My instructor thinks I'm incompetent

[Elven_RN, ASN, RN]

Warning: Long post!

So yesterday for clinical, our instructor paired each of us up. I had practiced the head-to-toe assessment at home because my first one I did very poorly and I was going through the steps in my head the night before clinical. I was prepared to do it myself, but the girl I was paired with was taking over a lot of the tasks. She is wonderful and not bossy, but she definitely has more of a take-charge personality and I am less assertive; so things I wanted to do, she already started and I just rolled with it. For instance, I wanted to do some vitals, but she already either did it when I wasn't watching (like maybe when I ran to get equipment) or started it already when I was in the room, so I tried to be a team player and write down the values, cause at least that's doing something right? We worked a little bit with the nurse assigned to that patient and she was helping us make an occupied bed since our patient was incontinent. I was trying to throw in my weight wherever I could, I was grabbing the soiled linen and throwing it into the hamper because obviously it shouldn't be on the floor, bed or chair right? But I sensed slight annoyance from the nurse cause I had my back turned for a second when I was putting linens in the hamper, but I was really fast and turned back to assist them in helping to move the patient. I kind of just shrugged it off, because maybe I was just imagining it. Now, I can be a bit ditzy; it's something I need to work on! I get my lefts and rights mixed up or sometimes I'm not following directions properly or standing in the wrong spot; I wasn't paying attention and was standing on the wrong side of the bed to help move the patient, but was quickly told to come over to the other side... It was one of those "Oh, duh, I meant that!" moments, so I quickly went to assist. I really did try to work hard, observing when people needed a hand and jumping in, but apparently it was not enough.... I received this email from my instructor last night:

The nurse taking care of your patient today commented that you did not actively participate in caring for the patient, but seemed content to stand back and let the other student take the lead. I noticed the same behavior last week.

Being a student nurse is not observational. You must participate. We are beyond sitting down and talking to patients at this point. You seem very hesitant to care for patients.

While your grades are quite good, you must apply what you are learning in the classroom and lab to the clinical area. We need for our graduates to be competent in all areas.

I hope to see improvement in our remaining weeks.

I was just beside myself...I had a very long school week, barely getting any sleep and working really hard to do well on the quiz, pass my skill test, and be competent and thorough in my clinical. So I was just stunned; I went from feeling awesome, to down in the dirt. I thought I really threw in my weight and to have not only my instructor, but also the nurse say that was devastating for me... It's really hard being the quiet person, because the one that talks the most or takes over tasks the fastest gets noticed for good work, and I'm left looking like a failure.

A little background on what my instructor was referring to when she said she saw me not wanting to participate last week as well: I again, was paired with another take-charge student. We were doing meds and I again, was trying to share the workload. We both had to take a sheet of the list of drugs to look up in our drug guide and find what it was used to treat. So we worked on that, and when I got finished with mine, I jumped in to help with hers. We both took turns doing our three checks. It was definitely a new experience for me; I had never given meds to a patient before. I passed my skill test for it the day before, but that was different and old-fashioned compared to what it was like in real life. I learned to input everything on the computer and scan and for me typically, I usually am pretty bad at something the first time I'm doing it, but after a bit of practice, I can be highly proficient. I was not very proficient my first time around, the other girl was taking over a lot and she already knows a lot of the ins and outs of the hospital, I have a tendency to feel a bit lost and confused when I'm new, and my instructor would remind me to take a turn doing something. I guess that's mainly where she thought I didn't want to participate. I get confused about who's doing what and when we're going to switch tasks...so ok, my bad for not being as with it, but honestly, I feel like it was so unfair to be called out like I did in that email.

She didn't even specify what it was exactly I was doing wrong, which left me wondering, "Was it this?", "Was it that time?" The only time she ever spent with me on the floor was during the meds last week, and for a little bit of time yesterday in assisting with something. She isn't there for most of it and was going off of what that nurse was telling her, which again, the nurse wasn't with us the whole time we were with the patient aither.

