I know nothing!!

colleennurse, ASN, RN · Dec 9, 2006

i'm 3rd semester in 2 year program and i hate...i mean, despise:devil: going to clinical. i absolutely dread it. bostonjenn, i thought someone had jumped into my body just now while i was studying hematology and posted all my exact thoughts under your name:clown: .
fraud: :yeahthat: totally! i feel like the things i'm doing can be done by...well, a robot:monkeydance: , i guess. oooh...i took someone's vitals (it's even more rewarding when a machine or robot does it all for you)...and, oh, wow...i changed somebody's bed while they were in the bathroom (just like a real housekeeper!)...and check it out: i put this funky-looking thing in my ears (just like the one i had when i was a kid) and listened to some funny noises in a couple different places:smiley_aa ...& in a couple hours, i get to cut up somebody's meat and make small talk with them while they eat (just like when i used to babysit!)...and just before bedtime, i get to look at a list of pills, pop them out of their package....all by myself:yelclap: ...put them in somebody's hand & watch them swallow them! i'm a... ? i'm not saying i'm above any of these tasks...i just want to feel the way a nurse is supposed to feel.
i always feel like i'm doing...okay:uhoh3: ...but that if another student was here, she'd/he'd be doing more thorough assessments, or understand my pt's condition better, or know exactly why they're receiving each and every medication they're getting.
and my grades are fine, too. we're pass/fail for clinical now, but last semester, i even got an a...felt completely undeserving. this year, i finally got the guts to confide in my instructor & tell her how i feel (basically word for word what jenn said) and she told me that a lot of being a nurse is being eyes and ears:redlight: . knowing the hob should be up, knowing if someone's loc is changing, knowing what looks off in an assessment, knowing what vs to check if, say, pt says he's short of breath, etc. it made me feel a little better...this instructor is not known to coddle.
my biggest hang-up with clinical is initial pt assessments:chair: . every day as i'm walking from my car to the hospital, i mentally picture myself running at full speed, screaming, and just charging into my pts room:troll: , getting my vitals, doing a quick head to toe, seeing if they need anything, then getting out! it's my most dreaded part of clinical and i just want to get it over with asap. and i don't mind sitting with my pts or talking with them, or giving baths, etc...i just loathe initial assessments:devil: . i feel like i don't know what i'm doing. and i always forget at least 2-3 things to check before i leave the room...and i have to go back in, explain to the pt that even though i told them i could leave them alone for awhile to rest, that now i have to "quick" check their pedal pulses, or skin turgor, or lower extremity strength.
you know what i would :heartbeat ? one or two days to just shadow a nurse. watch everything she/he does...what assessments they do and why, etc.
i have to believe that once i become a , and am employed at a certain place for awhile, i'll be much more comfortable with these things. if not...god help us all:rotfl: ! this was a bit of a rant...thanks for reading - i'm just so excited that other people feel the same way that i do :icon_hug: (sniff, little tear). everyone i'm in school with just looooves going to clinical. not this girl.

the things you say you are doing at clinical (changing linens, popping pills out of a package) those are the things that a nurse does on an everyday basis. as far as your assessments, you will not feel confident for a while. i have only been a nurse for 6 months, and i still get another more experienced nurse when i see something that i am not sure of. you may think that some of these things mean nothing, but even something as simple as changing someones bed can make them feel a lot better, especially if someone has not offered to do it for them. once you are working you will not loathe things as you do now, i hated clinical when i was in school, but i like what i do now. you will come up with your own way to get through an assessment (every hospital does it different) and after a few weeks, you will do it all and not forget anything, it will become habit. i think all of your feelings are normal. i still feel stupid sometimes. wait until you are on your own and you give report to a nurse who asks you 5 thousand questions, and you are thinking to yourself, should i know this??? it's normal! good luck!

MBARN · Sep 16, 2008

You aren't the only ones that hate clinicals. I feel like I know nothing! I am scared to of the working world. They want us to "ACT" confident when we are with a patient but most tasks we have just witnessed or just did once so how can you feel confident?

WDWpixieRN, RN · Sep 16, 2008

As a fairly recent graduate, it seems I heard the words "Fake it until you make it" several times.

