Feeling incompetent...need advice

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I'm a second degree ABSN student in my 3rd month of a 12 month program. While I'm doing well in lecture, the practical skills are KILLING me! Everything seems so much harder for me to learn than it does for everyone else. For example, I'm STILL having problems getting accurate blood pressure readings. I've ordered a new stethoscope (which I can't afford, btw, lol), but I'm not certain that will help much. I've practiced relentlessly on my boyfriend and occasionally on my classmates when I'm able, but without someone going behind me to tell me if it's right, the practice seems somewhat futile. The program I'm in doesn't help much, either. We learned on manikins (which is deceptively easy...not at all like real people!), and never had the chance to practice on real people with a dual stethoscope (like I've been told they do regularly in many CNA programs!!). The difficulties don't stop with blood pressure, though. I have a hard time finding pedal pulses, and today when we learned to do IM and SubQ injections I struggled with bubbles in the syringe and bent a needle! To put it simply, I'm clumsy, anxious and disorganized learning these new skills, and I feel so stupid! I try to watch You Tube videos in an attempt to self-tutor, but that only goes so far. As of right now, we've only had clinicals in a LTC facility, but I feel so incompetent in that setting, I'm terrified that it will only be 10x worse at the hospital.

Any advice that anyone could give me would help. I just don't want to be a horrible nurse, and I'm afraid it's looking like I might not be cut out for this. I don't want to give up, but I also don't want to try to force a square peg in a round hole at the expense of the patients, you know?

Thanks in advance, everyone.

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Skills are a stumbling block sometimes. It's so different from regular course work. I was absolutely TERRIBLE at skills for a while. My issue was mostly anxiety based. What worked for me was practicing over and over and over until the motor memory would take over when my brain shut off because I was so freaked out during check off. You just can't do these things enough.

Some things are just learning little tricks about getting bubbles out. Do you understand exactly what you're doing with BP reads? Maybe it's a matter of not knowing what exactly to look/listen for. As far as finding pedal pulses, that's hard on most people, let alone a sick or elderly patient. Can you find your own?

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Specializes in Med/Surg, OB/GYN, Informatics, Simulation.

My best advice is practice! And not to stress out about it, I still get worried I'm not doing something right and struggle finding some people's pulses (some people are just really difficult to locate anything on them). And know that I'm sure a bunch of others in your class feel the same way, everyone worries their first time, and I'm sure half are just agreeing saying they've found a pulse or whatnot. No one can do everything in nursing without practice.

I struggled with blood pressures as well, I practiced as often as I could to get better at it. It helped me having someone who knew how to do it check someone's BP and then have me do it so I knew I was in range. I'm curious to how they're teaching you, are you palpating the BP first and then inflating the cuff to 30 above the estimated systolic; or are you just pumping it to 200? Another trick some people use is the needle will sometimes 'jump' on the BP which can give you a rough estimate on someone's BP.

Also my school supplied us with practice equipment, if your worried about getting rid of air bubbles get a syringe (you can get one without the needle) and just draw up water to practice.

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Thanks anonymous. I think I know what I'm supposed to be listening for. I mean, any tutorial video I watch I can easily identify the correct sounds. Yet in real life, I seem to be getting a lot of instances in which I think I hear the blood pressure much higher than the patient's previous readings would seem to indicate. I read that a double tubing stethoscope can sometimes create this problem b/c the tubing can rub together and mimic the sound (hence me ordering a new scope). Hopefully that will help, but it still really bothers me that I haven't yet mastered what seems like such a rudimentary skill! With pedal pulses, I was able to find the dorsalis pedis pulse on myself pretty easily, but I struggled with the posterior tibial pulse. I finally found it today after watching another You-Tube video, lol, but it was faint and it's soooo easy to press to hard or too soft and not be able to feel it even if you're in the right spot!

Thanks again for taking the time to respond. Just having someone to vent to about this helps. When a couple of students in my clinical group mentioned to our instructor that we were struggling with blood pressure, she simply told us to try to get more residents' blood pressures. No other help was offered. Crappy teaching is a big part of my problem, I think...

