Had my second clinical ever today and already losing my mind a little bit

[dr.dorian]

This is long. But I have not vented all semester and I need to vent in a bad way.

Theory has been great, no problem there. My major source of stress from the beginning has been sim lab, competencies, or clinicals. We're done with sim, done with competencies, now we just have clinicals, and I have been eaten up with anxiety every week. Doesn't help that anxiety is a usual struggle for me, even when I'm not under this much stress.

I realize this was only my second clinical ever, but I just feel awful for some reason. At my school we have until noon the day after clinical to submit an 'EHR' type thing the faculty created. I sat down at my computer this afternoon to start working on it and doom washed over me. I realized I had absolutely no information on my pts I&O, gastro, urinary, or nutrition. I hope this is not as bad as it sounds.

Some students were paired and some were not today to 'save time'. I was paired. My partner had to pass meds and then our pt had to go to HBO therapy and we did not see them again before we left. So, I did exactly as my instructor told me. My partner did a focused assessment, I changed pts gown (no time for a bath) while partner pulled meds w instructor, partner passed meds, and we immediately whisked pt off to HBO.

So, cue me feeling useless for the next two hours. I offered to help but no one needed it. The only thing I did was help a random pt eat lunch. When I was documenting, my partner was making small talk constantly even though I constantly steered the talk back to our documentation... in the end it took me FOREVER to write my nurses note. Partner and I also tried to look at pts chart to get the info we were missing, but as soon as we got labs we needed, the doctor took the chart and we never got it back (That's right, no EHRs in this facility, only paper documentation. I actually like it even though I have no experience with an EHR. The RNs are not chained to computers hours a day and it seems nice. But what do I know? Literally nothing).

The thing is, I am fairly confident that my instructor will understand what happened. She has been very reasonable so far. I just feel like this makes me look bad and I feel very uncomfortable when anything goes wrong in clinical due to the pass/fail nature of the course.

I really could have looked at the chart sooner, but didn't. However, I did not even realize my partner did not ask pt about any of those things until much later while we were writing our (rather, my partner's) assessment findings.

Also, I'm kind of irritated that both of our clinicals so far have been cut short. We have only been there about 3 hours each time and while that's kind of great, it's also not great because we simply do not have time to do everything we need to do. If we had the full 6 hours we're supposed to have all of the issues I've had both weeks would have been a nonissue.

First semester is over in 3 weeks and I have never been so excited to have the entire summer to just work and relax.

[Leonardsmom,LPN]

Hello,

Don't stress over this situation, you are new at doing this and it is something that your clinical instructor realizes and expects you to improve with during the semester. Part of being a nurse is being organized while at the same time being flexible. For the patient that you had and the situation that you described a few things that I would suggest in that situation is that while you where changing their gown, would be to do an assessment yourself. You might not have time to do a full assessment, but while the other student was pulling meds there might have been time to listen to heart sounds, lung sounds and bowel sounds. Look at the skin and take note of any issues with color, check temperature of the lower extremities, check for edema and capillary refill. For the gastointestinal portion of your assessment looking at the abdomen while the original gown was off, listening to bowel sounds and palpating can be done in less than a minute. For nutrition had your patient had breakfast or lunch? If so how much of their meal did they eat? What was their weight, what type of diet did they have ordered? Depending on what type of lab information was available and what you had been able to get from their chart, were there results for total protein, albumin and prealbumin? Those lab values will gie you a snap shot of the patients nutritional status. For urinary was your patient continent of urine, if so did they need to urinate while in your care? If they did urinate what was the characteristics of the urine, if incontinent how many incontinent episodes did they have? For I&Os were they receiving IV fluids, any fluids taken in with a meal, how about their bedside water glass for intake. For output did they urinate if so was it measured or unmeasured, did they have any drains.

It takes time to get comfortable and quick at doing an assessment. If you are able to bring a paper into the room with you either bring in a copy of the EHR document that you have to do for your instructor, or you can create an assessment sheet that has on it the information that you need to gather, this might help especially at the beginning and help reduce some of the stress. Another thing is to develop a plan of the things that you need to do for the day, with the understanding that you will need to be flexible. For example at the beginning of your shift you get report from the nurse about the patient (make sure to have something to write down the information), after that depending on when you need to have vitals and assessment done, if the patients chart is available take a look at that to get some basic information down. After that do your vitals and assessment on the patient at this time you can help them with any of their ADLs they may need help with, changing their gown, bathing, brushing their teeth. This is also a good time to observe them to see what they are able to do, and you can get a full skin assessment, observe their balance and gait if ambulatory. After that is done chart your assessment findings in their chart and look in the chart for any additional information that you need for your documentation for your instructor. Once you have the necessary information that you need, your assessments are done and documentation is done, that is when I would suggest to offer to help. Doesn't mean that if a classmate or your instructor asks you to help with something that you refuse before that, do help but before you start looking for opportunities to help others make sure that your responsibilities are taken care of first.

It does get easier, hang in there.