Final year and semester. nursing student, and still struggling at clinicals

[xafina]

Hello all. This is my first time posting here (but have visited the forums off and on), and I'm sorry if this post is going to sound dramatic or a dumb problem. But I am in my final semester of my final year of nursing school, only a couple of months before I graduate (hopefully...but more and more I feel like that's not likely), and I find that I am still struggling at clinicals.

For background, I'm currently completing preceptorship at a cardiology floor. My relationship with my preceptor is...tenuous, if I had to pick a word. To be frank I'm terrified of her. I always feel like a complete and utter idiot whenever I speak to her. She has this tone to her voice and the way she looks at me that just rattles at my bones (or maybe because I'm so damn mentally weak). It's just gotten to a point where I'm so scared of asking her questions because I already know she thinks I'm an idiot and I don't want to worsen her perception of me.

And personally, I don't even disagree with her thinking that. For example, no matter how hard I study ECG strips, I still find it difficult to read and analyze when I look at my patients' tele strips. I can recognize NSR and if it's AFib at the minimum, but it's so difficult for me when there's a lot of artefacts. I don't know what's the P or the T or even if there is one, I don't know if there's a PVC or PAC or any heart blocks. I have asked for her help when it's particularly hard to read for me and her responses range from "I thought you said you were gonna read the strips" to "I'm not teaching you anything unless you already know" in clipped tones. It just makes me feel so bad because I just can't seem to get a handle of it.

Additionally I always feel so rushed because I feel like she wants me to finish everything at her pace. I am taking full patient load with her (4-5), and I understand that she wants me to learn time management, but I find that sometimes days vary. Sometimes I won't have my morning meds done until 9:15 (when it's busy), or I'll get behind on charting, and she'll demand, "Why isn't this done yet?" and clap her hands at me loudly and say "Time management, time management!" She did this once in front of another staff member and I felt so embarrassed I couldn't even look at that staff member in the face the rest of the day.

But the worst is that I just feel like I lack common sense and the critical thinking skills needed to be a nurse. At this point I'm still so unsure of the course of action to take when seeing abnormal findings. I'll have an idea of it based on the knowledge I have from classes, but then I'll go to my preceptor and find that it's not what she would do and then I feel like an idiot all over again. At this point I should be able to think of nursing interventions without having to go to my preceptor about it but with that I also find that I'm struggling so hard.

This got long....tl;dr, I am horrible at clinicals: I always feel rattled and unorganized and like all the things I've learned in class isn't processing in my mind to churn out actual nursing actions in the real world. I suffer from anxiety (generalized and social) and depression and my clinical experience is really triggering me right now. I find myself crying every day and on my off days from clinical dreading having to go back in fear of killing or harming a patient with my stupidity and anxiety. I'm in financial debt for my schooling and am in no financial place to fail and redo this year, much less change programs entirely. In the miracle that I even pass, what place will hire me when I'm so terrible at this and am sure will have terrible references (if I even have any). I just don't know what to do. I really feel like a failure and a waste of space and am just better off dying altogether.

Sorry for the venting...

[Triddin]

I wouldn't say you are horrible at clinicals. It sounds like you and your preceptor communicate on different channels/ don't mesh well. That doesn't make you a terrible nurse. And it's anxiety provoking when you don't get along with your preceptor. And to hard to do things at your preceptors speed because you are still learning.

Have you thought about hiring a tutor to help with reading rhythm strips? Having a strong foundational knowledge about cardiac electrophysiology will help you understand what p waves are, for example, why they occur and why you should be concerned if they aren't there. A good tutor can help with that.

Can you speak with your program head about switching preceptors? Is that possible? Explain how you two aren't meshing? Or can you speak with your instructor and try and get you and your preceptor back on the same page?

How much time is left in your preceptorship? Could you drop down by one patient so you can focus more on your time management if you feel that is an area you are struggling in?

I know it feels overwhelming when you don't get along with your preceptor and you feel like an idiot. Critical judgement comes with time and sometimes there is no immediate right answer. Part of critical judgement is knowing when to act, or to wait. But again, that comes with experience, it will come for you too. Make a list I'd what you do well, where you feel you need improve, where your instructor/ preceptor think you need to improve and create a learning plan from there

[Nature_walker, ASN, BSN, RN]

I just don't know what to do. I really feel like a failure and a waste of space and am just better off dying altogether.

Please get help for your anxiety and depression! If you feel like harming yourself or having these intense feeling of being worthless please reach out to someone. The national suicide prevention lifeline is free and and 24/7. 1-800-273-8255 Talk to a councillor or professor at school if you would rather talk face to face.

Nursing school is hard. It is intense and it sounds like you and your preceptor are not meshing well at all. Combined with your anxiety and depression already it sounds like you need some help to get through this. Have you sat down with your preceptor to talk at all about how it has been going? How much longer do you have with her?

Please seek help for these feelings. ((((Hugs))))

[NICU Guy, BSN, RN]

And personally, I don't even disagree with her thinking that. For example, no matter how hard I study ECG strips, I still find it difficult to read and analyze when I look at my patients' tele strips. I can recognize NSR and if it's AFib at the minimum, but it's so difficult for me when there's a lot of artefacts. I don't know what's the P or the T or even if there is one, I don't know if there's a PVC or PAC or any heart blocks. I have asked for her help when it's particularly hard to read for me and her responses range from "I thought you said you were gonna read the strips" to "I'm not teaching you anything unless you already know" in clipped tones. It just makes me feel so bad because I just can't seem to get a handle of it.

Additionally I always feel so rushed because I feel like she wants me to finish everything at her pace. I am taking full patient load with her (4-5), and I understand that she wants me to learn time management, but I find that sometimes days vary. Sometimes I won't have my morning meds done until 9:15 (when it's busy), or I'll get behind on charting, and she'll demand, "Why isn't this done yet?" and clap her hands at me loudly and say "Time management, time management!" She did this once in front of another staff member and I felt so embarrassed I couldn't even look at that staff member in the face the rest of the day.

Your preceptorship should be a learning experience. At the beginning, you should be observing. As it progresses, you should be taking more of the load, but it is still a learning experience. She has the expectation that you should be able to handle a full load in a cardiac unit from day one, which is wrong. See if you can switch preceptors, this person should not be taking students. It sounds like she didn't want a student and is taking it out on you.