onewill

That is a true statement.

Absolutely! I would appreciate that very much.

You have been very helpful. I have not quite landed on ideal brain sheets. I am definitely grateful to see what you are using. I'm not good at remembering the patient specifics without them - I'm stretched too thin for where I'm at in my development. Thanks again!

Hi, I am going into my second year of my ADN program and hope to get an RN position at my local hospital so I want to now get a position as a CNA there. It makes sense that I highlight that I am a nursing student who has done my clinical rotations at this hospital. However, I am wondering if it would be a good thing or a not-so-good thing to list my student RN skills like IV starts, medication administration, NG tube insertions, Foleys, etc.. I know as a CNA that I won't be applying these skills and I don't want to make it appear as if I might inadvertently have some role confusion if I am hired and overstep my scope. What do you think? Thanks so much!

Thanks for posting that. I am in nursing school and as a former social worker, I am drawn to the hospice field where a nurse can establish relationships. However, I understand that the pay is significantly less than other areas of nursing, yes?

I believe you have been honest as well as very respectful. Thank you for advocating for new nurses...it enhances patient care in the long run.

Oh gosh do I feel your pain!

Amen.

Apparently some nurses think it's ok to eat their own young. Mentor and support the new ones for the very reason that it IS a tough profession! Someday they will be taking care of YOU - why make them bitter!

I think it sets up a student for errors and patients for harm to expect a novice to manage such a load safely.

Wow. I must say there is some definite wisdom there thought I'm sure not all would agree with the length of time it takes to get up to speed. I think your situation suits a student like myself better. I was having a challenging time maintaining safety in my third semester going from 2 to 3 patients. For our last semester, it will be a preceptorship with the expectation that you can get up to 5 patients.

That actually sounds like a great idea! If you are immersed day after day in that environment you keep taking steps forward without the loss of momentum in having several days off. I'm just hoping to make it to my final semester..I'm repeating my third semester due to my inability to advance to more patients efficiently and safely (I was going from 2 to 3).

Again, your post was extremely helpful and I plan on using it as a template to plan my clinical day. I hope you are mentoring up and coming nursing students in your program - you seem to have a handle on how to tackle the sometimes not-so-reasonable expectations.

Hi. This is like my clinical expectations. My ADN program has a good reputation; however we are in the same town as a magnet hospital and it IS difficult to get a job there unless you have a BSN. You sound like a bright and talented individual well suited for a rigorous nursing position. Do you feel well supported by your nurse or instructor or more stressed by one or the other?

Hopefully this thread is helpful for other instructors to read. It's certainly helpful for me to write about it. I'm grateful for the honest feedback I am getting. Yes, the night before, we have one patient that we do our prep work and thorough research on as you've described and present a short written clinical worksheet that takes a few hours to prepare. The next morning, one and then two more patients are added on the fly during report. Your point is well taken about standing up for myself. I did try that tactfully yet there were some instances that weren't worth standing up for myself - sometimes it is just better to accept the criticism whether or not it feels fair if you have an instructor that seems to be triggered by you. The pinnacle of my demise in my third semester was when I was flushing a saline lock to prepare to switch it to a pump infusion. It leaked clear saline under the clear tagederm - I simply couldn't identify it like I would if it had a blockage or if it infiltrated. But it leaked under the arm and gravity caused it to drip under the elbow where I couldn't see it for what it was. I thought it was a good teaching and learning moment as it was a tricky thing to identify for a novice like me who has only read about such a complication rather than see it with my own eyes. My instructor pulled me off patient care immediately and to my shock, told me she would need to send me home rather than let me finish my shift. This is when I did look my instructor directly in the eye and I firmly stated, "I don't want to go home, I want to learn - you are my teacher, please teach me. I've been improving, I know I can be successful - why aren't you invested in my success??" It was a pretty intense exchange but it saved me from going home; instead, she pulled me off patient care and allowed me to shadow her as she supervised and helped other students (during which time, I saw that one of my peers was about to give a deltoid IM injection into the subcutaneous tissue under the arm - my instructor verbally guided her to the proper anatomy without ill repercussions). That's when I realized that my instructor had a negative personal bias towards me and that my semester was going to be futile - she did not treat the other student like me. I was written up and within two weeks of that I withdrew because her scrutiny became more relentless and it ultimately broke me. I believe I earned her respect...but it was more important for her to be "right". She happened to be adjunct faculty and maybe she was trying to prove herself to the nursing department. To be fair to her judgment, it is true that as I was "breaking", I began making mistakes when she came to supervise me (contaminating tubing and having to replace, contaminating my sterile gloves and having to replace, having a sealed baggie of labeled pt meds drop out of the pt binder I was carrying and get picked up by another nurse, it made me look like a total bobble head that had no business being in nursing, I just sunk). Instructor case was made and I withdrew rather than risk imminent failure. I was an A- student prior to this. I want to learn to be a good nurse. I'm willing to remediate, put in extra hours outside of clinical practicing skills, but it is so much better for handling pressure when you sense that an instructor really wants you to succeed and recognizes what you're doing well or acknowledges your continued improvement. I am grateful for having a forum to help me make sense of my educational experience.

