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Feeling overwhelmed - not getting it (Update)

Sorry this is so long!!!

Hello again everyone,

I just wanted to give an update on how things have been going and say thank you for all the kind words and messages I've received about my clinical worries.

The first few weeks were...rough.

On, I believe, my second clinical day I made a major error - my patient was a high fall risk. At this point we hadn't done any patient research and had gotten a very short tour of the hospital rooms (we start out in med-surg) so I was still a bit unfamiliar with where everything was. Things seemed to be going smoothly until the end of my shift when my instructor had come in to check on me and the patient. When she arrived I was in the room with my patient who was sitting up in her chair eating her dinner.

Here is where it all went downhill - my patient was supposed to have a personal alarm on - they didn't. They were supposed to have a bed alarm on - they didn't. I had never seen a personal alarm in my life so I hadn't had any idea where or what it was. I had heard about bed alarms but hadn't been shown where they were or how to tell if they were on. My nurse had never mentioned anything in report besides saying that my patient needed some assistance getting to and from the restroom. Boy did I get an ear-full that night from my instructor. My patient hadn't gotten hurt but it was a possibility. I came home feeling very defeated, and my confidence was shook, but felt I learned from the mistake and always made sure to check that my patient's bed alarms were on as soon as I entered the room. (9 times out of 10 they are never on when I first meet my patient that is a fall risk)

After that I had a few good clinical days and started enjoying clinical (finally!) - I still didn't perfect my head-to-toe assessment but it seemed to get better each week and I was forgetting less and less. Still it felt like my instructor was less than pleased with me, any time I did not ask a question I would be scolded but the times that I would try to ask her a question about something I was unsure of she either could not be found or seemed irritated that I was asking a question at all..

When mid-term evaluation came about I was dreading it, I was sure that she would give me a negative eval because I was still struggling to catch up with my peers who just seemed to "get it". When she called me back she told me she was giving me a satisfactory at mid-tem (yay!) and that she understood that this was all new to me because I have had ZERO clinical/hospital/aide experience up until nursing school. I felt so relieved.

But...it seemed after mid-term things have just gone down-hill.

It started with a patient who's IV had come undone and fluid (normal saline) was just leaking everywhere. I went and immediately got my instructor, who at the time was working with another student putting her physical assessment into the computer. I would have gotten my nurse but my instructor was in the empty room across from mine and wasn't sure how long it would take me to locate my assigned nurse.

My instructor had asked me if we had learned how to start and prime IV tubing. I told her that they had taught us the week before in lab but it was very rushed (was done in about 10-15 minutes) and I was having some issues so I didn't get to finish and had to watch others - so I hadn't completely practiced and didn't feel 100% confident in doing it on my own.. So my instructor replaced the tubing (with some issues) and later on in post-conference we had discussed what we were learning in lab the upcoming week. When she said, "Ok, so you are all learning how to start and prime IV tubing this week" a classmate corrected her and said, "No, we learned that last week we're doing piggybacks this week." My instructor threw her hands up and started yelling at me and asking me why I said that I hadn't learned how to replace IV tubing if we had been taught it. I explained again what I had told her previously and she just shook her head. One of my clinical classmates brought it up how upset my clinical instructor seemed with me, but also said that she wouldn't have felt comfortable doing the skill because it hadn't really been practiced with us outside of that quick 10 minute practice. When we want to practice a skill we must do it on our own time and the was the week of sterile-technique/foley check off so I was more concerned with passing that check off than practicing fixing IV tubing which I figured I could practice the following week. So that felt like Strike ONE against me.

The following week we were instructed to shadow a nurse to learn about delegation and help when we could. My nurse was wonderful and gave me many great tips, the day went very smoothly. Toward the end of our shift the nurse sat down to chart and told me to sit by her so I could see how she did it. At the point my instructor comes up and sees us sitting down and asked us how everything was going. The nurse told her that the day had gone well and that she was just showing me how to chart and how to make it a little easier. I mentioned that I thought it was a great idea to start on it now so she wouldn't be rushed at the end of her shift. My instructor just looked at me and said, "Yeah because these nurses have FIVE patients to care for and not just ONE." and the way she said it had rubbed me the wrong way because it felt like a dig. I wish I could think of how to describe it but it bothered me - almost as if she had felt I was downplaying how busy our nurses are. I have said over and over again how impressed I am with the nurses for having the ability to care for multiple patients and stay on top of things. At the end of post conference I mentioned how much I enjoyed my day and all my instructor said to me was, "Yeah this was good if you actually learned something." Ok?

Then comes this past Monday where everything seemed to just fall apart on me. By this point we have had 11 clinicals and there are only three weeks left in our semester. In pre-conference we were discussing patient safety and I mentioned bed alarms and how I'm always making sure they're on when I enter the room. I should have known I would have jinxed myself.

By this point our clinical instructor has said she wants our vitals and physical assessments done within the first hour of clinical which is possible but the only issue we all have is that either our nurses are too busy to stop and give report when we get to the floor so we just wait until they are finished with what they are doing and then get report. Then finding the vitals machine can be difficult because at the time the patient care techs are trying to get their vitals done (we get to the floor at 1-1:30 and they need to have vitals done by 2pm) so we either have to ask a patient care tech for a machine or try to hunt one done which can take a good 5-10 minutes.

