I don't feel prepared for med/surg clinicals

[cuppa_tea]

Okay. I'm excited about our first med/surg clinical day! I am asked to give a pt their insulin with insulin pens. The pt's nurse had already set them up, primed and all, I guess. I didn't see her do it. I asked my instructor AND my team leader to watch me do this injection because I've never done it on a live person. I've done it once on one of those squishy pads. ONCE! The dose is already dialed up. They won't let me do it in the belly, so I decide the back of the arms. I gather up the skin and push the needle in and push the injection button and it stops mid-injection. I push and pushed and pushed and yes, the needle was still engaged. I couldn't deliver the rest of her units. I looked around at my instructor and pulled the pen away. She went and got me another needle and I tried again. I pushed the button and it stopped, like before, but was mostly done. The next injection of a different insulin I got most of the insulin in and the freaking button jammed on me AGAIN! There were 2 units left and my instructor just stood there, along with my team leader and just looked at me. Neither of them offered assistance. I was very upset that I was hurting my pt. and I said so to my instructor. She told me to throw them away in the sharps container, which I did. I walked out to the nurse's computer and she asked me where the pens were and I told her, "I threw them away, like you told me to". She said, "JUST THE NEEDLES!!!!" (in my fluster, I forgot that only the needles were to be disposed of). She was upset, to say the least. She was going to make me call down to the pharmacy and tell them what I did and order up 2 new pens for my pt. I was was so disheartened. It wrecked the rest of my day on the floor. I had to admit what happened at post-clinicals to my classmates. I felt like an idiot and I was ashamed. I felt like my instructor and my team leader failed me. I asked for help and received none.

Now for the second shoe drop: a few days after that clinical, I was pulled into my instructor's office and I was told that the nursing school dept. head decided I needed to write a paper about insulin types and means of administration and costs of them to the hospital. Seriously? I'm already kicking myself for what happened and very upset still about hurting my pt and my instructor and leader did nothing when I asked for help. I was given the weekend to accomplish this paper, this on top of a bib card and studying and working. I'm a student, right? I'm supposed to be evolving my skills and advancing my pt care skills, right? It's supposed to be a learning situation, I thought. I know it's only a paper, but I feel like I'm being punished. The dept. head and I have been butting heads since day one and I've become her whipping boy (girl), as of late. It's not that I didn't give my pt. her exact dose of insulin...it's about throwing away 2 injector pens that still had doses in them. No mention of my pt., just the cost to the hospital for those 2 pens. Really? Am I the only one that's ever made a mistake on her first day of clinicals? If I had overdosed my pt, THEN I would expect a reprimand, even dismissal. I'm dreading my next clinical, which I was once very excited about (to watch a surgery). I feel absolutely wretched about the whole incident. Shown once really isn't what I would call "trained". I feel like an idiot in front of my classmates now. What am I supposed to be learning here? I'm not receiving any more training with the injector pens and I would have thought that to be more effective! I am very, very discouraged at this point.

[parrothead36]

wow, that was an aweful lot to encounter on your first clinical day! don't let it get you down, just look at it as a learning experience as i'm sure you have already. although i do have to agree with you in that the learning experience should have been you actually learning how to give the insulin injection and not writing a paper. i understand what you mean when you say that you don't feel prepared for clinicals. i myself have that feeling sometimes. but no matter what, just stay positive and focused on the light at the end of the tunnel!!!

[cuppa_tea]

Thanks for the positive advice. I want this so badly and I'm afraid I'm going to end up shooting myself in the foot, if you know what I mean. Thanks for the good wishes!

[purple_nomad]

Oy. I hate those moments.

But aren't we, as nurses, supposed to validate feelings? Consider your feelings validated, friend! It stinks to feel as if you're being punished and it stinks to feel like you're lost in hospital-land, but maybe you'll learn something when you write this paper that you will need later in your career! Who knows?

These moments are truly rotten, but by next year, you'll be able to smile and shake your head, because now you know so much more! Clinical instructors will get frustrated, cool off, and then maybe give you one compliment that will send you soaring in your self-esteem. (If they don't, try and find some other nursing buddies, peer-level or otherwise, to help boost your nursing confidence)

[cuppa_tea]

Yes, I agree this paper is a learning tool (NOT the cost part, though). I want to see another insulin pen injection one more time. If my instructors are not going to teach me, then I will ask a nurse on the floor to show me. The look on my pt's face is still bothering me. I hurt her. I've been telling everyone that will listen how excited I am to be on the med/surg floor. I can get back up on the horse and try again because I have been waiting for this since last semester. I think at our level we still need safety nets. Our class is kinda cut-throat, so it's gonna have to be all on me. I am just going to use the nurse's at the hospital as an education source. They didn't seem to mind our questions. And thank you for your encouragement. I was feeling pretty crappy and very discouraged. Thanks! :tku:

[purple_nomad]

Asking the nurses is a good idea. I think sometimes instructors feel a lot of pressure from the whole thing. Maybe it's because it's a favor from the hospital that we're even THERE. I'm sure there are discussions among hospital boards about liabilities that nursing students present. So when we mess up, I think the instructors take it in that context and they can tend to get...a little stressed out and then it comes out really hard on us because, well, they're our instructors!

Nurses are used to this sorta thing. They have to provide education to their patients all the time about these instruments. I'm sure showing a nursing student will be their pleasure, especially since you have a basis of understanding.

Good luck! You'll do great!

[ChristineN, BSN, RN]

Insulin pens can be tricky, especially if you aren't used to giving injections in pen form, or injections in general. My hospital is slowly converting our insulin from multi-use vials over to pens, and I have seen even experienced nurses make similar mistakes simply because they are accustomed to how the pens work.

Next time you are unsure or uncomfortable about a task at hand, I suggest you speak up more and be more vocal about your concerns to your instructor. Perhaps something to the affect of "So I take the pen and would hold it aginst the skin like this..." and go over the steps with your instructor.