Confidence, real or acting is important when dealing with pts. They will smell you a mile away and some will insist you never step foot in their room.

Others will welcome you and be very understanding. I'm 3 months in to my first job post-grad and STILL feel like "I know nothing". Apparently it comes with the territory for a year or two. Just relax and do the best you can, keeping safety first and foremost in your mind. If you don't know, ask. Most nurses and fellow students are willing to help and understand.

Best wishes!!

MBARN · Sep 16, 2008

As a fairly recent graduate, it seems I heard the words "Fake it until you make it" several times.
Confidence, real or acting is important when dealing with pts. They will smell you a mile away and some will insist you never step foot in their room.
Others will welcome you and be very understanding. I'm 3 months in to my first job post-grad and STILL feel like "I know nothing". Apparently it comes with the territory for a year or two. Just relax and do the best you can, keeping safety first and foremost in your mind. If you don't know, ask. Most nurses and fellow students are willing to help and understand.
Best wishes!!

Thank you so much! Your post was very helpful!

Nenja · Sep 24, 2008

See THIS is me. This post is old...please tell me its better now. lol

I find myself almost rehearsing on my drive Okay, THIS is what you're going to do. And you're going to fake that you're confident about it. Kay?

The first time we were told to do an initial assessment, I asked my instructor if I could watch the nurse I was paired with do it on another patient and then do mine, realizing that the 20 minute assessment we learned in skills lab is not what we do for an initial. I'm thinking, I'm supposed to document this. On a REAL chart with my REAL signature. I want to know I'm doing it right. She was not so kosh with my suggestion.

We also have a reflection paragraph to email our instructor after each Clinical. I, too, said that a shadowing experience before being tossed into Clinical would have been stellar. I mean...most of us have NO idea.

My biggest hang-up with clinical is initial pt assessments:chair: . Every day as I'm walking from my car to the hospital, I mentally picture myself running at full speed, screaming, and just CHARGING into my pts room:troll: , getting my vitals, doing a quick head to toe, seeing if they need anything, then GETTING OUT! It's my most dreaded part of clinical and I just want to get it over with ASAP. And I don't mind sitting with my pts or talking with them, or giving baths, etc...I just loathe initial assessments:devil: . I feel like I don't know what I'm doing. And I always forget at least 2-3 things to check before I leave the room...and I have to go back in, explain to the pt that even though I told them I could leave them alone for awhile to rest, that now I have to "quick" check their pedal pulses, or skin turgor, or lower extremity strength.
You know what I would :heartbeat ? One or two days to just shadow a nurse. Watch everything she/he does...what assessments they do and why, etc.

WDWpixieRN, RN · Sep 24, 2008

The first time we were told to do an initial assessment, I asked my instructor if I could watch the nurse I was paired with do it on another patient and then do mine, realizing that the 20 minute assessment we learned in skills lab is not what we do for an initial. I'm thinking, I'm supposed to document this. On a REAL chart with my REAL signature. I want to know I'm doing it right. She was not so kosh with my suggestion.
I mean...most of us have NO idea.

I can't tell you how many times I wished this. And can't imagine why it ISN'T done. Maybe someone with more insight can tell us. But as a new nursing student, new to healthcare and hospitals in general (only ever having had babies and not being sick), I had NO clue how to assess properly, quickly, and accurately. I still feel so incompetent at it, but it does get better and I am learning.

It just really does seem a shame that we can't learn to model our behavior on someone out there slugging their way through a morning shift. It is a VITAL skill to learn in order to keep on track with a shift's work....

Ah, well....good luck anyway!!:redpinkhe

jjjoy, LPN · Sep 24, 2008

The only valid reason I can come up with for not encouraging observing experienced nurses do their initial assessment is that too many don't do it very thoroughly and instructors are afraid you will learn bad habits.

A less cynical argument is that the experienced nurse IS being thorough, but they are so quick at it at the student doesn't see it and thinks that the nurse wasn't thorough and that must be okay.

However, if it's true that a sufficient initial assessment CAN be done so quickly, it's good for the student to see it in action and to try to identify how it was done. "Oh, the nurse was assessing for bilateral coordination when she had the patient demonstrate that they could use the incentive spirometer."