This past week I got on the floor (I'm usually the first out of the conference room) call my nurse who is down in the cafeteria - so I wait for her to come up and then she still had something to do before she would give me report so I waited about 15-20 minutes then another 5 to find a vital machine. My instructor said that as soon as our vitals were done to come and find her so we could chart them. I found her right away and after I put them in she told me that my bed alarm was not on and my patient was a fall risk - they have a falling star outside of their door. I was so mad at myself because I always check and I don't know how it slipped my mind. She was understandably less than pleased. Strike TWO.

Then later on it was time to put in my physical assessment and my instructor asked me about any redness and if I had checked her abdominal folds (my patient was obese) ..sh*t! I know I had seen when I had changed her brief but could not remember what I had seen.

My instructor was LIVID with me - she told me that we have three weeks left in the semester and I'm still not getting my assessment correct. So I left and went and checked my patient and came back and documented where any type of redness was found. Then my instructor asked me if I even knew why redness would be an issue and I did/do because of the possibility of skin breakdown.

As my instructor was telling me why I need to check for skin breakdown and as she was talking I said, "Yeah." and "Yes." and "Ok." which for me is how I acknowledge to someone that I'm listening to what they're saying. She stopped in the middle of our conversation and said she wanted to give me some "friendly advice" and told me that when I say those things when someone is talking that it comes off that I am not actually listening. She said that it seems that I'm just trying to get someone to shut up. She said she's listened to me talk with patients and that is how she feels that I'm coming off to my patients. She didn't say that patients have expressed this but that this is how she feels that it can be taken as.

I've stopped and thought about what she said - it does make sense to me- and said that I would work on it and try be more conscience of when I start to do those things. But now I'm wondering does she think that about me - does she think that I don't listen to her?

We've got three clinicals left and a final clinical which she said we have the option to be on the floor or off the floor. I feel like I have to really work hard to prove to her that I'm not incompetent but based her nonverbal and, well, verbal queues it doesn't feel that she's feeling confident in my ability to pass clinical or be a very good nurse. At this point I'm not feeling so sure myself.

I have worked my butt off in the lecture portion, have spent hours and hours in the skills lab, passed every single check off in the first go (physical assessment, med pass, and sterile technique - next week is IV initiation and then IV meds) but I feel like such an a** in clinical. I'm starting to doubt that I'm cut out for nursing - I don't feel that I am observant enough for the profession and I'm not a quick thinker. But at this point I feel stuck. I have expressed my concerns with my husband who is frustrated that I am struggling - not to mention I have already acquired some student loan debt so he's rightfully worried about that. I'm worried that I'm going to disappoint my family and in-laws if I am unable to do this.

I feel lost. I feel stressed. I find myself constantly snapping at my husband and my son and I hate it. Everyone else seems to love clinical and is just so excited to be there and I just don't feel that way yet. I don't feel that I'm where I should be - I should be able to do a physical assessment correctly by now.

Perhaps I need a program that goes at a bit more of a slower pace? I spoke with some ladies that attend another nursing program and was told that in their program - 1st semester is basic patient care, baths, vitals, and physical assessments. Then 2nd semester they start working on med passing and then go on from there a little bit at a time. How my program is set up is that we learn most skills first semester (we end the semester with starting IVs and giving IV medication) and then perfect them as the semesters go on until graduation.

Sorry at this point I am just rambling.

Thank you for "listening" to my struggles. I appreciate it. You all are wonderful!

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

You need to review your physical assessment, both head to toe and focussed, and get yourself more comfortable. If your husband or a friend or another family member is willing, do some practice on them. That way there is no pressure and you can get more comfortable with it, eventually it just becomes muscle memory!

I think you are now intimidated by this instructor and that is going to make you more nervous and more likely to make mistakes and be forgetful. Maybe you should sit down with your instructor and clear the air, this may help you feel less intimidated by her and more confident in what you are doing. When she offers criticism engage her in conversation, don't just answer "ok" and "yes" "no". Explain to her how you will do better next time, return with a response that actually tells her you want to work on getting better and are listening to her and just not hearing her. Just like you do when you offer patient education. If a patient says "ok" "yes" etc, you have no way of gauging interest or if they are even understanding what you are telling them. If they answer "At home I will cleanse the wound, apply bacitracin etc..." you know they are listening and understanding what you expect of them. There is a difference between hearing and listening. If that doesn't go anywhere, do your best to get through the semester, but I would advise you to avoid having her again. I found in nursing school, once an instructor gets a negative opinion of a student it generally doesn't just go away!

If you get your patient information the day before clinical (in order to write your care plan :arghh:) read up on what assessment findings you need to specifically look for during your head to toe assessment. Go through this in your head so you will remember this while you are actually doing your physical assessment. Maybe make yourself a small cheat sheet as well to put in your pocket.

