On clinicals.

sailornurse · Oct 23, 2015

Hi,

Wow you have only had one clinical day at the hospital? Be Gentle on yourself. Many of us have felt similar, yeah it's one thing to practice on manikins in lab or on another student. Go slowly & carefully. Try carrying index cards in your pocket with the steps of things to remember. Review quickly before entering patient's room. Have you talked with other students? I doubt you are the only one feeling this way. Yeah, it's scary.

I remember teaching clinical, one young student who kept reporting back that her patient was still asleep, breakfast trays had arrived. I watched as she stood in the doorway & peeked in. So, I walked towards her and said If we don;t wake him up, his food will get cold. I woke her patient up, introduced myself and my student, hung around as she helped him up, and explained that we would be back later to listen to his heart, lungs and also to help him wash up. I knew she was terrified.

Have you talked with your instructor?

dreamer0x · Oct 23, 2015

I feel that because your anxious it affects your performance. I believe you know what you're doing it's just that you're nervous. I know because when I get nervous I mess up on a lot of things such as public speaking, job interviews, when I went for my driving test my nerves are what failed me, but at home I knew what I was doing. Today in lab i was nervous because while performing the skill everyone was watching and of course I messed up a few times. I know when I start clinical I'll probably be in your shoes. Hopefully it get better for the both of us!!

akulahawkRN, ADN, RN, EMT-P · Oct 23, 2015

First off, don't be so hard on yourself. You're only in, what, your first week of fundamentals? Of course you're going to miss little things! Do patients terrify me? No, not really. Before getting into nursing, I worked in EMS for 7 years, having thousands of patient contacts. I kid you not, thousands. Then I stepped away from patient care for the better part of a decade. Yes, lots of knowledge and skills get very rusty over that amount of time. What terrified me when I went back and saw my first patient on a med/surg floor at a local hospital? That I might forget to assess a body system or something.

My program required us to use specific assessment sheets to gather our physical exam data for our first semester. My first assessment of my first patient took the better part of 45 minutes because I felt I needed to address every part of that sheet. Fortunately for me, I had a very patient patient. What did those assessment sheets do for us? They made us assess patients in a systematic way so that we didn't miss something. Try to "cluster" your care activities together so that you're assessing while doing ADLs or doing a bed bath or bringing a meal. This way you're disturbing your patients as little as necessary. Over time you'll come to understand when it's OK to wake someone up to do an assessment, provide food, or do a med pass and when not to.

When I introduce myself to a patient, especially if I'm a student, I announce myself as such, ask for their patience and forgiveness at being slow, and allow them the dignity of refusing to have a student care for them, if possible. Now that I'm a working nurse, I simply introduce myself as their nurse, how they can contact me (call bell) if needed, and then I ask them what their concerns are. After that, I do my assessment and figure out what needs to be done, if anything.

I'm an ER nurse, but I'm not that removed from working a med/surg floor (yet).

Many patients actually like having students care for them because they actually get increased attention and help doing things. Why? You only have one or two patients to deal with instead of a full load. That alone gives you more time with each patient. Some of them almost feel a little pampered, even though they're not feeling entirely well.

Yes, you're learning to be an LVN/LPN. Yes, I'm an RN and do things a little differently. Doesn't matter. You're learning. Work on assessing patients in a systematic fashion and remember that patients don't necessarily have to disrobe for you, you just need to know how to assess what you need. This way your patients at least get to have some small amount of dignity and privacy. Oh, and in a way, nursing involves a bit of acting... learn to put on and take off "the nurse face" that you'll learn to have. It helps mask your discomfort and helps your patient feel like you're used to whatever happened. Trust me, a HUGE messy "code brown" in bed is embarrassing enough, but if you look like it's just part of doing business, then you've just lessened their embarrassment. Make sense?

