Feeling like an idiot during sims lab... Normal?

[RookieRoo]

Hi everyone,

I'm a first semester student in an accelerated 2nd degree program. So far I've taken nursing basics/CNA type classes and a history of nursing class. I'm also finishing up a pharmacology class and this class involves simulation labs in our robotic simulation center.

We have had two of these and I just generally feel soooo slow! And stupid! The first sim, the "doctor" told us to give our "patient" a 30mg IV dose or morphine. I thought it was high but was prepared to administer it, and then another peer of mine brought it up and we discussed it. She thought it was high too, so we called back and the doc said oops, 10mg not 30mg. So it was a good catch except it wasn't really my catch, since had it not been for my peer I probably would have administered the erroneous dose (I did look it up in the drug book to check dosages prior to my peer confirming though). So that was sim one.

Second sim, the "patient" was a type 1 diabetic and had just received humalog. It was lunch time and we were also prepping him for a blood transfusion. He kept complaining of being cold, tired and had chills/shakes... For some reason my whole group got hung up on the mind set that he just really needed the transfusion to make him "perk up" rather than the fact that he was experiencing symptoms of hypoglycemia from his rapid acting insulin and having refused his lunch! We eventually figured it out and pushed sugars but again, I just felt so slow and stupid. I know the symptoms of hypoglycemia perfectly well and yet I did not connect them, clinically, to my patient.

Should I be concerned that I am being slow and missing something, or is it supposed to take awhile to make clinical connections like this? Any advice or encouragement?

I feel like I also get nervous because of the one way mirrors and the professors watching us, I don't want to look stupid, but then I end up missing things. Gah. Advice?

[Kuriin, BSN, RN]

I think everyone feels like an idiot during simulation lab because: 1) You're not dealing with an actual patient, 2) You're constantly being evaluated by nurses and teacher's assistants who have done this before, and 3) You're being watched. As someone said, SIM makes you humble. Don't fret over it. As long as you know your stuff, you're good. Dealing with actual patients, you will find, will be much easier. :)

[applesxoranges, BSN, RN]

One thing that sucks about Sims Lab is that you're not with a real actor clinically which is both good and bad.

[Stephalump]

Nursing school is hard. We have these expectations that we should be amazing nurses, our professors are pushing us to act like amazing nurses, we're comparing ourselves to one another....

But we aren't amazing nurses. We aren't even nurses yet, much less decent ones. ?

Don't beat yourself up. The purpose of sim lab is to practice, so you can be slow and think things through and make mistakes in a safe environment, and each time get a little faster.

I hated sim lab. If having people video and stare at me through one way glass wasn't bad enough, the artificial environment was even worse

[NICU Guy, BSN, RN]

If it makes you feel any better, in your first sim there was nothing you could have done to prevent respiratory depression with that patient. We had a group that anticipated the scenario and made sure they didn't give him an overdose (even pulled the Narcan from the Pyxis when they pulled the morphine). The patient still required the Narcan. They wanted to see how you reacted to the respiratory depression. My patient ended up coding due to our delay in getting the Narcan. Don't worry, you are a fresh newbie, you will have an excellent Med/Surg instructor and will see a dramatic difference in the amount of knowledge you will have by next August.

[nlitened]

You are learning, and everyone starts out feeling that way. You will become more proficient and the critical thinking will come more quickly and naturally...right now you are a new nursing student. Don't beat yourself up about it- it's a learning experience.

[ruralnurse84]

I felt like a complete idiot in the SIM labs, was a lot more comfortable in actual clinical. There's something about the one way mirrors and creepy mannequin that made me feel incompetent. Fortunately real patients and their problems went a lot better, and as a new nurse I'm gaining confidence with each day.

[SopranoKris, MSN, RN, NP]

Don't feel discouraged! SIM lab is where you're supposed to make mistakes, with no repercussions :) Our SIM labs purposely put us through scenarios that we haven't been formally trained in. They are gauging to see how we'd handle an unfamiliar situation. How do we question things that don't seem right? How do we use what the patient is saying and what we see with how we think we should act? Do we call for help when we don't know what to do or if we're unsure if what's going on is appropriate? They're watching how we critically think through a situation.

I love SIM because you can make a "mistake" and not actually cause real harm. And it's great to learn from your mistakes. Do they video/audio tape your SIMs and play them back to you with feedback? I find that the most useful part of SIM.

[akulahawkRN, ADN, RN, EMT-P]

I'm probably in the minority here but, I really enjoyed simulation lab. It's one of the safest places that you can make mistakes in nursing school. I think throughout my own nursing school program, we had a simulation in semesters 2, 3, and 4. Every semester had at least one simulation lab that we all attended as a mandatory experience. We knew ahead of time what the basic scenario would be and we knew ahead of time what the various medications might possibly be ordered. This was not something that we would go into blind. What was really good about simulation lab is that it gave us a chance to function as a team and take on different roles throughout the semesters. It also gave us a chance to really try to think through the problems presented and see if we can either stave them off or see if we can recover from them. I think the biggest challenge with simulation lab is that it is really easy for us to try to get too involved and end up trying to solve the problem as if we were a medical provider.

In a sense, they tried to push you outside of your comfort zone so that you can at least develop some sort of a sense of knowing when to call for additional help and knowing when to challenge providers on their orders. Sometimes they can give you some very inappropriate orders and it's up to you to figure out that those orders are, in fact, inappropriate.

Towards the end of nursing school, it became more of a really nice safe place for us to try to really run like a thoroughbred and if we made mistakes, learn from those mistakes that we did make. In some ways, making mistakes during simulation was encouraged because that way we would learn a whole lot more from it. I think just as valuable as simulation was the debriefing time that we spent at the end where we would review the entire scenario and go through the roles that the various people had and why they did what they did. I can not more highly recommend simulation lab for a learning experience!

Even though we were being watched by our our instructors and being criticized (positively) on what we did, and even though we were effectively in an artificial fishbowl environment, simulation lab is an amazing tool that you can use to learn from. I think the hardest part about simulation lab is really looking at the manikin and treating the manikin as if it were a real person. The manikin that we used for most of our Sim lab was a very expensive and capable manikin that could mimic most of what a patient can do, except move limbs and talk for itself. Our instructors had to play the role of the patient and usually had to play the role of the provider as well. At first it was a bit disconcerting remembering to talk to the manikin as if it's alive and hearing the voice come from somewhere behind you...

[NuGuyNurse2b]

I actually prefer SIM over clinical, too. I feel like SIM prepares me for clinical moreso than clinical itself. I remember listening to lung sounds and I said to my instructor I think I'm hearing wheezing, then the patient got alarmed and said what's that, and in that moment, despite me knowing what wheezing is, I froze and my mind went blank. My comment made him panic, which made me panic.