2nd year Medsurg 2 and transitions

art1stic · Apr 13, 2011

Wow 30 students? That's horrible, I don't mean to judge your school but where is the help from the instructors? That's just plain wrong. :mad:

As for third semester med surg, I'm currently a third semester student, and boy I can tell you it does get harder. I'm going to try to explain my clinical experience the best I can.

The best advice I can give starting off the bat is learning how to group and prioritize your patients. For example if you have to do vital signs accuchecks and physical assessment, why not group those actions altogether, go to your next patient, then sit down and chart. Who's resting comfortably and who needs immediate attention? Pqrst pqrst pqrst have that in your head when you assess each system, each problem presents differently and your instructor is going to see if you're asking the right questions. You're patient is the best person for a history and physical.

Im only working with 2 patients right now but it gets overwhelming checking labs, new orders, vital signs, assessments, documentation, reporting, accuchecks, medications, bed side care, nursing process; all this and you have to think critically of the actions you are doing throughout your day. a lot of second year stuff is deeper nursing process, interventions, correlations between diagnosis, labs, treatments, how the patient is progressing or declining, how they presented on admission, and how they're doing now. What are some goals, interventions, and teaching you can do for this patient on your day of care? What have you evaluated, what can do you better?

I noticed that in the second year theory classes and taking tests are 30 - 40% of nursing school and clinical becomes 60%. Make clinical your priority, go in there and take everything and anything you can get. Ask your rns and lvns for procedures you can do(ims foleys g tubes, ngt etc) you're instructor will see that you're going above and beyond what's expected.

My last piece of advice is that there's always going to be a question you're instructor asks that you won't know. And they know that, they want you to start thinking critically and find the answers and get back to them. Be prepared to be suffer mental pain, anxiety, and exhaustion. But always think about the patient first and why you went into the field in the first place. It's always rewarding looking back and realize you gave a helping hand.

I know exactly how you feel. There are days where I don't want to go to clinical, quit nursing, or just sleep forever. Never have I felt psychological pain.but were all going through it. So remember fight through it and no excuses!! :yeah:

brittany_micah · Apr 13, 2011

Well I have since heard that out of those 30 students some of the instructors did not think they should have passed 2nd semester so they continued to "weed out" Idk how true that is, but THANK YOU for the great advice! Everything you said was very helpful and I know a lot more what to expect now. As hard as 1 patient is right now that is not realistic to think I will have that ratio once I graduate. Thanks for the reality check, encouragements, & Congrats to you for almost being done!! :)

Aeterna, BSN, RN · Apr 14, 2011

I find it depends on your school and depends on your instructor.

In my school, third year was notorious for being very difficult and exhausting - a gamut of new skills, re-enforcing the old skills, difficult courses (pathophysiology, anyone?), high workload, higher expectations leading up to the final year, etc. And yeah, it was pretty hard! But I hear different things from different schools so it depends.

Also depends a lot on your individual clinical instructors. I had one instructor in the first semester of my third year who was very much a laid-back kind of person who encouraged us to explore things in the way we saw fit. My instructor in the next semester was more drill sergeant-like, with very fixed ways of doing things and very specific expectations. Still, I learned a lot from both of them and got valuable experience in both semesters. And I agree with art1stic - instructors often ask questions knowing you probably don't know the answers, hoping you'll go out of your way to find them and apply the concept to your patient(s).

I found that nursing instructors look for students who do their prep work (i.e. looking up their meds beforehand, not the day of clinical), ask questions, and take initiative. They're not looking for students who know everything (or think they do!) You're students - it's expected that you don't know many things that seasoned nurses can do practically with their eyes closed. If you come across something that doesn't make sense or you don't know how to do - ASK! No one will look down on you for it. Hell, I remember in my second year asking another nurse how to operate the digital scale and (thankfully!) she didn't even bat an eye and simply explained it to me.

Don't be afraid to ask for feedback or help. In one of my classes, I wasn't doing as well as I wanted to and asked my instructor for a time to discuss my grades in her class and how to improve them. We determined that I would benefit from more frequent feedback so, for a few weeks, we met for about 10 minutes after every class to discuss my performance that day and possible ways for me to do better next week. Not only did I receive very valuable feedback, but I also showed my instructor initiative and interest, and she rewarded me for it.

About halfway through my first semester of my fourth year, I told my preceptor, "I find I'm having difficulty prioritizing things and end up feeling really overwhelmed. Could you help me give me a nudge in the right direction every now and then?" and she did! (Although, she also told me that that particular skill comes with time and experience)

In short, complete your work on time, show up to class/clinical on time, ask questions, know what's expected of you (especially since each instructor has different expectations!), ask for feedback frequently and/or for suggestions on how to improve, and just keep pushing and pushing forward. For clinical, always ask the nurses if you can help with anything - if a student asks me this, I am more likely to think of something neat to show her/him!

VickyRN, MSN, DNP, RN · Apr 14, 2011

excellent post, aeterna :)