First clinical nightmare

[Flylik3abr1]

I'm curious to know if other nursing students have had similar clinical experiences to my first one.

I am in my 5th week of my ADN program and our program focuses extensively on Nclex style questions and the theory aspect is very subpar. As far as our skills go we have only been validated on med admin, vitals, and basic wound care.

We arrive at the clinical site and our nurse instructor shows up and verifies our identities and brings us up to the IMC unit. We are each assigned a patient and told to wait outside of our patients door. Prior to this we have not received any other information from the school outside of just the clinical site and date/time. After waiting 10 minutes the instructor swings around the corner and asks what I am doing. I told her I was following instruction and waiting. It turns out the Nurse I was assigned to got report on the other end of the hallway and just went straight to the nurses station. So I missed report. Nice.

I then go ahead and introduce myself to my patient and he was an elderly man admitted for a pressure sore in his sacral area. He was really pleasant and remained asleep the majority of the time I was there. Since we were on the IMC all of the patients were hooked up to monitors so I didn't have to do much to get their vitals. I assisted with his medications and went to check on the other students. Our instructor then grabs me and tells me to give another patient a bath. No problem. Just one thing. I have never been taught how to give a bed bath. I mean it surely wasnt hard but this is my first clinical experience I dont know what I can and cant do. I tell my instructor and she gives me a really confused look and says "They haven't taught you basic patient care?" I understood her frustrations but she clearly wasn't communicating with the school.

She borderline throws me into a room with a patient on contact precautions (nice) and I awkwardly act like I know what I am doing until a tech visits and sees me struggling. She helps me out and I go on about my day. Fast forward 5 minutes and she sends me on a break. So I break with the other students and we talk about our day. The other students were working side by side with the nurses learning everything they are supposed to. My nurse was nowhere to be found at all in our hallway and I was mainly working with the instructor on random assignments all over the floor. After breaking I go back to my patients room and the wound care nurse is finished and is on her way out. My instructor walks by and asks if I got to see anything. I didn't and she basically said I should have come back sooner. Okay.

Two of the other students in my class were assigned to a patient who got rushed to surgery. They were allowed to assist and watch for a couple hours but then came back. Our instructor asked them if she got a chance to perform her head to toe assessment. In my head Im going (wha wha wha whaaaaa?). We havent been taught how to do that. So they of course say no. Our instructor became so furious she grabbed them put them in a conference room and started yelling. These poor girls came out crying and I was just frozen because I knew I was in the exact same boat. So I go back to my patients room to try to basically get a general assessment but when I show up his wife had woken him up to feed and she told me he needed some time so I left. At this point our instructor gives us some papers that have body systems on there. Greaaaaat. This is our assessment form. She tells us to try to get as much patient info as possible. But there is biographical information on there like birthday and religion etc. I ask her if I can see the patients chart. She laughed and said "This is to test YOUR assessment skills, not your nurses." So I go back into my patients room and he is fast asleep and I notice his respirations dropped from 20 all the way down to 5 when I was last in there. I go see the nurse and she rushes in to see what's going on. I am then grabbed by my instructor and assigned to watch a procedure and fast forward 30 more minutes of random assignments I am told to give report on my patient and provide my assessment notes. This lady cut me off on every body system and told me I clearly didn't know what an assessment was. I told her I very much did not because we havent been taught that. She got snippy and said "Well what dooooo yall know?!". We all just kind of looked at each other and she said "Clearly not enough. I don't know how you're expected to pass this clinical if your docucare is submitted the same as your assessment notes here." She then tells us to leave and we all just kind of remain quiet until we get to our cars. It wasn't the smells, or the blood, or the wounds, or any of that which got me. But the embarrassment of being put there without any experience or information and being completely disorganized and rushed literally brought me to tears when I got in my car. So I'm not having any sort of existential crisis about this. I know nursing is hard. But I wanted to know if everyones program throws them to the wolves like that or if it was just us?

[DahliaDaisy, RN]

We had in school "labs" they were called, for the first 8 weeks. It was then that we learned a BASIC head to toe assessment that we used for our first 8 week hospital clinicals. We also learned to pass meds in stages; PO, then Injections, then IV bags and secondary or piggyback IV's. You could only do in clinical what you had passed in procedures testing. During our second semester we had to pass out of a 100 point head to toe assessment by doing it on a friend in front of a professor during procedure testing, but you never will have the time, nor will it be necessary to do every single thing on that list with every patient. Part of critical thinking is learning how to focus your assessment to that specific patient.

