Need advise from working nurses, from a student

[BSN89]

Hello all,

I am nearing graduating as a 5th semester student. I completed a rotation in an ICU and felt completely lost...I have not been able to see or experience a whole lot during my previous clinicals and was made to feel incompetent this week by the nurse I worked with. I misunderstood a direction she gave about having an IVPB..and she got so upset and became so indifferent to me...from this point on the entire day was a flop. Anything that I could mess up on, I did. I was just so anxious, I shook the whole day and could not think clearly. I said I would withdraw air out of the foley while removing it...I told her our pt had LR hanging when they actually had NS.....I had no idea what any of the meds were being given would do to our patients...I spike the bag she wanted for an on deck replacement because she handed me secondary tubing with the new bag (there was half a bag running) and I did not slice the threading anchoring out pts ART line to his skin correctly, so she had to cut it herself. There were man other little things as well.

I heard her bashing me to a graduate nurse outside of my patients room...and when I came out she made a comment about common sense very aggressively and while looking directly at me. She also made a comment about talking to me instructor.

All of my peers have told me they see me in a high acute setting...but I completely flopped.

I think I am burnt out from running myself so hard for so many years now, surviving on three hours of sleep or less....that I'm struggling cognitively.....and with minimal energy, focus, and motivation. Its been a very intense program to juggle with a family and job.

I just don't know what to do and feel like I am a lost cause, one of those who won't make it.

I have been a 4.0 student academically but feel like a fish out of water clinically. I do not feel competent piecing this all together while hands on...and feel like nursing is just not for me. I do not have the tough skin...and apparently lack common sense.

This is so disheartening to realize as a third year nursing student and realizing that I likely need to just remove myself from the program. I feel that I function at a fundamentals student level rather than a critical care student. I suddenly realize I have no idea what I am doing and do not feel able to handle all of the responsibilities a nurse does, and in a safe manner.

I have been sick to my stomach and in tears non stop the last few days.

[BSN89]

I apologize for all of the typing errors. I am very frantic right now.

[ruby_jane, BSN, RN]

So completely unprofessional of that nurse. And btw, that's exactly how my preceptorship went so I feel this deeply for you.

You do NOT need to remove yourself from the program. You had ONE bad clinical. It is possible she did not give clear directions. It is possible you were overly nervous. You are there to be TRAINED. It is also possible that she misunderstood her assignment. When I preceptor someone it's see one, do one and I always make sure to ask what you've done before. It takes longer but the mentee learns from me.

Not everyone is cut out to be a preceptor.

She will likely talk to your instructor. You may want to jot these thoughts down so that you can come back to them if needed. The school needs preceptors more than they care about the preceptors' lack of professionalism...

It is not uncommon to have every single thing you know fly out of your head in a new setting.

Head up. How have the rest of your clinicals been? What interests you?

In my personal experience: the transition directly into the ICU would require six months of training and an incredibly supportive preceptor. Hospitals are not equipped to provide this.

Best of luck to you.

[LibraNurse27, BSN, RN]

Hi BSN89,

Number one, sleep is SO important. Important for brain health, ability to learn new information and skills, ability to focus and regulate emotions, etc. Getting enough sleep is more beneficial to your success than pulling all nighters studying or doing anything else, I promise you. It is scientifically proven that the information you cram in those sessions will not be retained for long. Also sleep deprivation causes so many physical and mental health issues. It is dangerous to you and your patients to be sleeping so little.

Second, ICU is a hard place to do clinicals! My program did not send us to ICU except for a few students in the last semester who were permitted to precept in ICUs. Nursing students should be focusing on the basics, patient assessments, passing meds with time to look up what they are for, supervised skills, etc. All of these should be learned before giving ICU meds, touching arterial lines, etc in my opinion.

It sucks that some nurses do not have patience for nursing students. None of the "mistakes" you made sound unreasonable for a nursing student to make. Sounds like there was not clear communication between you and the nurse you were shadowing. Learning how to hang IVPB takes time, spiking a bag that wasn't ready to be used yet is not the end of the world. Most likely a combination of sleep deprivation and hostility from your preceptor led you to become frazzled and perform worse throughout the day. Nursing school is for learning to become a nurse. No one should expect you to perform as an experienced ICU nurse!

