I'm struggling during clinical and simulation

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Hello, 

This is my first time posting in one of these but I feel so lost and discouraged so I thought I would give it a try. So, I am a nursing student in my 3rd semester and I feel like I'm struggling in clinical and when performing simulations. Every time an instructor asks me a question it's like my mind goes blank and I don't know how to respond or what to say. I always end up responding with "I don't know.” I just always feel so uncomfortable. I do pretty well on my tests but I'm having trouble explaining the things I know to my instructor and sometimes patients. During simulations and clinical I struggle by not knowing what to do. I know I am supposed to do my assessments and take vitals but then when I'm in the room with somebody else, like another student or professor, it's like I'm frozen or I'm running around like a chicken with it's head cut off. I had simulation the other day and me and another student are assigned to be primary and secondary nurse. I was assigned the primary nurse. We get in the room and I am reading the patients chart and looking at orders, while the other student does the assessment and vitals. After they finish I tell her the STAT orders and we start doing them. I get the meds but then I totally screw up on educating the patient about them. Then I kept forgetting to perform hand hygiene, which I know is very important. I was doing so bad that the other student had to take over. Afterwards I got scolded about not knowing the meds, lack of hand hygiene, and acting more like the secondary nurse than the primary one. It was our first day back after a Christmas break so I knew that I would be rusty, but now I'm starting to doubt if I'm able to do this. It's so sad because I love nursing but I feel like I'm hurting inside. I feel as though I can never do anything right and that I'm just in the way. Now every time I think about clinical or simulation I get so scared and I also feel like my professor thinks I'm stupid. Does anybody have any tips about being more efficient in patients room? I always feel like I'm in the way or don't know what to do next. In clinical it's better because I actually leave the patients room, but in simulation we only leave the room for meds. I don't know. I just don't feel confident anymore. I forgot to mention that I am very awkward, introverted, and shy. I also struggle with social anxiety. I thought I was getting better but I don't know anymore. Sorry this is so long but I had to let this out before I explode.

Shan, RN

69 Posts

Specializes in Oncology.

This may be sort of an extreme tip, depending on your circumstances, but have you thought about getting a part-time job as a PCT/CNA while you're in school? That was a HUGE thing that made me comfortable interacting with patients (real or fake) before I ever had to do so in a nursing capacity. Whenever we had simulation, I just operated like I would at work and I felt a lot more comfortable than a lot of my peers who found the whole situation to be totally unfamiliar. In simulation, you feel like you're under a microscope and like you have to perform well in an alien environment; anything you can do to make that setting feel more familiar may help you out. If you can't work as a PCT, I'd suggest practicing simulation at home. Pick a stuffed animal and practice assessment, patient education, etc. Try to develop good habits (like hand hygiene) before you have to perform them in front of judging eyes. Regardless, you are not alone in feeling this way; simulation is terrifying for a lot of people and can make 90% of what you know fly out of your head. Best of luck to you!

delrionurse

81 Posts

Don't doubt yourself. There are some bad instructors. Sometimes the simulations are in line with the unit your are studying. Is there practice simulation lab hours you can go to so you can be more comfortable? They are always going to put a scenario in there that makes you use therapeutic communication. A lot of times they are testing you on that by having the pt or family member refuse care, tell you there's more pain. Practice techniques to answer those questions, and then critical scenarios like decreasing O2 levels, increasing SOB. 

londonflo

2,367 Posts

Specializes in oncology. Has 46 years experience.
xo_tt said:

Afterwards I got scolded about not knowing the meds, lack of hand hygiene, and acting more like the secondary nurse than the primary one.

Were you 'scolded' or getting constructive criticism? I read your quote that there was an information session on what you did wrong. and some ideas to better your knowledge base, performance and skill level.  

Specializes in ER, Occupational Health. Has 16 years experience.
Shan said:

This may be sort of an extreme tip, depending on your circumstances, but have you thought about getting a part-time job as a PCT/CNA while you're in school? That was a HUGE thing that made me comfortable interacting with patients (real or fake) before I ever had to do so in a nursing capacity. Whenever we had simulation, I just operated like I would at work and I felt a lot more comfortable than a lot of my peers who found the whole situation to be totally unfamiliar. In simulation, you feel like you're under a microscope and like you have to perform well in an alien environment; anything you can do to make that setting feel more familiar may help you out. If you can't work as a PCT, I'd suggest practicing simulation at home. Pick a stuffed animal and practice assessment, patient education, etc. Try to develop good habits (like hand hygiene) before you have to perform them in front of judging eyes. Regardless, you are not alone in feeling this way; simulation is terrifying for a lot of people and can make 90% of what you know fly out of your head. Best of luck to you!