NotAllThoseWhoWander · Oct 30, 2015

Hi,
Wow you have only had one clinical day at the hospital? Be Gentle on yourself. Many of us have felt similar, yeah it's one thing to practice on manikins in lab or on another student. Go slowly & carefully. Try carrying index cards in your pocket with the steps of things to remember. Review quickly before entering patient's room. Have you talked with other students? I doubt you are the only one feeling this way. Yeah, it's scary.
I remember teaching clinical, one young student who kept reporting back that her patient was still asleep, breakfast trays had arrived. I watched as she stood in the doorway & peeked in. So, I walked towards her and said If we don;t wake him up, his food will get cold. I woke her patient up, introduced myself and my student, hung around as she helped him up, and explained that we would be back later to listen to his heart, lungs and also to help him wash up. I knew she was terrified.
Have you talked with your instructor?

I have made it known that I'm nervous, yes. It's gotten better though. Recently we were paired off with nearly-graduated nursing students, and my mentor really calmed my nerves (especially when I watched her do it).

NotAllThoseWhoWander · Oct 30, 2015

I feel that because your anxious it affects your performance. I believe you know what you're doing it's just that you're nervous. I know because when I get nervous I mess up on a lot of things such as public speaking, job interviews, when I went for my driving test my nerves are what failed me, but at home I knew what I was doing. Today in lab i was nervous because while performing the skill everyone was watching and of course I messed up a few times. I know when I start clinical I'll probably be in your shoes. Hopefully it get better for the both of us!!

I feel ya. It's been getting better with experience though. We'll both be fine :) I just made a calming mixtape to listen to on the way to clinical. We'll see if it helps or not.

NotAllThoseWhoWander · Oct 30, 2015

First off, don't be so hard on yourself. You're only in, what, your first week of fundamentals? Of course you're going to miss little things! Do patients terrify me? No, not really. Before getting into nursing, I worked in EMS for 7 years, having thousands of patient contacts. I kid you not, thousands. Then I stepped away from patient care for the better part of a decade. Yes, lots of knowledge and skills get very rusty over that amount of time. What terrified me when I went back and saw my first patient on a med/surg floor at a local hospital? That I might forget to assess a body system or something.
My program required us to use specific assessment sheets to gather our physical exam data for our first semester. My first assessment of my first patient took the better part of 45 minutes because I felt I needed to address every part of that sheet. Fortunately for me, I had a very patient patient. What did those assessment sheets do for us? They made us assess patients in a systematic way so that we didn't miss something. Try to "cluster" your care activities together so that you're assessing while doing ADLs or doing a bed bath or bringing a meal. This way you're disturbing your patients as little as necessary. Over time you'll come to understand when it's OK to wake someone up to do an assessment, provide food, or do a med pass and when not to.
When I introduce myself to a patient, especially if I'm a student, I announce myself as such, ask for their patience and forgiveness at being slow, and allow them the dignity of refusing to have a student care for them, if possible. Now that I'm a working nurse, I simply introduce myself as their nurse, how they can contact me (call bell) if needed, and then I ask them what their concerns are. After that, I do my assessment and figure out what needs to be done, if anything.
I'm an ER nurse, but I'm not that removed from working a med/surg floor (yet).
Many patients actually like having students care for them because they actually get increased attention and help doing things. Why? You only have one or two patients to deal with instead of a full load. That alone gives you more time with each patient. Some of them almost feel a little pampered, even though they're not feeling entirely well.
Yes, you're learning to be an LVN/LPN. Yes, I'm an RN and do things a little differently. Doesn't matter. You're learning. Work on assessing patients in a systematic fashion and remember that patients don't necessarily have to disrobe for you, you just need to know how to assess what you need. This way your patients at least get to have some small amount of dignity and privacy. Oh, and in a way, nursing involves a bit of acting... learn to put on and take off "the nurse face" that you'll learn to have. It helps mask your discomfort and helps your patient feel like you're used to whatever happened. Trust me, a HUGE messy "code brown" in bed is embarrassing enough, but if you look like it's just part of doing business, then you've just lessened their embarrassment. Make sense?

First of all, thank you SO much for taking the time to write all of that. It helped - it really did. I'm just now understanding the importance of clustering care, and I think it might be a huge cause of my nervousness. Tomorrow I'm going to leave behind the clunky clipboard, and go off of my pocket notes. Maybe I won't feel so tied to a sheet of paper.

Thank you for the patient care tips. I need them, in such a foreign environment! :bugeyes: