How to be more confident in clinicals?

motivated2nurse · Feb 14, 2009

Relax, do your best. Look like you know what you are doing, even if you dont. Ask questions and dont look nervous even if you are. I use a lot of humor. I laugh at myself and I admit my mistakes.

meluhn · Feb 15, 2009

You should take a deep breath and take a few minutes to look at the chart and learn about your patient. Try to figure things out. (critical thinking) Don't worry so much about what people think. Sometimes you can have so much anxiety about not wanting to look stupid that it distracts you from what you are supposed to be concentrating on and then you really do look stupid. Try to focus on what is going on with your patient.

NSALVADORE · Feb 15, 2009

I agree with the previous posters!! I just remind myself I'm a student, I'm doing my best and I *do* know what I'm doing and try so hard not to get flustered. If I'm unsure about something I ask, If I am asked something that I don't know I say with a smile, let me find out for you!! If I feel I'm getting overwhelmed or frazzled I take a second to have a sip of water and take a few deep breaths then I'm able to jump back out there and get it all figured out =)

Esther2007 · Feb 15, 2009

You can be confident in clinical by working as a student tech or a CNA.

jpeters84 · Feb 15, 2009

I have the same problem. The thing of it is, is that our patients are scared and they need to feel safe and reassured and if their caretaker is frazzeled and nervous it's going to make them more anxious. I have gotten a couple pieces of advice along the way that have really helped me so I thought that I would pass them along to you:

1. Be extremly well-prepared. Be so prepared for clinical that you know your patient's inside and out, their past medical history, what drugs they're on, what procedures you might have to perform on them, so on and so forth that by the time you get into their room you know their situation like the back of your hand. Also come up with a game plan. At 0700 I'm going to do this, at 0800 I'm going to do this, and write out every hour what you want to accomplish with this patient, put it on an index card and take it to clinical with you so that you have a gameplan.

2. Act as if. And when I say act as if I don't mean that if a doctor asks you to iv push meds and you haven't done that yet and don't know how to do it to go ahead and do it...I just mean that before you go into your patient's room give yourself some kind words of encouragement and walk into that room with kindness but like you own it. Walk into that patient's room like you're walking into a 50% off sale at Manolo Blahnik. Act as if you have done patient care for the past thirty years. Act as if it is no big deal. Fake it until you make it and before you know it you'll be comfortable with the ackwardness of it all.

3. Come up with an alter ego. I learned this from the following article from allnurses.com. It's a fantastic idea. Like Beyonce has an alter ego called Sasha Fierce for her stage performances, I have an alter nursing ego based on the character Miranda Bailey on ER. My alter ego is smart, confident, knows her stuff, and is not afraid to get in there and do what needs to be done. Now when I'm back at home I can be as shy and ackward as I want to be but when I get into that hospital I'm Miranda Bailey, RN and I'm amazed at how much this helps me. Cheesy I know but try it! I needed a little push too but you have to force yourself to get over being too nervous. Eventually it's time to just push past it. I hope this help!

Here's the article.

It's called "Nancy and 'Babs'" by Babs0512

You can find this article under articles at allnurses.com

On my way to work I usually got the "performance jitters" - you see, I was not the Nurse my patients saw each day, that was a role that I played; I played it well.

Each shift "Nancy Nurse",my character, was efficient, intelligent, quick thinking, compassionate, organized, quick witted and funny. She also had excellent assessment skills, and even better intuition. She always "knew" which patients required closer monitoring - sometimes it was just a "feeling", but over the years - she learned her feelings were rarely wrong. This was "Nancy Nurse" - ER nurse extraordinaire!

Inside "Nancy" was her other persona, Babs. Babs was a good nurse, but prone to anxiety, self doubts, afraid of things she might see like bones protruding, arteries pulsating blood around the room, taking off the boot of the farmer whose chainsaw "slipped" and cut through the boot, or looking under the bandaged foot of the patient whose every step dropped maggots on the floor - or worse, the elderly man who shot away half his head but whose heart still beat so we had to "work him" even though we all knew what the outcome would be. "Nancy" got an adrenalin rush from these things, Babs did not.

Babs has seen lot's of things. She and "Nancy" once spent 8 hours taking care of an 11 month old who was found not breathing while sleeping face down on a water bed. Every one told "Nancy" that dead babies look like "beautiful sleeping china dolls", Babs noted this baby was mottled, gray and looked dead - nothing like a China doll - and Babs was very sad and confused and thought a lot about this over the 8 hours she and "Nancy" spent keeping this child "alive".

