Nervous about clinicals

[aismail3]

Hello everyone:

I just came back from my Clinical Orientation. I thought orientation would help make me feel more comfortable about my first clinical that starts next Thursday, but instead I'm more nervous! Our instructor gave us so much information that there is no way I'll retain all of it for the weeks to come. I'm also nervous because I don't feel prepared. I'm currently a junior in a 4-year BSN program. We have to do head-to-toe assessments each day during clinicals (obviously), but we haven't done head-to-toe assessments for MONTHS at university. We also have to give IV's, but we only got to practice ONE time on a synthetic arm thing (lol). I just don't feel comfortable with giving people shots. I'm also nervous about doing a complete care plan. How often do nurses do care plans in the real world? (I've been told not often; is this true?)

Does anyone have any words of encouragement? What was your first clinical like? I fear getting an unsatisfactory for doing something stupid, failing the class, and having to wait a year to start over. (God forbid).

P.S. I was at this hospital once before shadowing an ICU nurse. I fainted! Till this day I get 'tired' or dizzy if I stand up for too long. I felt dizzy during orientation. What should I eat for breakfast?

Thanks,

and sorry for asking a bunch of unrelated questions in one post.

[elkpark]

Everyone is anxious about starting clinicals -- what would be scary is if you weren't anxious. :) Your instructor will be well aware that all of you (in your group) are new to clinicals and scared. Your statement that you haven't done head-to-toe assessments "in months" suggests that you have done them in the past -- have you reviewed your previous learning and skills in that area, or maybe even practiced on someone (a friend or classmate)? That should help relieve your anxiety somewhat and help you be prepared for clinical.

As for care plans, different facilities use them in different ways. At the hospital at which I work, the admitting nurse does a complete, written care plan on every client admitted, and the care plans are reviewed and updated in treatment team meetings every few days, so, yes, I write care plans all the time. Other facilities have different documentation. However, it doesn't really matter how often nurses do care plans in the "real world" -- you'll do many things in nursing school that nurses don't do in the "real world" as part of the educational process. The point of care plans in nursing school is to help you learn to think like a nurse -- identify and prioritize a client's problems/issues that can be addressed by nursing, plan interventions to address them, evaluate how successful those interventions are, and determine whether or not other interventions need to be added or substituted -- and to enable your instructor(s) to see how well you are learning that process. Whether or not nurses work in a setting where they actually write care plans (longhand or via a computer program), they are thinking about their clients and going through that process in their heads, and it is the basis of nursing practice.

Breakfast is important on clinical days (that was something instructors in my nursing program many years ago really beat into our heads). Even though I was not a regular breakfast-eater back when I was in nursing school (my dietary habits have improved since then! :)), I always made a point of eating breakfast before clinical. In general, you want something with plenty of fiber and some protein but not much sugar -- peanut butter or cheese on a whole wheat (or other high fiber) bagel or toast, high fiber cereal with milk, a fiber and protein "bar" (I love the Clif bars); something like that.

One thought that kept me going through nursing school was that thousands and thousands of other nursing students, for many, many years, have felt just as anxious, unprepared, and inadequate as I was feeling, and they all (well, most of them :)) made it through this same process and came out the other end as successful graduates and nurses. All of us licensed nurses here have been in the same place you are right now, and through the same process, and we all survived. Your odds are pretty good!

Best wishes for your studies! :balloons:

[nrice28]

Hey, although I haven't started clinical either. I do start next friday and I have gone to my orientation last weds. I am so nervous too! My instructor knows how nervous we all are. She actually gave us a pep-talk about when we are standing and watching a wound dressing change to make sure to move around a little. She said every semester someone faints. She said the most important thing was to make sure you eat and drink a lot of water! She told us to bring lots of snacks and lots of water. I personally don't know if I will be able to eat. I mean, I am nervous thinking about next week! But I am totally nervous about the physical assessment too! I mean we did check offs not too long ago. but I am going to be on the orthopedic floor so I am pretty sure I am going to just be giving lots of bed baths and stuff like that. I heard that the first semester is basically all of that type of stuff. Everyone I have spoken to in the 2nd year say that first semester is the worst! If we can get through the poop..lol. then I think we will be okay. I am just so nervous. I mean, I don't know how ur graded but I printed out the sheet and its so crazy! Its intimidating! But my instructor just said try to learn as much as possible by just standing in the room when a DR. comes in and just watching. She also said that we should just act confident and the patient wont even know how freaked out we are! Let us know how it goes next week! I am excited and so nervous!

