Feeling really REALLY stupid about clinicals

RNMeg · Feb 19, 2010

You don't have to be bossy, but you may have to be firm. Remember, you're not there to bug the patient, you're there to help them get well. Keep in mind the rationales for the interventions you're doing, and have them ready if the patient asks. If they complain about being turned, remind them that it's to keep them from getting pressure sores. If they complain about ROM, remind them that they need to move their muscles or they'll atrophy. As far as the foley, what I usually did was empty it, write it down, and let the patient's primary RN know when I saw her. You can do it :) Just work on being more confident in patient rooms.

allnurses Guide · Feb 19, 2010

You won't learn without the corrections, so try to remember that when you get down on yourself. Nobody knows this stuff by instinct, though they may do a good job of faking it.

As far as patient care when they don't want to be bothered, both they and you know they are in the hospital for a reason - to get well. You are there to facilitate that. If they meet their nursing goals, they will be on their way out the door most likely. Remember, there are things they have choices on and things they do not. Being turned, moved, bathed, having their wounds dressed are things they have no choice on. It is all part of getting and staying well. What they want off their individual lunch menu, they get to choose. You too have things you have a choice on. You can choose to practice clinical assertiveness for the patient's own good or you can choose to struggle, doubt yourself and possibly fail! Wouldn't you rather at least be doubting yourself for something you DID do and would have liked to do better than to be wondering if you should have done something at all, period? You already know the answer or you would not be posting here. Big hugs, chin up. You sound like most normal new nursing students and you will be amazed at how far you have come by graduation!

aei631 · Feb 19, 2010

I'm not a very assertive person either so what I do when I've got a patient with a stand-offish vibe is I don't give them any options. I'll go in their room for whatever reason, and as I am leaving I'll tell them "I'll be back in 30 minutes to reposition you." That way they know what to expect, and it's clear it's not optional. I agree with previous posters that you should also be able to tell them why you are doing what you're doing when they ask you why they have to be bothered.

CaptScrubs13 · Feb 19, 2010

Something similar happened to me last week too. My patient was really not interested AT ALL in getting up, moving around, getting washed up etc. I told my instructor and she said you can't force them to do anything (pt can always refuse) but you should try to talk to her and say "you don't lay in bed all day at home do you? brushing your teeth and hair will make you feel a lot more refreshed" after talking to her, she agreed, sort of reluctantly. But once I started giving her the bed bath, all she could say was how good it was. Sometimes you just need to talk to them and try to convince them it will help them out and make them feel good.

locolorenzo22, BSN, RN · Feb 21, 2010

you have to learn that for the most part, you ARE their nurse during your clinical day. I always started the day by introducing myself to patients and explaining "My name is lorenzo, and I'm a RN student doing clinicals here today, and I am going to be your primary caregiver today. How are you feeling?" After a while, if I got the "bad, go away" vibe...I also asked "how do you feel about having a student today?" sometimes that my be the issue.

work on just getting in, doing your assessment, charting your I&Os, and doing everything YOU can....

mammac5 · Feb 21, 2010

Live and Learn! It didn't go well, so next time be prepared to do better. In all fairness to you, it might have been nice if the expectations were more clearly communicated to you, ie., how frequently you were to check and document I&Os. Ask before next clinicals. Typically I&Os are checked and documented every 2 hours for adults, although this may vary widely depending on institution so ask.

When you go in the room for the first time to introduce yourself to your patient, be strong. You're a nursing student and have a lot to offer this patient. In addition, he/she is getting LOTS of extra nursing attention that the staff nurses do not have time to do. You're valuable...even though you're new to this. Go in, introduce yourself, assess the room for safety, check any/all equipment being used (Foley, IV pump, O2, SCDs, etc.) and then ask the patient if there's anything you can get/do for him/her before your start the assessment. DON'T ask them IF you can do an assessment.

In short, ask more questions of your instructors and LESS questions concerning the patient's desire for you to perform nursing skills/interventions that you KNOW are needed. You can give options...such as, "It's time to reposition you for good circulation and to keep your skin healthy. Do you want to be on your left side or right side?" "It's important for you to get plenty of fluids. Can I bring you apple juice or would you prefer tea?" "I'm going to change your linens now. I'll help you up to the chair to sit while I work on that."

You're in charge -- within reason -- when it comes to what goes on in that patient room. It's not about being mean or rude to patients for the sake of your education...it's about the fact that, even as a student, you have something to offer that patient. If they didn't need nursing care, they'd be at home!

Psilant · Feb 21, 2010

My instructors explained it like this... they are in 'YOUR' home (meaning your hospital, your rules). Don't be rude, but explain that these interventions must be done. It doesn't matter if you are a student or not.

If you have a lack of confidence in your patient care, fake it while you are in their room! Ask your instructor/preceptor questions BEFORE you start a procedure, never think you can 'figure it out' on your own. You CAN do this!!!!

FowLaf24/7 · Feb 21, 2010

I believe everyone can relate to how you are feeling at one time or another, and some weeks all the time. I believe some of the problem could be communication. If the expectations were not presented very well, then problems will inevitably will present themselves. One really needs to be very aggressive on receiving as much information as possible. This problem if not dealt with, could follow someone to the any nursing floor which one could find themselves. So, like everyone else let's be aggressive in our communication.... :yeah:

HyperSaurus, RN, BSN · Feb 21, 2010

Heh, I had a pt who wasn't interested in getting up at all. I just kept coming in and sitting her up, and eventually coaxed her into walking...usually by acknowledging then ignoring her protestations.

MPKH, BSN, RN · Feb 21, 2010

Sometimes you have to be firm with your patients. What I do is give them a choice in when they would like a certain procedure done, not if they would like a certain procedure done. Instead of asking them if they would like to be repositioned, I will let them choose--"Would you like me to help you reposition now, or in 15 minutes?". This sets them up so they know what to expect. Also, I like to tell my patients my plan for the day--it prepares them for what's to come, and they can put in their input (which is very useful). You don't have to be bossy--just firm, consistent, and approachable.

As for making mistakes, that's okay. Learn from your mistakes. You shouldn't be worried about making mistakes...you should be worried if you're making NO mistakes. Nobody does everything perfectly, and as a student, you have the liberty of making mistakes and learning from them...provided that they do not cause the patient harm. Confidence comes with experience, and the more you learn from your mistakes, the more experiences you'll have, and the more confidence you'll build. One thing that really helps me is to imagine myself as a "real" nurse--if the nurses can do it, so can I.