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tachybradyRN · Jan 25, 2013

marbar14 said:

I am a junior in the BSN program and I just feel depressed, incompetent, and lost during clinicals (MEDSURG II specifically). I feel like I should already know all my labs and their normal ranges by heart. I also feel like I should be able to look at the s/s of a patient, be able to now all that is wrong and nursing diagnosis interventions right after the assessment and labs... I just don't know if this feeling is normal or if I don't know enough. I want to be GREAT NURSE. PLEASE share any experiences or advice. Please keep the banal/cliche advice out of here ? I need real advice. Constructive criticism! Thank you!

I'm a registered nurse who has been working for almost 4 years now.. med-surg, telemetry, and now ICU for the last two months, and I still don't "know all that is wrong and the nursing diagnoses, interventions right after assessment and labs." Yes, I know my common lab values by heart at this point, and yes, I know that xyz s/s are probably abc diagnosis, but I will never claim to know everything. I think a lot of what you're talking about comes with experience, and your experience (though it may be in a bunch of different areas and specialties) in nursing school is limited. You'll start feeling like it "clicks" more when you're out and working on your own, trust me. In the meantime, I would suggest you start to familiarize yourself with labs that go with diagnoses.. For example, if a pt is here with an MI, we would want to look at what? Maybe CPK/MB/Troponin? A pt comes in complaining of symptoms of PE.. besides the CT-Angiogram/VQ Scan, we would want to know about their D-Dimer, etc. Pt is here with pneumonia... we want to know about their WBC, H+H, maybe if they have a differential what their band percentage is? Lactic acid? Electrolytes? Start to look at the whole picture.. like, my patient's potassium is 6.8. What does that mean? What might a potassium of 6.8 cause physically in my patient? What do I need to look out for? How do we fix it?

It really is just a matter of time and experience. It will come, just be patient with yourself.

hodgieRN · Jan 25, 2013

My advice would be to relax. It's a good thing that you want to be a great nurse, but great nurses aren't unrealistic overachievers. I know it's kind of brutal, but it's honest and it might be some of best advice you will hear. So, you feel depressed and incompetent because you can't immediately spot every single little thing that's wrong...while you are a junior in nursing school. I could tell you that you aren't expected to basically diagnosis a pt within a second, or tell you that nobody has every lab memorized before nursing school is out, but that fact that you expect this is an issue. So here's that thing....every one of us has seen the nurse that has these unobtainable standards from day to day. They are the nurses who are running around with their hair on fire when there is no fire. They are ones that make the whole floor on edge when it shouldn't be. They are the ones who freak out when codes happens or when some tiny little thing happens. That kind of stuff will age you. The hospital is a stressful, unpredictable environment. But, you can choose to let things get to you or go with the flow. Honestly, are you really expecting to know everything by heart before your senior year of nursing school? Nurses who are unrealistic always set themselves up for failure. When you think that nothing will get by you, when everything will be caught by you, when you think you can learn everything once and never forget it...when the time comes that something does get by you (and it will happen), you will flip out and no one will like working with you. The problem with this (and this is the advice I want you to hear), the nurse who has these unrealistic characteristics in the beginning, are the ones who think their !@#$ don't stink down the road. They start to believe they are the saving grace to the floor...and that nurse is always the one who ends up killing someone because of their arrogance. There's a difference in people pushing themselves, who are curious, who never stop setting goals, who never stop learning and someone who freaks about because their "A" type personality spirals their emotions out of control. Now, I'm not saying you are going to be that nurse, or even saying you are freaking out at all...I'm just saying to realize where you are in your learning and realize that there's a fine line with overachieving. Chill and take it all in, not be depressed and "incompetent." You watch...there's nurses who runs around and needs to have all the baskets stuffed, bedside tables oriented the same way, and have this pinned and that marked...but wouldn't you know it, they suck at taking care of pts b/c they spend so much time on little things that don't really matter. So, identify this now and ease back. Set realistic goals. Enjoy taking care of people and learning. You aren't a student who needs to be kicked out of school b/c you forgot the normal level of sodium. But you are at risk for being the nurse that burns out and has high blood pressure because someone didn't fill the syringe basket. If you don't know that labs, just keep studying. And stop feeling sorry for yourself b/c that's not how a great nurse is born.