[babyCNP]

Let me tell you, I have been nervous about clinicals every single day up until I got a job at a hospital. I didn't believe anyone when they told me that it would help. I just felt like I would dread going to work like I dreaded going to clinical. I think the fact that I only had clinical 2 days a week was also a contributing factor- I wasn't getting enough time in.

So, this summer, I bit the bullet and quit my restaurant job and got a job as a clinical assistant on a post-partum unit at a local hospital. I started the end of July. And let me tell you- it has done WONDERS! I started my senior year of nursing school the end of August and the very first day of clinical I could definitely tell a difference in how much more comfortable I was!!! I am able to approach patients with more confidence, do patient teaching, and answer the questions they have with ease. For the first time, I actually feel like I am ready to graduate and be a nurse. I highly suggest getting a job in a hospital! A lot of the times, hospitals offer special positions for nursing students (like my position, Clinical Assistant, or Nurse Intern, is for nursing students only). You are working along side nurses and a lot of times, they will let you do things like injections or other skills and it gives you TONS of practice on top of what you're doing in clinical already. Plus, you're getting your foot in the door somewhere and it will make it easier to get a job once you graduate. Good luck to you! Each day will get easier and easier and you will be more and more confident.

[nrice28]

Thanks so much! Yeah, I was going to do an externship next summer. This is only my first semester so I can't try to even get a job yet. But in my school you can't work where you go to clinical. which kinda hurts my chances. I would love to get a job b/c your so right. I think I have hangups about speaking with patients, procedures, um everything. lol..but I have heard good things about an externship so I hope I get into it. But congrats..ur almost done!! :)

[TerpGal02, ASN]

I am still anxious for clinical every weekend and I will be finished with my first year of 2 in December if that's any consolation to you.

[penny112]

I graduate in June and I am still nervous every time I go to clinical. It's just the nature of the beast. Just remember that assessments and everything else are skills that you learn and build over time. You are not going to be perfect and that is okay and expected, it's why we are students. Everything is a learning experience and often, mistakes can be the best teachers. Some really good advice I received from a 1st semester teacher... fake it until you make it! Make sure you are well rested for clinical days, always eat breakfast, and remember that a big part of nursing isn't just in the technical skills (those come with time) but in your people skills. Talking to patients used to be one of my biggest fears but I made sure to walk in that room with confidence and a smile (even if I was a shaking mess on the inside). Remember that your fellow classmates are all feeling the same way. Lean on each other. And remember that all nurses were once in your place. As for the skills, they can definitely be scary when doing them your first time on a "real" patient and often for many times after that. Just tell yourself that in order to get comfortable with them you just have to do them over and over. Even though I was nervous, I tried to hype myself up and get excited over getting to practice them. I told myself, just get over this so you can get good at it. You have learned the steps, you know what to do, and you are being supervised. Just have faith in yourself. With so many things, fear is really what can mess you up. Before giving shots, drawing blood, I tell myself, I know how to do this, the patient has to have it done no matter what so I can't worry about hurting them. Shots are hard to mess up. Just aim and go for it with confidence. With other classmates, I've noticed that those who had mishaps with shots did so because they were scared, tried to go to slow or that kind of thing and the needle just bounced off skin, haha. With blood draws and IV's I just tell myself that I know the steps and I will get the vein. Confidence and a cool head go a long way. And sometimes I don't get it but that's just the way it goes. The more you do get, the more confidence you gain.

As for care plans, they can be a pain in the butt and not all facilities do them the way that we have to do them as students but the thought behind them is imperative to being a good nurse. It gets you thinking like a nurse. What are the concerns I have about this patient based upon their diagnosis and my assessment? What symptoms are they exhibiting that support my concern? What outcomes am I trying to achieve for this patient? What can I, the nurse, do to get these outcomes going and what is the rationale behind my interventions? Eventually, this will become our thought process. Basically, it's why are we doing what we are doing.

I have had some bad clinical days and some great ones and I've driven home crying from both types. There are days that you might wonder why you are in nursing school and then some days that really remind you why you are. It's a scary thing to be doing something that you don't feel comfortable with and not know what you are doing but you are never alone. You always have someone to go to. Although it may seem like it, you are not being thrown into a situation all by yourself.

Just remember, be confident in yourself. Know what you know, know what you don't know, and know where and how to find out. And my favorite, fake it until you make it. You've got this!

[link51411]

I passed out when we were practicing giving shots in the fake fat pads. and now I work in a neuro ICU where i help MDs drill into brains go figure