Lastly, I don't recommend letting other people tell you where they see you ending up as a nurse. Do YOU want to start in critical care? Go through your clinicals and see which areas appeal to you and which you feel you could handle as a new nurse. Some people do start in critical care, but it is a steep learning curve. Being a new nurse is always hard so it is important to find a specialty you enjoy and hopefully a floor that supports new grads. Don't give up! One bad day and mean preceptor doesn't mean you should not be a nurse!

["nursy", RN]

Please, please, please take a deep breath....you will be OK. You are not a lost cause, and you WILL make it. If you read enough of these posts, there are a million of them from licensed RNs in their first year, that feel even worse than you do because they have finished school, got their license, and have been working, and feel like they are just not getting it. It is HARD. There is a lot to learn. There is really no such thing as a "critical care student," most ICU's don't even take nurses without several years of med surg experience. And that is for a very good reason. Some students/nurses will pick it up quicker than others, and if you compare yourself to them you will feel miserable. So don't do it. Review the stuff that you fell short on, and keep going.

[BSN89]

On 1/31/2020 at 11:36 AM, ruby_jane said:

So completely unprofessional of that nurse. And btw, that's exactly how my preceptorship went so I feel this deeply for you.

You do NOT need to remove yourself from the program. You had ONE bad clinical. It is possible she did not give clear directions. It is possible you were overly nervous. You are there to be TRAINED. It is also possible that she misunderstood her assignment. When I preceptor someone it's see one, do one and I always make sure to ask what you've done before. It takes longer but the mentee learns from me.

Not everyone is cut out to be a preceptor.

She will likely talk to your instructor. You may want to jot these thoughts down so that you can come back to them if needed. The school needs preceptors more than they care about the preceptors' lack of professionalism...

It is not uncommon to have every single thing you know fly out of your head in a new setting.

Head up. How have the rest of your clinicals been? What interests you?

In my personal experience: the transition directly into the ICU would require six months of training and an incredibly supportive preceptor. Hospitals are not equipped to provide this.

Best of luck to you.

Thank you for your feedback and encouragement.

To answer your questions, my other clinicals have gone wonderfully. I have very positive and strong feedback from every other rotation and have been a very strong student for the other settings/interactions. I think the pressure got to me this week but I do also feel completely unprepared and not par for where a 5th semester student should be.

The thought of having to face my instructor and knowing I had a complaint against me absolutely kills me. I have a lot of eyes on me, being such a previously strong performer. I have been such a perfectionist and killed myself to be a strong student, that I feel I can not muster up the strength to combat such a poor report when our clinical group has received strong feedback from nurses about other students. My confidence is beyond shattered and all I can think of is leaving..but I cannot let my family down after all of the sacrifices we have made the last three years.

My interests have been high acute settings..so this is devistating.

[ruby_jane, BSN, RN]

On 1/31/2020 at 11:45 AM, BSN89 said:

Thank you for your feedback and encouragement.

To answer your questions, my other clinicals have gone wonderfully. I have very positive and strong feedback from every other rotation and have been a very strong student for the other settings/interactions. I think the pressure got to me this week but I do also feel completely unprepared and not par for where a 5th semester student should be.

The thought of having to face my instructor and knowing I had a complaint against me absolutely kills me. I have a lot of eyes on me, being such a previously strong performer. I have been such a perfectionist and killed myself to be a strong student, that I feel I can not muster up the strength to combat such a poor report when our clinical group has received strong feedback from nurses about other students. My confidence is beyond shattered and all I can think of is leaving..but I cannot let my family down after all of the sacrifices we have made the last three years.

My interests have been high acute settings..so this is devistating.

You will need to dig a little deeper and find your resilience. You don't know what the report will be. You've done well so far.

You have come a long way. ICU is most def NOT the only acute care setting there is. BTW - if you say "I only want acute care settings" you actually tick off the hiring managers. "My heart is in acute care but right now my best interest is to learn all I can to safely transition into the role of a competent nurse."