LadyFree28, BSN, LPN, RN · Jan 25, 2013

\ said:

My advice would be to relax. It's a good thing that you want to be a great nurse but great nurses aren't unrealistic overachievers. I know it's kind of brutal, but it's honest and it might be some of best advice you will hear. So, you feel depressed and incompetent because you can't immediately spot every single little thing that's wrong...while you are a junior in nursing school. I could tell you that you aren't expected to basically diagnosis a pt within a second, or tell you that nobody has every lab memorized before nursing school is out, but that fact that you expect this is an issue. So here's that thing....every one of us has seen the nurse that has these unobtainable standards from day to day. They are the nurses who are running around with their hair on fire when there is no fire. They are ones that make the whole floor on edge when it shouldn't be. They are the ones who freak out when codes happens or when some tiny little thing happens. That kind of stuff will age you. The hospital is a stressful, unpredictable environment. But, you can choose to let things get to you or go with the flow. Honestly, are you really expecting to know everything by heart before your senior year of nursing school? Nurses who are unrealistic always set themselves up for failure. When you think that nothing will get by you, when everything will be caught by you, when you think you can learn everything once and never forget it...when the time comes that something does get by you (and it will happen), you will flip out and no one will like working with you. The problem with this (and this is the advice I want you to hear), the nurse who has these unrealistic characteristics in the beginning, are the ones who think their !@#$ don't stink down the road. They start to believe they are the saving grace to the floor...and that nurse is always the one who ends up killing someone because of their arrogance. There's a difference in people pushing themselves, who are curious, who never stop setting goals, who never stop learning and someone who freaks about because their "A" type personality spirals their emotions out of control. Now, I'm not saying you are going to be that nurse, or even saying you are freaking out at all...I'm just saying to realize where you are in your learning and realize that there's a fine line with overachieving. Chill and take it all in, not be depressed and "incompetent." You watch...there's nurses who runs around and needs to have all the baskets stuffed, bedside tables oriented the same way, and have this pinned and that marked...but wouldn't you know it, they suck at taking care of pts b/c they spend so much time on little things that don't really matter. So, identify this now and ease back. Set realistic goals. Enjoy taking care of people and learning. You aren't a student who needs to be kicked out of school b/c you forgot the normal level of sodium. But you are at risk for being the nurse that burns out and has high blood pressure because someone didn't fill the syringe basket. If you don't know that labs, just keep studying. And stop feeling sorry for yourself b/c that's not how a great nurse is born.

^^^Best. Realistic. Nurse. Advice. EVER

I think this is the best advice I have EVER seen...and the most HONEST. (Can't say this ENOUGH ? )

It would behoove you to take a breath. Understand you are still learning. Understand that you are still a student nurse, and you are building on your experience...it doesn't always click in your junior year, it doesn't always click in your senior year... It way click well into the first two years of your nursing practice...and even THEN it may take more time to "put it all together." My point is you NEVER will know EVERYTHING. In nursing, we are always investigating, data collecting, tweaking interventions, goals may change, etc. At this time, immerse yourself in "taking it all in"...know your resources to get your information, learn from your patients...keep building in your practice.

grpman · Jan 25, 2013

First, not knowing your normal ranges is an easy fix. I won't waste your time with telling you how. But do remember that most nurses don't know all of these ranges by heart unless it applies to their area of practice.

Also remember that experience often masquerades as genious. There is no way to have the understanding or clinical skills that a 10 year veteran nurse does. Is that 10 year nurse a genius? Probably not. However, he/she is very experienced. You can't study enough to make that happen. So relax.