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Russoderm, we were taught to do the pulse obliteration technique, although I haven't really done that in practice. It occurred to me last week that that might actually be really helpful, so I plan to give it a try. I really wish I had someone like you did who I could go behind! That sounds like it would be really helpful. I can sometimes do that with other students in my clinical group, although most of them are about as unsure as I am, so when we get different readings, there's no telling who's right! I've got practice needles (we have to buy all of our own material as a separate cost outside of tuition), so I'll definitely practice with that. Blood pressures is my big thing because it's so hard to really practice that on your own.

Thanks again.

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Specializes in Med/Surg, Academics.

About the BPs. Sometimes, it's not that you're getting the reading wrong, but that you have no confidence that you're getting it right! I was not confident at all about my BP readings in clinicals, but I did the best I could. Then, I had a home health assignment for a community health rotation. I followed one nurse the entire course, riding in her car, and going to see her patients with her.

I took the vital signs for her on each patient. At first, she would double check my BP readings, and guess what? They all came back very close to mine (

So, you see, in many cases, it's really confidence that gets in your way, not your skills. If you have a teacher who is very helpful, ask her to practice with you and another students for 15 minutes or so, just doing BP readings. If you're within 5 mmHg, your confidence will increase.

Good luck. I know it's frustrating. Been there, done that. :)

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Specializes in Oncology/hematology.

I am really bad at BP's... and in the hospital and community setting- they're all digital!!!

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I agree that it takes a lot of practice to get comfortable with any skill. If you live with your parents or a spouse, whoever, you could take someone's BP daily until you get comfortable with it, if they don't mind of course.

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hint for the bp-challenged: make sure the ear-tips on your stethoscope point forward, towards the tip of your nose. you can adjust them with a little brute force :D. if they don't point forward, to aim right down your ear canal to your tympanic membrane, they will be up against the walls of your ear canals, and you won't hear for beans. (one of my pet peeves for people playing nurses and physicians on tv-- they always have them on backwards.)

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The problem with this is that my boyfriend's blood pressure is very loud and easy to hear. I've also taken it so many times that I know what to expect, so it's kinda like cheating, lol.

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Specializes in PICU.

A couple of thoughts, first off it doesn't sound like your instructor is bad, practice really is what will make this better. Second, taking blood pressure readings is not a ruidmentary skill. It is basic, but there is a lot that goes into it. It isn't simple, although it's often taught like it is. I have done an EBP project on getting accurate blood pressure readings, and I was amazed at how much there is to know that they did not teach us in school.

Getting an accurate blood pressure is such an important assessment tool, we actually had a section on it in my master's level assessment course. I do think the radial pulse obliteration thing is very helpful, because it gives you an idea of what to expect for your systolic pressure. That will help you be more accurate. Another thing that my advanced assessment book recommended was using the bell of your stethoscope instead of the diaphragm. I tried this on myself (it is possible to take your own manual BP although a little awkward) and it was SO much easier to hear. Just remember that the key to using the bell of your stethoscope is not to press too hard. If you press it down then you turn it into a diaphragm. Not sure if that will help you, but thought it's worth a shot:)

Practice is really the best way to get better with skills. You will get very little practice in a 12 month program, but that's fine. You'll have plenty of time to practice skills when you're out working too.

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Specializes in PDN; Burn; Phone triage.

OP -- darling, we need to get married and have hopelessly fumbling chillens.

I always "got" the didactic stuff. To an insane degree.

Barely passed skills lab. Y'know. With fake arms and stuff.

Finished up clinicals and capstone eking out the slightest bit of skills knowledge. Everything is easier when your instructor or preceptor is standing right over you and practically doing hand-over-hand. (Doesn't help that I'm a naturally passive person, go with the flow, etc.)

So, hey, don't be afraid to learn like I do. Push yourself. But I'll be damned if the first really successful IV I put in a patient wasn't done when I was alone with a patient who had horrible veins. Confidence! is key.

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