Frustrations with Clinical

BeenThereDoneThat74, MSN, RN · Jun 2, 2009

I'm sorry you are having such a difficult time in clinical... yet again. May I ask what the problem was the first time you took the course?

As far as who is giving your instructor the feedback, I would venture to guess that the NM is not randomly giving feedback, rather getting this feedback from the staff nurses. It is possible that she is interpreting the info that the staff nurses give her, and giving a comprehensive summary to the instructor, rather than having each staff nurse give the feedback to the instructor themselves.

It does not hurt to ask the instructor about the specific incident, nor does it hurt to be honest (yet extremely diplomatic) by saying that you did not do what was stated. There is a possibility that it was a case of mistaken identity.

If not, I sugest you being humble, and taking the approach that you want to do whatever you can to learn from your mistakes and to never do it again. Being defensive (even if you think.... or KNOW you did nothing wrong) will not go over very well. :twocents:

swirlything · Jun 2, 2009

Sometimes, getting through school is about kissing-up and doing what you're told rather than what would actually facillitate learning. My advice, at least till you're through this semester: kiss-up and blend in.

Daytonite, BSN, RN · Jun 2, 2009

you said. . ."at the moment, i'm in danger of not receiving a satisfactory grade (i'm getting the impression that the num doesn't like me despite only speaking to me twice!) and i feel that if my facilitator spoke to the rns on the floor that we've been working with instead of the num, who sits in her office, the reports might be a bit more accurate (and a bit more pleasing) and therefore give me a better chance of hitting a satisfactory grade. . .the num has so far reported a number of untrue things about my performance to my facilitator, including that i attempted to mobilise an obese mrsa patient with chronic cough and confusion without speaking to the rn and before handover. this is entirely untrue and inaccurate and i think it's unfair that the num only bases her observations on what she sees from the corridor every now and then."

questions: if you are busy and engaged in the tasks you are supposed to be doing, how is it that you know so much about what this num does (sits in her office) and how she does it (what she sees from the corridor every now and then) that you can make an accurate evaluation of her work? since the num has experience and a license, why should we believe your self-evaluation of your performance over hers?

the nums been doing this job a lot longer and has a lot more experience at managing people and collecting information about their performance. observing something you did with her own eyes is direct evidence supporting her evaluation--even if she saw it from the corridor when she looked out from her office. it counts. i think you are just angry that she discovered what you did and you don't know how she found it out.

one of the things that has always irked me the most has been workers who misinterpreted other people's jobs. when they say, "all i ever see is you sitting and talking on the phone!" is misinterpretation. what they saw was a few moments out of an 8-hour shift when a nurse was on the phone calling a physician informing him of a change in a patient's condition or asking for orders for something a patient needed. it is the other person who adds their own interpretation based upon their experiences that it is something more than it appears to be. sitting in her office for how many moments it was observed doesn't mean it was where she was for the entire work shift. nor is it a bad thing. i was a manager. some managerial tasks must be done sitting down just as some nursing tasks can be done seated. the first time assistive help accuses you of sitting on your derriere when they needed help with a patient which they didn't ask for and you can only assume they meant for you to psychically divine you will understand exactly what i am talking about!

celclt · Jun 2, 2009

I hear your frustration. Take what daytonite is saying and know she and many experienced nurses on here want to help. THE biggest "aha!" moment has been realizing that you need to what you are told with no backtalk and showing up on time,everytime. You can be the biggest brainac in the free world but if you cannot do those 2 things in nursing school (or as a nurse) you are screwed. To put it bluntly:imbar ---I thought my smarts could get me thru nursing school easy peasy--- no it takes strong work ethic and will.I have been in your shoes- raised cane and been angry but at teh end of the day, you are going to have to let it ride and just play the game. Do what you are told, show up -from one student to another! {hugs}

iamrysmom · Jun 2, 2009

It must feel so confining to not jump in and do the basics, and it sounds like you are bored out of your mind. I have found that instructors (or their egos rather) want to feel needed. They want to feel like they are teaching us something and if we put ourselves in thier shoes...they have to cater to all levels of functioning. Unfortunately in some cases we have to appease the instructors to get where we want to go. It certainly takes away from the learning environment, but there are some things as students that we do not have any control over until we get what we want...our degrees. Then we can go back and give feedback without shooting ourselves in the foot. In the meantime, give them what they want.

As far as your situation, I would take the humble approach and ask for direct feedback on how you can improve. It shows interest, it shows that you are not a threat to the instructors knowledge, and the last interaction with you is what will stand out in her mind when writing evaluations.

cursedandblessed · Jun 2, 2009

attitude is everything in nursing school, as is following directions. since you have mastered a good many skills already you will be ahead of the game very soon. actually you already are.

i get from your post that you seem to feel held back because you already know this and don't feel like observation is productive. right now might be a lesson in patience. eventually you will be responsible for so much, you may not know what end is up.

i'm in a summer rotation with a mixture of students, some of us have less than a year to go, some have only completed one semester. there are some things that i need to go get an instructor or a nurse for that i have done independently previously because of this. am i offended, no. do i feel like it's holding me back? no.

i'm at the facility i want to work at eventually, this is my time to shine to show i can follow rules, be a team player, and that nothing is beneath me to do. i have already received a good report because i took things that i am allowed to do for my nurse and cna and did them.

rachelgeorgina · Jun 3, 2009

If you are busy and engaged in the tasks you are supposed to be doing, how is it that you know so much about what this NUM does (sits in her office) and how she does it (what she sees from the corridor every now and then) that you can make an accurate evaluation of her work? Since the NUM has experience and a license, why should we believe your self-evaluation of your performance over hers?

Several answers to this question:

1. The NUM's door is always open and her office has a window. It's right in the middle of the corridor on the way to the linen closest, dirty utility, clean utility, general store, the bronch suite, sleep study suite and half the patient rooms! You can imagine we pass by the open door about one hundred million times a day while engaged in tasks!

2. Once the morning rounds of showers/sponges, obs and breakfast have been done, us students have little to do. Plenty of time to observe what goes on around the ward.

I think you are just angry that she discovered what you did and you don't know how she found it out.

I'm certainly not angry. Frustrated, rather. I've done all the sponges/showers and obs for my RN's patients (all I can do on this clinical) and gotten it all correct (including asking for assistance when unsure.) So no, I haven't done anything wrong. If I had, I'd hope that I'd have been pulled up for it right on the spot so I could fix it. Rather than have it reported to me through the grapevine.

sounds like you are bored out of your mind!

By 10am, that's excatly right! Before 10 there's one or two patients that need feeding, plenty of patients that need showers and sponges and they all need their obs, of course! After that it's things beyond my scope of practice and there is literally nothing to do but make sure everyone is still alive and ask the RNs every so often (without being annoying) if anything needs doing.

Right now might be a lesson in patience.

I'm definitely practicing this!!! It's probably a skill I need to master!

Thank you all for your advice. I've got specific ways to improve from my facilitator (which I was already doing, anyway) and the staff on the ward, including the ward clerk have all kicked in to remind me to lower my voice (I'm quite loud, without realising!)

2BSure · Jun 3, 2009

You can imagine that I've got the basic skills pretty together...
I guess you can imagine that it's frustrating when you're enthusiastic and want to learn and are restricted to basic care that you're already relatively skilled in.

I do not imagine that you have the basic skills together at all. Sorry dear. But there is a reason you are repeating this course. Yet it sounds a bit like you are too skilled for it (in your opinion). Even if you had beautiful nursing skills your softer skills sound a bit lacking. Also, your attitude towards the NUM needs adjusting. You stated you had two interactions with her...why? I suspect she gets your feelings about her and thinks you are a bit jumped up. It is absolutely NONE of your business what the NUM is doing or when she does it. It is, however, entirely her business what you are up to. Observing what goes on in the ward is one thing but keeping tabs on an NUM is unreal.

It is generally the case that complaints rather than compliments reach the ears of those in charge -- it comes with the territory. I have had a patient lie about me -- it comes with the territory.

CBsMommy · Jun 3, 2009

I was never bored in clinical. Even if I was shadowing someone, I would just jump right in there and offered to do everything! Even if it was mopping the floors, taking trash out of every patient's room, ice water, painting my resident's fingernails, brushing hair, changing beds, I was always keeping busy. I remember one time at clinicals where I was truly bored and had a CNA that didn't want to show me anything (she hated her job and was truly miserable). I went down to lunch and another student asked about MRSA. I immediately volunteered to our instructor that I would do a report on MRSA and when we met up at post clinical conference that I would give a presentation. Not only was the teacher thrilled that I was willing to step up to the plate to keep myself busy but she was thrilled that I would help the other students learn. And I didn't have to sit around (I really HATE that). See, always something to do!

AOx1 · Jun 3, 2009

I think you need to be more proactive. Keep your own documentation of what you have done each day. Also, just because the focus of your clinical is basic tasks doesn't mean that you can't find ways to remain engaged. Connect what you are seeing in your general observation and the vitals to the pt's diagnosis. Ask questions of the nurses. Interact with the family and the pt. See if you can engage in simple teaching (ex- Mrs. Miller, I'm checking your vitals prior to the nurse giving you your digoxin.)

You can perform assessments of skin as you bathe a pt (you could read ahead if you haven't already covered this). If you have already done all this for the day and all your patients are well cared-for, you could ask your peers if they need assistance. Communicate all this to the instructor. Just because you aren't seeing him/her constantly doesn't mean he/she isn't involved. They may be in a room with another student.

I would let them know what I have already done, my observations, and that I have offered assistance to my peers. If there is still nothing to do (and this would be quite rare, I assure you) you could ask to perform a basic physical exam component (ex- maybe listen to lung sounds) or practice documentation, even if it's hypothetical. For example "Mr/Mrs Jones, I performed vitals on my pt Mrs. Smith and they are within normal limits. Would you be willing to look over my documentation?" Or practice how you would document abnormal vital signs. Curiosity and a willingness to always learn are what will impress an instructor. On the very, very rare times when the unit is not busy and I am at work, I spend my time doing my favorite thing...talking to the patients! It's really knowing someone's typical affect and behavior that will alert you to changes in status.

rachelgeorgina · Jun 4, 2009

I have to say that I have been making as much effort as possible without annoying the floor staff or getting in the way. I've offered to do every task within my scope of practice and ability (and hence done about ten million showers and sponges! No complaints there!)

Today I took my own stethoscope (the only one we can find on the ward - that isn't around a doctors neck!) to listen to different chest/breath sounds (I'm on a respiratory ward) when there's nothing left to do. I also found my partner on the unit and we practiced manual blood pressures and other observations on some of the less sick/more with it patients. I've done my own pressure assessments and falls assessments on spare data sheets on patients during the day and read every single pt's notes, too! So, proactive +++

On the best side, though? I got to see a bronchocopy today. It was AWESOME!