Your clinical instructor should be the best gauge as to where you are. They see students daily and have a good estimate as to where you rank in the mix. If you are really curious and brave, ask them.

I also think your feelings are relatively normal for an overachiever. By no means are you the only one feeling this way.

dah doh, BSN, RN · Jan 26, 2013

Wow! That's a lot of stress you're putting on yourself unnecessarily. Take a step back and take some nice deep breaths! Nursing school is for learning the general background and give you a feel for what it could be like as a nurse (depends what type of nursing you end up doing). Just try to learn as much as you can in school because you will need it to pass boards. Then once you get a job, try to learn as much as you can so you can practice safely. It usually takes new grads a few years to feel more comfortable doing their job. Will you make mistakes? Sure, everyone does...but as long as the patient isn't harmed, then use it as a learning experience and don't do it again! Will you remember all the normal lab values and patho? Maybe if you work with it all the time. I've learned that with the right approach, most doctors and nurses are willing to teach you. Oh yeah, don't forget to step back and breathe...sometimes it's just the trick to give you time to think and focus...and that help you come up with the right answer.

OCNRN63, RN · Jan 26, 2013

marbar14 said:

I am a junior in the BSN program and I just feel depressed, incompetent, and lost during clinicals (MEDSURG II specifically). I feel like I should already know all my labs and their normal ranges by heart. I also feel like I should be able to look at the s/s of a patient, be able to now all that is wrong and nursing diagnosis interventions right after the assessment and labs... I just don't know if this feeling is normal or if I don't know enough. I want to be GREAT NURSE. PLEASE share any experiences or advice. Please keep the banal/cliche advice out of here ? I need real advice. Constructive criticism! Thank you!

Well, I hope what I have to say is neither banal nor cliche, but what you're describing takes years of working with patients to develop. It takes time to be a good nurse, let alone a great nurse.

Try to give yourself a little slack. You're in your junior year; you are still in the learning process as a student. Perhaps talking with your clinical instructor(s) and asking them for some feedback would be helpful, as well as asking what they consider a realistic description of clinical skills for someone at your level.

Setting goals is admirable, but make sure your goals are attainable and realistic. Perhaps setting shorter term goals will eventually help you reach that long-term goal.

marbar14 · Jan 27, 2013

Thanks. That does help. I just got a job as an RN fellow on a rehab unit so I hope that experience will help me out. The labs are mostly what I want to at least have a good grasp on right now.

marbar14 · Jan 27, 2013

Thanks everyone this really helps out. I'm glad to hear that I am not supposed to know everything by senior year and that experience will be what really will help me be a great nurse. I really like what OCNRN63 suggests: setting short term goals to get to my long term goal. I also definitely don't want to be the lady who's hair is on fire when there is no fire. I have been working since I was 15 years old and I've worked with those types and I didn't enjoy working with them either. It seems like everyone is telling me to step back and take a breath that I'm being unrealistic. I can see that I am being unrealistic and now that takes a lot of stress off my shoulders for next clinical and now I can learn at clinical rather than freak out thinking I have to know everything already... I think freaking out hindered me from learning and was putting a block on my brain absorbing anything. So this has changed my attitude for next clinical and I think definitely for the better. Thanks again everyone! This site rocks and so do you guys!!

Esme12, ASN, BSN, RN · Jan 27, 2013

Give yourself a break...you will getthere....many nurses have little "brain sheet in their pockets to help them out. Here are a few....use them change them. I hope they help..

FinalGraduateShiftReport.doc

DAY SHEET 2 doc.doc

marbar14 · Jan 27, 2013

WOW! Esme12 These sheets are awesome especially the report sheets I scramble words on to paper from report and then I have things written every where and all over the place and by the time I look back on them I'm like HUH? This will definitely help me out to stay organized!!:) Thank you!!!!!