OP, this is a great suggestion.  While you do this, develop a routine and don't deviate except as necessary.  A routine will help you to remember to everything that needs to be done and make you feel more confident.  A checklist to use at home (and in clinicals/simulations if allowed) will help you to establish your routine.

Specializes in Administration. Has 47 years experience.

Awkward/Introverted/Shy/Social Anxiety. You need to concentrate on those things. None of those bid well for an RN, particularly in a hospital setting. You'll get eaten alive by management, fellow nurses, Doctors etc. Thought about some type of therapy? Also, at home do these scenarios ad nausem and talk OUT LOUD to yourself as if teaching the class. Best to you.

AG89

3 Posts

Specializes in Medical-Surgical.

While already suggested, I found it extremely helpful to practice on stuffed animals or family and friends.  Start out by writing down all of the appropriate steps in a given clinical scenario and read them through a few times. Then, put those notes away and start practicing on a stuffed animal/toy and say each step out loud as you are performing it.  If you forget a step, quickly glance at your notes and put them away again and keep going.  Once you are finished you can review your notes in their entirety and see how well you did.  Fix any mistakes the next time you go through that same scenario and do this until you no longer have to consult your notes.  Once you feel comfortable performing this on a toy, you can move towards practicing on family/friends.  This will provide you with a more "patient" experience, which can sometimes interfere and leave you feeling like you don't know what the steps are; when in reality you DO! 

Additionally, it might help you to record these practices so that you see what you're doing/where your mistakes are/what can be improved, etc.  Furthermore, observing someone else (either in person or through educational videos) can help in further solidifying the sequence of steps that need to be complete.  

The key to any learning is to identify how you learn best and incorporate as much of that into what you're trying to learn as much as possible.  If you are more visual, then instead of writing out the steps, use pictures; if you are more hands on, then get a nursing buddy to help practice.

Hopefully these suggestions prove to be helpful.  

Specializes in MICU, STICU, CTICU, CCRN. Has 4 years experience.

Hey OP, 

First off, BREATH. Everyone has been there, whether it was a moment in nursing school, or even after in their career. This is an ever evolving career that will constantly push you outside of your comfort zone, challenge your way of thinking, and always drive you to be better (hopefully). That said, the best advice I can give is to set some goals for yourself! Start small, at the beginning of each clinical/simulation set a goal, maybe it's to know the medications, or maybe it's to focus extra hard on your "five minute room assessment" when you first walk in. Either way, don't think you will tackle it all your first go around. Then when you complete your clinical/simulation days, take the time (I usually do so on my way home) to REFLECT on your goal, assess how you've achieved it, pick out some positives from you day, and then look at the negatives. This will help you to get your goals set for the next day! Believe it or not, I am about 4 years post graduation and I STILL find myself doing this. I feel it helps, especially when taking on a new job, new specialty, etc. 

Additionally, I would consider (if possible) finding an internship or CNA job in an area that interests you, even if it's just casual. It will immerse you in the content, allow you to hone in on those communication and interpersonal skills, and it will make you more comfortable in your role. Locate your resources within that job, and most importantly never stop learning! Buy some books, find some websites, and locate your RESOURCES. Best of luck OP, I have no doubt you'll be JUST FINE. 

Specializes in ICU. Has 7 years experience.

First and foremost, give yourself some grace. Skill comes with practice and time - a lot of time clinical simulation doesn't always look fluid.

The key to simulation is the instructors want to assess your critical thinking, depending on patients conditions. 

When you first walk into the room, there should be a running list in your head of things to do for each patient. 

If you're seeing that you're anxious, take a deep breath before you begin. Also know, it's less about you and more about performance and the patient. Focus less on worrying how you look 😊 

Steps for Clinical Scenarios

1. Hand Wash

2. Greet the Patient 

3. Assess Vitals

4. Listen to Pt Complaints

5. Note Signs and Symptoms

6. Read Patient Charts - Meds ordered, allergies, code status 

7. Understand diagnosis 

8. Come up with patient plan of care 

 

hope this helps 👍🏽