Having trouble in clinical

TofuSandwich, ASN, RN · Feb 16, 2018

It sounds like you might be more of a hands on/application learner. Getting more practice applying the information you learn in class will probably help you retain it a bit more. Clinical can be great for that but if you're feeling rushed and stressed while you're there you might not have the time to really think through everything that is going on with your patient, and how to best care for them. You might want to try looking up case studies for conditions as you learn them in class. Working through the case study outside the stress of your clinical site means you can take your time and really understand how your patient will present, what issues they will be having, and what interventions would be appropriate for you to implement.

As far as the task based skills, that's a tough one, and they're really doing you a disservice by not having open lab hours. Unless you can convince them to let you set up a time to practice, watching the videos might be your best option.

BassCatchingNurse · Feb 17, 2018

Don't be so hard on yourself. Speed and knowledge come with time. That is why experience pays!! You sound like you are where you should be as a student to me. Also, you will run into skills even after you have been nursing for a while that you haven't done in a while and will need help! My only suggestion would be to do as many things in clinical as you can!! Do not be that person that sits there and lets everyone else volunteer to place that IV or insert that NG tube. Jump on it. Best of luck to you!

verene, MSN · Feb 17, 2018

Stop. Breathe. Clinicals are hard for most students - particularly first semester. You're new and there is a lot to learn and take in!

For learning about diseases: It sounds like you are decent at straight memorization (hence you know it well for exams, but your forget about it). Before nursing school most of your academic endeavors likely only cared about memorization. However memorization isn't the highest level of learning it's the lowest! (According to Bloom's taxonomy and my instructors were all over this in nursing school) To really succeed you'll need to bring your understanding to a higher level - one of the best ways to approach this is to think about how you might teach a topic to someone else. Imagine explaining the illness to a patient, or a coworker and give the explanation out loud. It seems silly but it works! To vary it imagine explaining to a patient, patients 5-year old, and patients provider about what is going on - what terms would you use to describe things, what other topics could you link an idea to to make it easier to understand? The more you make links between concepts the more you will really understand a topic rather than just memorize it. Plus you've now reheorificed patient and family education which makes it easier when the patient in clinical does ask you a question.

If you are taking patho at the same time as pharm link conditions to their medications, and link the medications to physiological processes! This will help you understand the treatments and be able to reason back and forth from whichever piece of information you have.

Organization: Are you prepping on patients the day before or the morning of? In clinicals were I prepped the day before I was able to spend lots of time reading all sorts of things and making notes. Day of, I had to learn to prioritize - what information is most crucial to being able to provide care right off the bat. I'd then grab that information and quickly look up anything I wasn't familiar with (medications/conditions). The start planning your day - ask unit nurses to show you their "brains" and find one that works for you. The more you can get organized at start of shift the easier it is to see what is coming and plan for it.

This also allows you to coordinate better with your instructor - If you can anticipate that your patient might need an NG tube placed you can look things up then and give the instructor a heads up "Hey patient X is likely to have an NG tube placed. I looked through the notes/watched the video on placing one but it's been 3 months since I placed one can I run through the procedure with you verbally before we go in the room" sounds much more prepared.

As another poster said, it sounds like you may be a hands-on learner. In which case talk to your instructor, and let them know how you best learn and see what can be done in the clinical setting to support your learning style. Your instructor may learn a completely different way and not realize that is why you are struggling rather than just being lazy and not knowing the material - showing an instructor you care, but need a little support around trouble shooting your learning can go a long way towards building better rapport with the instructor and getting some more constructive feedback to help you improve.

Finally, I wouldn't worry about being slow at this stage. Speed and confidence both come with time and experience. It's better to go slow and do a skill well than rush and make a mistake. Also not everyone is great with hands-on technical skills - there are areas of nursing that are less mechanical/technical skills based and it may turn out that you end up being an great nursing in one of those areas. This is why reflection and continued self-evaluation is a part of learning. What areas of nursing care do you feel confident in? Where do you feel weak? Let those inform both your learning and where you may one day chose to practice. Nursing is a broad field and just because you feel like you struggle in one area doesn't mean you can't be totally awesome in another.

QuietIsntAWord · Feb 17, 2018

Your post reminded me of the only chance I got to start an IV while in clinical. I have an intention tremor (when I try to focus my hands on something small they start to shake) and on top of that I was nervous. I wasn't able to start the IV. My first job straight out of nursing school was private duty nursing, no huge skills to be used there just great assessment skills. Then I moved onto LTC and was thrown into IV's, TB tests, IM shots etc. which I hadn't done in years since lab practice in nursing school. I simply asked my charge nurse if she could show me how she does it because I didn't feel comfortable doing it alone. Now, 3 years later, I'm sticking everyone like it's no issue.

I say all that because I honestly think nursing school prepares you with the basic stuff and how not to kill someone, but I honestly think the learning begins when you are just in there doing it!

Please, never ever ever forget that you can ALWAYS ask for help.

RatherBHiking, BSN, RN · Feb 23, 2018

All good advice so far! I don't think 30 min is unreasonable when you're still new. The fact you're anxious giving meds is because you don't want to mess up and you probably feel rushed. That's how mistakes are made. Take your time. When you're feeling pressured just say let me take my time and think so I don't mess up because I want to get this down and then the more you practice the better you will get. Tell your preceptor you learn best by doing and you want to practice hand- on more.

However, most of your skills and time management will not come until you're doing your first job. I think it's crazy you go from taking care of one or two patients and graduate and thrown into 8-10 patients. It's hard. Also don't connect classroom to clinical, do it backwards as much as you can. In class you can read about how liver failure effects different systems but if you have nothing to connect it with you're going to forget. It's much easier to remember if you have a patient with liver failure and can see first hand how they are feeling and what symptoms they are having, which labs are out of whack and why and what the dr is ordering to correct the problems, what their prognosis is and then go home and read up on everything to do with that to really make it stick. Do that with whatever diagnosis your patients have and you'll soon start remembering much better.