The student should also be reminded that until they have enough of their own experience that they, as students, will take longer in doing their assessments. So I don't think it's too risky to allow students to see how "real world" nurses do their assessments. At the very least, where's the harm in the clinical instructor demonstrating doing an initial assessment with several real patients? Many patients are quite willing to agree to allowing students to observe as they appreciate that they have to learn somehow.

Also, by observing how several different people do ACTUAL, real-world assessments, students can get a better idea of various ways to flow from one area of assessment to another, so it can feel natural, as opposed to the only exposure being the very unnatural, very formal physical assessments graded in skills lab.

If I hadn't worked as a nursing assistant my senior year and had the chance to work with a number of great, experienced CNAs who could show me their tricks, I would've graduated from nursing school being awkward with the most basic of nursing care - patient transfers, bed baths, assistance with dressing, etc.

jjjoy, LPN · Sep 24, 2008

It seems like if you've been in school for at least two years, training as a professional, you should be able to have a clear idea of what exactly you're learning... as opposed to feeling like you haven't learned anything.

In school, the only definite skills I can identify learning thoroughly are how to pass NCLEX style tests and how to write nursing care plans. If that was the goal, my school was successful. Of course, I was exposed to many practical nursing skills and had a cursory overview of just about every condition under the sun. But I can't say with confidence that I "know" or "know how to do" those things. I do have some familiarity with them.

I came out of school with a much greater broader comprehension of the human spectrum of health and illness. Supposedly, I was trained to "think like a nurse." Maybe that's the most we can expect from nursing school.

WDWpixieRN, RN · Sep 24, 2008

In school, the only definite skills I can identify learning thoroughly are how to pass NCLEX style tests and how to write nursing care plans. If that was the goal, my school was successful. Of course, I was exposed to many practical nursing skills and had a cursory overview of just about every condition under the sun. But I can't say with confidence that I "know" or "know how to do" those things. I do have some familiarity with them.

It's funny you write that....that's almost verbatim what someone said to me at work recently as I was lamenting being taken off orientation and expected to be a "real nurse". And something along that line has been the continuing theme from others as my expectation is that I should be performing like a pro. After all, isn't that what most education/training is supposed to do for you?!?!

This business where I'm expected to be a full year or more before feeling comfortable in my New Nurse's Shoes is VERY uncomfortable and not easy for those of us who strive for perfectionism. As with nothing before in my life, I am extremely humbled in trying to be a good nurse...

starletRN · Sep 24, 2008

This thread is really helpful. I am in my final semester of school and feel like I'm getting dumber as I go. I'm one of those who strives for perfectionism and really beats myself up when I feel I don't do well. So, the idea of not feeling comfortable on the job for a year or more makes me want to run out right now and get some valium.

I'm a wreck during clinical, so I can't imagine me having that level of stress for an extended period of time.

itsmycalling · Sep 24, 2008

Hello all,
I'm in my third semester in a 2 year program and I'm so worried. My grades are okay (nothing special but okay) but it's clinical I'm worried about. I seem to be doing fine (my evals are good) but I feel like a fraud. I know NOTHING compared to the other students (who all happen to be great and I'm lucky to be with them). Even simple questions that I feel like I should know the answer too leave me dumbfounded. I have no confidence at all in the clinical setting and I'm worried about the "real world"........

Well you and I should start a club because I am in the exact same position!! 3rd semester of two year program as well. And the word "fraud" crosses my mind on a day to day basis.... BUT I will tell you that my heart is in it- I am there because I really do want to help people, so I figure that the rest will come. I am not just sitting on my butt thinking everything will just "work out" either. I am definitely trying my hardest. Hopefully it will pay off. Hang in there, I truly know how you feel.:wink2:

itsmycalling · Sep 24, 2008

Hmmmmm... didn't bother to read that the entry I just responded to was TWO YEARS OLD!!! That person is now a nurse!!!!! BUT, that makes me feel even better because soon enough, I will be in her position--looking back at these posts and wondering what in the world I was worried about!! Can we fast forward to next year?