Get into a routine at clinical. Learn to multitask and work your routine around the instructor, because you have no choice. First thing go in the room, greet the patient and introduce yourself, assure bed alarm and all alarms are on. You are making sure your patient is safe and they are talking and not in any acute distress.

I recommend next time instead of just letting the instructor prime the IV tubing say something like this "We did do it briefly in skills lab last week, but it was a quick review, so if I do it could you observe me and guide me through it?". This will show more of a willingness to learn and that you are motivated.

ADN programs tend to be faster paced, because they only have 4 semesters to teach you how to be a competent nurse. There is no reason to go at a snails pace, the sooner they teach you to do things like medication administration, the more time in clinical you will have to practice. What you describes as your friend's first clinical is a total waste of a semester in clinical!

BUCK UP and get it done. Practice at home so you get more confident, and you will be a professional and will have to talk to people in professional manner, learn how to accept criticism and respond to it using conversation, not just brief answers!

Good luck

HPRN

NurseGirl525, ASN, RN

Specializes in ICU.

You missed bed alarms twice? Is that what I am understanding? We do a lot of practicing. We get to do scenarios in the sim lab before doing it in the nursing home this semester and my instructors have been great. I will admit, I was very nervous the first week. I forgot stuff in my head to toe assessment but after that I have done several more and feel completely comfortable with it. We have done a couple of med passes in sim lab and feel like next week I will be ready to do insulin injections. Have you been communicating with the CNA's and nurses? I do that a lot and they know who I am now. I would think maybe you need to try and be a little more proactive on your clinicals. Maybe show your instructor you are taking initiative.

I think you are thinking about it too much. You sound just like several of the students in my class. Even at the end of nursing school, you still have little experience! It is when you start working that you will really get in the rhythm of things. I would suggest practicing your assessment at home and then if you do forget to do something go back in the room and look at your patient again. A typical clinical day for me consists of getting report, introducing myself to patients, getting vitals and doing as much of the assessment as I can while im in the room getting those vitals (listening to lungs, heart, pedal pulses, IV site, checking over visible skin,neuro) chart as much as I can do the same with my other patients then after their breakfast Ill do am care and bed change and examine the rest of their skin finish my assessment and then ive just got the rest of the day to do safety rounds etc... hang in there! just go into the room prepared to remember what you see. it seems like a lot of people are having trouble with clinical instructors being too harsh. Sometimes I feel like they forget we have no experience and are basically dummies. kinda scary buts its the truth!....the only thing that will help is more experience.

I'm sorry you're having such a hard time:( While I agree with the other posters as far as practicing at home and being a little more proactive, keep in mind that there is a chance that there will always be a clinical instructor/preceptor/nurse that may not like you. It doesn't matter. You're there to learn your skills, so that should be your main focus. Don't let your instructor take up space in your head and intimidate you. Even if you only had 10 minutes practicing the IV tubing, give it a shot, especially if it's normal saline:) It's okay to mess up (I did--all the time--in clinicals); it's not okay to not try. Better yet, on your first day of clinicals, find the nurse that LOVES students (there's always at least one) and attach to her/him like a leech...you'll always find a helping hand somewhere.

I cried everyday during my first semester clinicals; I knew I had chosen the entirely wrong career and that I was just AWFUL at everything I did. My clinical instructor had this nasty habit of poking me in the forehead when she wanted me to learn something; needless to say, we did not get along. Everything was a struggle; assessments, meds, charting, care plans (I hate you, care plans). And time management? Not a chance.

At some point, it will all click; you probably won't even realize it. It will just happen. You'll change IV tubing automatically, without thought, when once upon a time, it was the scariest thing in the world. That first IM injection that you gave with shaking hands will become second nature. And I promise, you will ROCK a physical assessment:) Just take a deep breath, center yourself, and push through this.

Your reply that all us baby nurses are wondering about really makes me feel good....

I'm sorry you're having such a hard time:( While I agree with the other posters as far as practicing at home and being a little more proactive, keep in mind that there is a chance that there will always be a clinical instructor/preceptor/nurse that may not like you. It doesn't matter. You're there to learn your skills, so that should be your main focus. Don't let your instructor take up space in your head and intimidate you. Even if you only had 10 minutes practicing the IV tubing, give it a shot, especially if it's normal saline:) It's okay to mess up (I did--all the time--in clinicals); it's not okay to not try. Better yet, on your first day of clinicals, find the nurse that LOVES students (there's always at least one) and attach to her/him like a leech...you'll always find a helping hand somewhere.

I cried everyday during my first semester clinicals; I knew I had chosen the entirely wrong career and that I was just AWFUL at everything I did. My clinical instructor had this nasty habit of poking me in the forehead when she wanted me to learn something; needless to say, we did not get along. Everything was a struggle; assessments, meds, charting, care plans (I hate you, care plans). And time management? Not a chance.

At some point, it will all click; you probably won't even realize it. It will just happen. You'll change IV tubing automatically, without thought, when once upon a time, it was the scariest thing in the world. That first IM injection that you gave with shaking hands will become second nature. And I promise, you will ROCK a physical assessment:) Just take a deep breath, center yourself, and push through this.

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