Feeling inadequate in skills.

amybethf · Apr 9, 2008

hey - this is not the time to give up! I think you are experiencing the normal jitters that come with graduation and breaking out on your own. You are not the only one feeling this way! Talk to some of your classmates and get it out honey, cuz this isn't the time to give up!! You will survive!!!! U are graduating in weeks and let that be the reason that guides you. Haven't u been thinking about this moment for 2 years!!!! All the hard work, no sleep, anxiety, sacrifices - it's almost over! Do not focus on your perceived inadequacies, do some more practicing for your re-do and knock it out! U can do this! Are u going to need to do some adjusting once you have to care for people as an RN? Absolutely, but you will take it day by day, just like you learned to in school and eventually, you will feel more confident as time goes by. And it will fly by! Then one day it will all just 'click'!

Relish these last few moments and give yourself a break - you made it! :yeah: :bowingpur

Look happily

UM Review RN, ASN, RN · Apr 9, 2008

What type of problems are generated by the lab dummy? Are they emergency situations?

All I can suggest is that in any clinical situation, remember your ABC's:

Airway/Breathing: Is the patient breathing? How well? Listen to the lungs. Get an O2 sat. Reposition, give O2?

Circulation: Listen to heart. Any chest pain, tightness, discomfort? Get vitals. Look at skin color and check pulses.

Justlearning · Apr 9, 2008

I was quite nervous as I did not know what we could do with the dummy. You can actually even get a bp on the dummy. My orders stated to hang NS @ 100 ml but no IV pump was present and bag of d5w was hanging. So my instructor said what is hanging, I looked but I did not want to disconnect from IV as I had no where to put it. I could see it running all over the floor. She kept asking me is this right, I said no but did not remove it. Then I froze up after I asked if I could get an IV pump. All my basics went out the window. The dummy was in respiratory distress, my partner was suctioning. It was a total disaster for me.

Justlearning · Apr 9, 2008

I could not get a respiration rate on the dummy, I had never actually auscultated a respiratory rate. I have always gotten one by watching the movement of the chest or abd. She had stridors and I could not hear her heart, only that it was irregular. After the instructor said I better get it together what if that was a real pt. I was so upset but thought if this were really my patient I would be familiar with hospital and know where all my supplies were. I could talk to this lady. I felt like an idiot talking to the dummy because of course she could not answer me.

UM Review RN, ASN, RN · Apr 9, 2008

I'm not sure if these might help you, but here's a link you might take a peek at:

http://www.geocities.com/nyerrn/simulators.htm#acls

Jedi of Zen · Apr 9, 2008

I'm a first year myself, but I often feel inadequate as well. Actually, the great irony seems to be that nursing instructors will often bend over backwards to try to help the students who are "good with hands-on, but not book-smart"; whereas the students who are the opposite seem to get left out in the cold. The former seem to intimidate some of the nursing instructors. At least, this is just my own experience.

I work as an EKG tech, and when I'm with patients at work, I don't even think about what I'm doing - it's all pretty effortless. But in clinical I still get rather nervous at times. I've heard nurses say that your real learning doesn't even begin until after you start working, so I guess I'm just pinning my hopes on that for the time being :) That, and that any nurse who thinks or seems to have it all together is probably someone who is potentially dangerous and ought to be avoided. lol.

hikernurse · Apr 9, 2008

It's easier if you suspend reality for a minute and pretend the patient is real. When we did it, we were given "report" and then we had to assess and treat the patient. Our report did not match the patient very closely and recognizing that was part of the test. For instance, if the report said the fluid hanging was NS, but D5W was ordered, say out loud, "This fluid is wrong. I need to grab a bag of D5W. It needs to run in at 100 ml/hour so I better put it on a pump."

Make sure you assess the patient first, though :).

I felt like an idiot when I took the exam, too, so I feel your pain . Just take it one step at a time and prioritize. Practice on a couple of pillows laid end to end--that can't look any less real than the plastic patient in the lab.

You'll get there...just believe in yourself :).

PS. Most of the skills you need on the job, you will learn on the job, so don't sweat that.

jjjoy, LPN · Apr 10, 2008

Too bad there's not MORE practice on such simulators as opposed to just one shot run throughs. How else are you to get comfortable and familiar with expectations and such scenarios otherwise? And it really takes more than just one or two scenarios to really assess the student's performance anyway, doesn't it? With just a few opportunities to be tested that way, you can only hope that you're not one of the unfortunate ones for whom it doesn't come naturally or whose educated guesses turned out wrong (as opposed to the students who were't sure about what they were doing either but happened to guess correctly).

Daytonite, BSN, RN · Apr 10, 2008

. . .some do not and say that we will get what we need after graduation, on the job training. . .i learn all and do well on written exams, but when we go to the floor we act in the capacity of the nurses aid and we are not asked to place ourselves in these critical situation. i am beside myself. i can't see myself passing it as i am so nervous about it i can't even think. any advise?

the other nursing students are correct. you will get the training you need after graduation. when i was a manager, we hired many new grads and were very aware and never expected new grads to have any kind of hands on experience or mastery with nursing skills. we expected that you knew what they were and had learned about them, but were surprised if you had the opportunity to have done a handful of them on real patients. this is one reason why computer simulation programs were developed. in my day we had a mrs. chase mannequin to work on in our school lab. most nursing students have this problem.

do the best you can to pass your clinical return demonstration for now. worry about on-the-job later on when you actually get hired. my advice has always been for students to approach clinical procedures like they are playing a part in a play. memorize the steps of the procedure as well as the physical actions you must perform. actors perform their words and actions (technically called "blocking") over and over and over hundreds of times before they even perform them in front of an audience. (a funny movie that focuses on blocking and what each actor is supposed to be doing and where they are to be standing as they say their lines is called noises off.) they can do them in their sleep. practicing a nursing procedure 10 or even 20 times may not be enough for some people to pass their clinical demonstration for a grade. when will the procedure make more sense to you? when you start doing it on real human beings, but that isn't possible now, is it? so, do the next best thing and memorize.

jjjoy, LPN · Apr 10, 2008

Oh yeah, can you and some other students access the computer simulator to practice with? Or if not, can you approximate it, using the same type of scenarios it would give you?

Of course, the problem comes in if you as students are not quite sure what exactly you'll need to do to pass. So you may fear practicing over and over something that's not quite right. The best you can do in that case is find as much evidence as you can for your action choices so that it's clear to the instructor (and yourself) that you know your stuff and are thinking of the implications... problem is, this can sometimes backfire if the instructor refuses to listen to rationales or explanations - grading only on certain, unspecified expectations (if it were clearly specified, you'd know exactly what to practice). Nonetheless, through such preparation, YOU will have learned a lot and built up your own confidence and knowledge base.

I remember being very unclear of expectations in lab. In your example, one instructor might think it obvious that you should describe how you'd change out the D5W for NS, while another might ding you for that - having expected you to physically remove the D5W.