For my last clinical, I had an adjunct instructor who is a full time instructor at another hospital based program and it was NOT pleasant. She wasn't familiar with this hospital (the biggest and best) or it's pyxis system, and though our NCLEX pass rates are the same, 97%, their program costs a lot more and has more resources so she was often rude and insulting to us. Glad THAT'S over and now on to 56 hrs working with a nurse for Role Transition and hopefully a Dec graduation!

[NICUismylife, ADN, BSN, RN]

you never will have the time, nor will it be necessary to do every single thing on that list with every patient. Part of critical thinking is learning how to focus your assessment to that specific patient.

I truly hope you change your mindset on this comment. You should do a full complete head-to-toe assessment on every patient at least once per shift. In the ICU setting, we do full head-to-toe assessments on every patient multiple times each shift. My patients can decompensate rapidly and it would easily be missed if I was focusing on specific body systems rather than the whole picture.

Just because a pt is admitted for a specific condition doesn't mean that the other body systems can be ignored. There may be a completely separate undiagnosed condition that you will catch by fully assessing each and every patient. Your healthy middle-aged kidney stone pt may just happen to have an unrelated DVT caused by her birth control pills. Your STEMI pt might also have an abdominal mass.

Also, keep in mind that just because the patient was fine yesterday, doesn't mean that he will continue to be fine today or tomorrow. That easy-peasy post-surgical patient could be fine and dandy, and then end up with a PE, or develop an ileus, or end up in respiratory or renal failure due to his medication regimen. If you're not watching every body system, it would be easy to miss the early signs of a complication.

Now, once that full head-to-toe is complete, and you have a full picture, then focuses assessments are appropriate, but please please please examine every single system on every patient every shift.

[DahliaDaisy, RN]

I'm sorry I wasn't clearer. The 100 pt head to toe assessment we had to pass out of in procedure testing that I was referring to was literately assessing 100 aspects, including testing all 12 cranial nerves. Of course one realizes that any and every patient can develop unexpected complications, but if you are telling me that every single nurse goes through a 100 pt check list including auditory tests on an appendix and making all five of your patients sniff coffee or menthol to make sure their olfactory nerve is functioning 100%, well you are either incredibly efficient or Flash Gordon lol.

[NICUismylife, ADN, BSN, RN]

I'm sorry I wasn't clearer. The 100 pt head to toe assessment we had to pass out of in procedure testing that I was referring to was literately assessing 100 aspects, including testing all 12 cranial nerves. Of course one realizes that any and every patient can develop unexpected complications, but if you are telling me that every single nurse goes through a 100 pt check list including auditory tests on an appendix and making all five of your patients sniff coffee or menthol to make sure their olfactory nerve is functioning 100%, well you are either incredibly efficient or Flash Gordon lol.

Oh my. That is a bit extreme. Just wanted to emphasize the importance of a thorough assessment on all patients. Thank you for clarifying your initial post.

[NICUismylife, ADN, BSN, RN]

OP: It sounds like there is a major disconnect between your skills labs (instructors) and your clinical (instructor). I agree with the others who suggest bringing it to the attention of your professors so they can confer with your clinical instructor. I think throwing you into clinical without even basic patient care training is irresponsible on their part, as well as being a disservice to you and to the patients. My program was well known for being very clinically rigorous, but even we spent the first 4 weeks simply learning how to be a CNA, just very basic patient care, vitals, bed baths, perineal care, linen changes, etc. Then when we went to our first clinicals, we spent 3-4 weeks (hard to remember exactly anymore) just performing CNA duties.

It wasn't until the 2nd half of the semester that the full head-to-toe assessment was taught and implemented in clinical, and we weren't allowed to pass meds until the 2nd half of the first semester either. I am beyond shocked that they allowed you anywhere near a med without knowing your 6 rights off by heart, and looking up every med and reciting indications, side effects, contraindications, etc.

You should not feel poorly about your performance. You did the best you could with the little knowledge you were provided. I'm so sorry that it went so badly. Keep us posted. I'm interested to hear if it improves.