This is a bit tough for me to explain coherently, so please, bear with me. I'd really appreciate the thoughts/opinions/advice of the members here as all the evidence (i.e. your postings and responses) are filled with intelligence, social awareness, warmth and understanding.
Here's the background: I'm a 20 year old nursing student - sort of second year, kind of first year. I did the first semester of first year but only one subject (non-clinical) in second semester, because I was unwell. So now I'm sort of meshed between the two. I also work as a nursing assistant in a nursing home and in a hospital for profoundly disabled children. I've also spent a good deal of time around hospitals as a patient (chronic asthma as a child) and a relative/visitor (elderly grandparents - the works.) So, I have a fairly decent basic understanding of how a hospital ward works (simply in comparison to many of my fellow students who've never set foot in a hospital!)
& the story: my clinical placement last semester was my second clinical placement for me, but the first for everyone else in my group. We were divided into pairs and assigned to different wards and we were to spend the week on AM shifts on this ward. I was placed with a shy, nervous, unsure international student (we had the same name!) on a respiratory ward, which was exciting as there were lots of things to see and to learn about.
The design of our clinical is that we are buddied up with an RN on the ward and our facilitator comes to check on us/visit once or twice throughout the shift. On the first day, this was fine and all went to plan. However from the second day onwards it became our responsibility to find a nurse to buddy with (most not being very receptive to students, we often ended up with casuals who had no idea about the ward) and try not to step on anyone's toes. It was very much a balancing act between learning/meeting our objectives and not getting in the way of the staff or treading on their toes. We certainly did the best we could, anyway. & though it was often very uncomfortable (dirty glares, being ignored etc) we did learn some amazing things (saw my first trach, TB pt, ND tube, PICC & CVC etc.)
However, my facilitator (who was barely around and took most of her reports from the staff on the ward, with whom which she normally worked) wasn't impressed with my performance and gave me an unsatisfactory grade. She cited poor professional behaviour as the reason and gave several examples which I'll share with you now:
I, naturally, have a loud voice and often failed to control this in the clinical setting
Whilst observing a bronchosocopy I let out a small, shocked "oh!" on the sight on an extra large glob of sputum on the screen. Totally unacceptable, as even though the patient was sedated, they were still concious and I could have scared them awfully! I recognised my fault immediately and shut the hell up and apologised to the nursing staff in the suite following. (Unfortunately, they intreperted my "oh" as an "ew" and passed this on to my facilitator.)
An exceptionally confused pt telling me that I spoke to loudly (after I'd gone to trouble of massaging his feet when no one else wanted to go near him because he was v aggravating!)
Myself and a casual nurse were tossing between getting a pt up for a shower or sponging him in bed. She'd decided on a shower and I went to hunt for the commode chair. When I returned the NUM had said best give him a sponge (probably a good choice, too) and reported to my facilitator that I wasn't following instructions or working as a team.
I appeared "overly confident". I'm not sure whether this should be put down to the fact that unlike the other students, I wasn't squeamish about giving a shower/sponge because I'd done it 100x before and knew my way around the hospital (which I was familiar with) or because when I'm nervous I dont withdraw, I tend to try to push through it by asking if there's anything I can do to help or asking questions about things Im curious about (e.g. the trach pt)
Asking the NUM at the nurses station about a pt's status and what her prognosis was. This was the wrong place to conduct this conversation, but I felt it in poor taste of the NUM to report me for doing this when she fueled the fire, so to speak, by providing the nitty gritty details
Apparently I interupted the NUM on the phone (I have no recollection of this and can't imagine myself doing so.)
I don't want these examples to come off as defensive, because there's really no point in my insisting that I'm right and they're wrong. On some accounts, I feel I've been poorly treated in terms of miscommunication of situations (e.g. the shower chair) however on the whole, I think I have some issues that I need to work on regarding professional behaviour.
My next clinical is coming up in three weeks time and I'm really looking forward to it. It's two weeks on a haemodialysis unit! I want to improve my performance in terms of professional behaviour and I was hoping that the collective knowledge of allnurses might have some ideas. Specifically, I think I need a hand with:
Appearing meek, proactive and willing to learn without stepping on anyone's toes, getting in the way of the staff or stepping outside my role as a student
Lowering the volume of my voice consistently
Carrying myself as "a professional" - not a friend of the patient or the staff (and not an equal of the staff, either)
I'm sure that's not everything but I'm about out of ideas. I really do need some prods in the right direction. Nursing has always been my dream, ever since I was a little girl. & I'm not bad at it, either. I work three jobs as a nursing assistant - they wouldn't have hired me or kept me on if I were no good, right? But I've got a lot to learn.