"Nancy" was excited with this new challenge. She expertly administered chest compressions, medications, LOTS of epinephrine and when the babies heart was beating on it's own, it was Babs that noticed she was pale, but at least didn't look dead anymore. "Nancy" monitored everything from the ET tube to the foley. Both waited during the snowstorm for the transport team to come to pick up the baby to take her to a pediatric ICU 45 min away. By the time the transport team got there, "Nancy" and Babs had spent the last half hour cleaning up the blood coming from the ET tube, her eyes, nose, ears, every place we stuck her with a needle, her rectum, and her foley. Both suspected DIC. "Nancy" gave the transport nurse a concise and efficient report - even nodding in agreement when the transport nurse said "This is a waste of time". Babs just felt exhausted, and very sad, and embarrassed because "Nancy" agreed with the transport nurse, but Babs didn't. It wasn't a waste of time. If nothing else, it gave the family a longer time to come to grips with the inevitable.

One day "Nancy" was eagerly awaiting a code that was on the way in with a 34 y/o female. She had been seen in our ER twice that week for chest pain. Babs was DREADING the patient coming in. "Nancy" took over - because she had to, she managed things that Babs found difficult to handle.

In comes this asystolic women, CPR in progress, intubated. "Nancy" put her on the monitor, verified ET placement, listened to lung sounds. Continued ACLS protocol - all to no avail. Babs was content to observe - she noticed things like voices of the family in the hall, jokes told by all those involved in the code, both she and "Nancy" heard when the code was called. Both knew this would be a coroners case, so all IV's, and tubes were left on the body. Babs washed up around her mouth, and put a pillow behind her head and covered her up with a blanket. Babs noted she looked like the color of clay - and she looked very dead.

"Nancy" efficiently recorded the code happenings, notified the coroner and looked over all the testing done on this woman on her two other visits to the ER that week. She had had CXR's, VQ Scan, many labs, EKG's, CT scan etc... all negative. On the second visit the ER doc wanted to admit her - she declined and signed AMA paperwork - "Nancy" made a mental note that that could have been the difference right there - perhaps a lethal arrhythmia that only showed up from time to time - if she had stayed - maybe she would still be alive.

Babs noticed a man pushing a stroller go into this woman's room - the chaplain was with him. Babs went in, after all, this was still her patient (and Nancy's as well). This was the moment that Babs and "Nancy" both saw the same thing - these two nurses came together for the FIRST time.

When they walked into the room, they noticed the body of the woman, she was center stage on the gurney, still gray and lifeless. Then both noticed a man sitting with the chaplain, both talking quitely, then both heard laughter and giggling, and keys jingling. It was then that they saw this baby, a beautiful one year old cheerfully throwing her arms up and down, jingling the keys and smiling - two feet from her gray, dead mother.

This, for whatever reason, was the turning point for "Nancy" and Babs. They became one. The haunting image of this beautiful baby with her dead mother will follow Babs forever.

After 8 years in the ER, this image, more than any other, took the joy out of the ER for "Nancy" and helped Babs see that she was probably never meant for the ER in the first place. Babs left within a month after that for another position.

Now Babs relies on herself. Her horror coping mechanism "Nancy" is gone. I hope to never need "Nancy" again.

AmberDawn · Feb 15, 2009

I'll keep this "multiple personality" concept in my head for clinicals in the future.

Overall, confidence in yourself to do the best you can and consider yourself capable are key concepts to maintain in any field.

cindyloulou · Feb 16, 2009

Clinicals can be difficult, especially with instructors that expect a lot from you. I have learned that if I go to the hospital the week before clinicals and do a "scavenger hunt" and get to know the lay of the land, it has helped. Just try to as organized as possible and have a good "brain" to work with throughout the day.

missjennmb · Feb 16, 2009

jpeters84 I completely did not expect that response. It made me cry so hard.

A warning next time before taking such an unexpected turn would be great. I generally try to avoid posts like that. They make me overthink things.

OP: my suggestion is to dive in first whenever the option to do a proceedure or observe comes up. I find that the quicker I am to do something new, the more confident I feel and the less anxiety and more confidence I have. When we started our first hospital rotation I was the first one to do a foley cath. I didn't want to do it, but I felt SO much better when I did it and it worked out. Since then I have always jumped on the opportunity to do anything and everything. I think sometimes I atleast question and overanalyze to the point that I lose my nerve and thats hard to hide. Even if I don't really want to do something new, I always volunteer anyways. My teachers have no idea that my insides are quivering with every new situation, nor do other students or the patients. But I always get a rush when I get to the end of a clinical day and did something new or with less supervision than before. Good luck.

jpeters84 · Feb 17, 2009

I'm sorry I didn't really read the whole article the first time. I initially really liked the article because the beginning of the article just articulates how having a confident alter ego can be helpful. It is kind of a disturbing article. But I still find it useful to think, ok I'm nervous today but my inner super nurse is going to come through and rock the floor today. Having a confident alter ego can be helpful for people like me that get really nervous, flustered, and are shy. But sorry again, the article does take a bit of a disturbing twist...