I feel so horrible. Feel free to give advice on what I should be doing! I know how to be a team player, and I even welcome it, but I also find working alone can be better sometimes so that toes aren't stepped on. There were three people in the room at times, working on the one patient, so uh, sharing tasks can get a little awkward. I already knew going into this program that it wasn't going to be easy, and I already knew my ditzy moments were going to cause some difficulty, and being a quiet, reserved person on top of that = potential disaster.

I often go from feeling amazing and confident and looking forward to being a nurse, to suddenly feeling like I hate it and it's not for me, that I'll just be a terrible nurse. Is it normal to feel this way in school?

Thank you for taking the time to read my long rant! I am interested in reading your comments.

[Here.I.Stand, BSN, RN]

Your instructor didn't say you were incompetent or should feel like dirt -- she told you what you need to improve upon.

If you are paired with another student, what I would do is BEFORE entering the pt's room, discuss the division of labor. If you're comfortable, you could even say the instructor gave you a note about taking a more active role, so it is important that you do.

So say she took VS and you wrote them down; suggest that you listen to the pt's heart and lungs and report what you hear. While changing the pt, say you'd like to assess the skin while the pt is on her side.

You don't need to "throw your weight around" during ADLs -- you need to communicate and collaborate. These are vital skills for a nursing student to learn. Not everyone is naturally assertive, but as nurses we need that skill as pt advocates. (You will also need it to say "no" to unwanted overtime, or "I will be there in two mimutes" when you are interrupted on the way to the bathroom!) Communicating as described above is a relatively easy, non-confrontational way to start.

[Here.I.Stand, BSN, RN]

Or even if she jumps in and listens to the pt's heart and lungs, it is perfectly fine for you to ask the pt's permission to do it again. "I am trying to learn these skills also -- may I listen for a moment too?" That's assuming the pt is a reasonable person and not griping about your presence.

[Elven_RN, ASN, RN]

Or even if she jumps in and listens to the pt's heart and lungs, it is perfectly fine for you to ask the pt's permission to do it again. "I am trying to learn these skills also -- may I listen for a moment too?" That's assuming the pt is a reasonable person and not griping about your presence.

We had a very difficult elderly patient with confusion, who claimed and acted liked just about everything that involved touching was hurting her and really didn't seem to want us there. So that was another factor that made things more difficult

[babychickens]

On out first clinical day I was paired with somebody I knew was assertive because we'd done a dry run on a fake patient the day before in preparation for clinical. I feared what OP described happening to me so I pulled my partner aside and said, "hey let's both get our needs met. I'm going need you to hang back a bit at times cause I've observed you think a little faster than I do. That's great but I need to get a chance to get in there and do some skills". My partner was more than happy to oblige. We've been cool ever since. Assertiveness is a skill practiced not just on your patients- it's everywhere in nursing school - MDs, techs, your fellows.

[chichi777]

Isaiah 41:10 Do not fear, for I am with you; Do not anxiously look about you, for I am your God.I will strengthen you, surely I will help you, Surely I will uphold you with My righteous right hand.'

[Elven_RN, ASN, RN]

Isaiah 41:10 Do not fear, for I am with you; Do not anxiously look about you, for I am your God.I will strengthen you, surely I will help you, Surely I will uphold you with My righteous right hand.'

Do you know how much I needed this right now? This was the second time this week I was reminded by someone not to fear according to the Bible - and also something that has been a personal issue for me for awhile! God bless you.

[neuron]

If you are the clumsy type, instructors can turn on you.

[Elven_RN, ASN, RN]

If you are the clumsy type, instructors can turn on you.

Unfortunately that just might be the case... I am clumsy when I'm new to learning something. What are some things you have done that made instructors turn on you?

[neuron]

Unfortunately that just might be the case... I am clumsy when I'm new to learning something. What are some things you have done that made instructors turn on you?

They were new once. They didn't have it all together. For example, being eager to learn but then when you make a mistake for example sterile technique they say you failed.