of you. Take directions from your faculty about what is expected of you and when to have the task or assignment completed. Ask questions. If you are having difficulty getting an assignment completed, talk to your instructor.

If you get instructions and think you understand it,it's ok to say something like "I want to be sure I understand the assignment/task and how you went it done. The directions are ....ABCXYZ.....is that correct?' That way you and your instructor can be sure you are on the same page.

Good luck!

[emmjayy, BSN, RN]

Okay, so here's the deal. I was sort of in your shoes last semester in that I was very hesitant, not sure of what was allowed, etc., and as a result struggled with just finding the courage to go in and independently grab vitals for a patient, never mind completing a head to toe assessment. Being able to assert yourself and advocate for your own education is REALLY important on clinical, especially if you have instructors who are unclear. Nail down expectations with your instructor - e.g., say, "So, you want me to select a patient and complete a head to toe assessment by x o'clock, correct?" Then, find the nurse, shadow for a bit, and TELL her, "I need to complete a head to toe assessment on one patient today, so I'll be going in to do one on Mr. So-and-so." It's very unlikely that the nurse will even care about what you're doing or feel like you're stepping on her toes because all you're doing is an assessment, it's not like you're sneaking in there and passing meds without the nurse's knowledge. Aim to get your assessment done as quickly as possible after arriving on the floor - after all, once you're a nurse you will be expected to go in and get that assessment at the start of your shift so you can notice any problems/deviations from baseline as the shift goes on! The patient you choose will get two assessments done that shift, but that's what happens when you're in a teaching hospital.

Be assertive. Go in and introduce yourself to the patient and explain that you're a student, you're helping out their nurse today, and you will be doing a quick assessment. If the patient contends that an assessment has already been done just explain that since you're also caring for them, you need to get a good idea of their health status as well. As a first semester student, I hadn't yet learned to give injections or insert catheters, so I usually made a joke to them that I wasn't allowed to poke them with anything yet so they had nothing to worry about. Then just get started.

Expect the first few assessments to be slow and awkward as you get into the flow of things but also remember that the patient does not know the steps of it and so they probably will not notice if you "mess up." Forgetting to do something in the correct order will not harm your patient, and having to go back and listen again for something you forgot will not hurt them either!

[Wuzzie]

Your instructor should be the one teaching you how to do a head-to-toe not the floor nurse.

Select your patient on your own, read up on the history, let your nurse know what you're doing and get your instructor.

[midwifemae]

Did you have any lab time to practice a head to toe? We had to pass a lab comp doing one before we ever saw a patient. I would practice your head to toe on someone at home if you can to become more confident in it. It took me time to memorize each area but if you literally go head to toe then you won't miss a thing.

It's too bad that your instructor was not clear enough, but you need to be sure to advocate for yourself especially since this is your grade and your learning experience on the line. Be assertive, as someone else mentioned. Write down any issues you are having at the time just to keep a record of it and if you can't get what you need from your instructor then you need to talk to your faculty who is doing the lecture portion. Good luck. Sorry you have had to deal with this...

Mae

[TxNrse]

Big Hug!! I'm sorry you had such a stressful first clinical day. When you say you failed clinical, do you mean that clinical day? Deep breath, shoulders back, head held high and move forward!! From here, you should be able to improve both your patient care and confidence.

My suggestion would be to meet with your clinical instructor and ask her what recommendations she can make in order to improve at the bedside. This gives her the opportunity to see you are wanting to improve and most certainly she will be documenting this. As someone else suggested, let your nurse know that you have an assessment to complete and do it early in the clinical day. Keep a patient cheat sheet in your pocket so you can make notes regarding your assessment and what you heard or identified. Good Luck--You can do this!!!