[BSN89]

I am literally in tears reading responses. Thank you so very much

6 minutes ago, LibraNurse27 said:

Hi BSN89,

Number one, sleep is SO important. Important for brain health, ability to learn new information and skills, ability to focus and regulate emotions, etc. Getting enough sleep is more beneficial to your success than pulling all nighters studying or doing anything else, I promise you. It is scientifically proven that the information you cram in those sessions will not be retained for long. Also sleep deprivation causes so many physical and mental health issues. It is dangerous to you and your patients to be sleeping so little.

Second, ICU is a hard place to do clinicals! My program did not send us to ICU except for a few students in the last semester who were permitted to precept in ICUs. Nursing students should be focusing on the basics, patient assessments, passing meds with time to look up what they are for, supervised skills, etc. All of these should be learned before giving ICU meds, touching arterial lines, etc in my opinion.

It sucks that some nurses do not have patience for nursing students. None of the "mistakes" you made sound unreasonable for a nursing student to make. Sounds like there was not clear communication between you and the nurse you were shadowing. Learning how to hang IVPB takes time, spiking a bag that wasn't ready to be used yet is not the end of the world. Most likely a combination of sleep deprivation and hostility from your preceptor led you to become frazzled and perform worse throughout the day. Nursing school is for learning to become a nurse. No one should expect you to perform as an experienced ICU nurse!

Lastly, I don't recommend letting other people tell you where they see you ending up as a nurse. Do YOU want to start in critical care? Go through your clinicals and see which areas appeal to you and which you feel you could handle as a new nurse. Some people do start in critical care, but it is a steep learning curve. Being a new nurse is always hard so it is important to find a specialty you enjoy and hopefully a floor that supports new grads. Don't give up! One bad day and mean preceptor doesn't mean you should not be a nurse!

Thank you so very much for this reply, I cannot tell you how helpful this is and how much it means. Truly.

[JKL33]

Let me give you a different perspective.

I was paired for my final practicum with a nurse who took me underwing and made me a side-kick, and then slowly became my sidekick. This nurse took me everywhere and let me do everything after reviewing it with me and talking through the plan. I performed every part of the nursing process. When I messed up things like what you are talking about (example: I drew up meds from an ampule with a regular needle while the preceptor was looking at some documentation, because I thought the filter needle was for pushing the meds into the line, not withdrawing them from the ampule), the preceptor smiled, explained, and said, "No problem, don't use that, I'll get you another ampule."

That's the kind of experience you could have had.

The things you "messed up" are no worse than what any other complete novice who has had very few hands-on experiences can come up with. How had I never before learned the proper use of a filter needle?? Well, I had never come across it before, that's how.

Nurses are very harried these days. Their situation with precepting students is not fair to anyone, including them. Just the same, this person went out of her way to be disparaging and mean and you have zero reason to judge yourself according to her poor behavior.

It may be hard to believe, but you're going to need to let this roll like water off a duck's back. Believe it. Keep putting the next foot forward.

You can do it.

[BSN89]

Oh my goodness, you all are SO incredible. I cannot even tell you how much your responses have given back to me...that experience all but collapsed every ounce of my self-worth. Thank you for all for helping to build me back up ❤️

["nursy", RN]

On 1/31/2020 at 11:45 AM, BSN89 said:

The thought of having to face my instructor and knowing I had a complaint against me absolutely kills me.

It sounds like all of your other experiences were very positive with good evaluations. Your instructor already knows this, they also know that the preceptor's opinion is very subjective, and not all preceptors are very good at precepting. I'm betting she will be supportive and constructive.

[TriciaJ, RN]

1. Trying to get by on 3 hours of sleep per night is like trying to survive on 300 calories per day. Please reevaluate the rest of your life and try to figure out what you can scrape off until you get through school.

2. One bad day does not a bad nurse make. You will quite possibly have other days like this throughout your career. I know I did. The difference will be that bad days won't shake you to your core like this one did.

3. The day I retired my brain actually retired about 2 hours before the rest of me. I made a really boneheaded mistake (nothing involving patient care) and when I meet up with my former coworkers they still tease me about it.

4. What Jack says about Jill says more about Jack than it does about Jill. I'm referring to your preceptor.

Hang in there.