You rock black sunflower! I am going to save what you've written (I'm new to this and must figure out if I can copy and paste what you've written (do I have you're permission??) so that I can apply it to my typical shift (assignments are NEVER completed by 630 so I would have to adjust accordingly and most night nurses will only report once, not sooner and when they're good and ready -- when they're dealing with a student. Some are more cooperative). You've given me more guidance than I have gotten from my instructor...when we started the third semester, she said - "this is the semester that you need to 'show us what you got' " meaning we were expected to be able to know to do this as you've laid out. Ostensibly within a couple of weeks anyway. I have done as you've recommended and then some with my instructor in terms of speaking to her in person, outside of clinical and after clinical to let her know how I best learn and that the pressure I was beginning to feel was starting to become the barrier, not the learning curve itself. I AM going to hang in there and hopefully my reputation with the rest of the instructors for next fall isn't too sullied that they will give me a fresh start to be successful. Thanks so much for your time to offer such a thorough plan!

We do work up to four patients by the end of the semester, not the beginning. First day or two, it is one patient. Second week, it is two and we stay there for a couple of weeks then it is three patients for several more weeks, then four towards the end. At the time I withdrew at 8 weeks, I was having trouble going from 2 to three patients - I was beginning to make mistakes and getting frazzled because I was starting to fear my instructor and my brain would just freeze. Interestingly, my peers in other clinical groups with other instructors were not hitting the wall I was hitting in this particular semester. My first two semesters we worked from one the first semester to two the second semester. I didn't have this anxiety those first two semesters. My instructors were tough but I didn't fear them and they gave good and positive feedback in addition to criticism. They helped me believe in myself. So to answer your question about new floors - We get rotated on the different floors in an unpredictable manner at the beginning of the semester so by the end of my shift on one floor, I have gotten used to the layout but one week later, I would be on a different floor. Then might end up on that original floor the following week but I've lost some of my familiarity by then and there is some backtracking and retracing steps again. Many of us could be released to work with our primary nurses. My instructor kept a tight hold on me which I believe made matters worse as she wasn't bringing out the best in me - so was helping to create crisis. I really needed a breather from her so that my brain could function like I knew it could. But again, I don't do well if I am pushed more quickly than I am ready anyway so it made sense to try and redo this semester, recover from my downfall, and get a new instructor for the fall. I hope I will be in a better place to handle the demand...also other instructors may be more patient and allow for individual differences.

Well, we don't get 5 until we get into our fourth semester of the ADN program. In the first half of my 3rd semester, I was going from 2 to 3 patients at the time that I withdrew. It wasn't just the number of patients, I felt it was the deadlines throughout the shift that I was pressured to meet (in a safe manner). You make some good points and now I don't feel so self-denigrating about not meeting a bar that was set too high too soon for me. However, it will be the same way when I return: start at 2 at the beginning of the semester, work up to three then four...but hopefully I will get an instructor that is more like your second one. I am interested in what other instructors might have to say about the expectation of working up to four for the third semester. Not having autonomy with retrieving meds and being unfamiliar with where supplies are on the different floors we get assigned to (we get a new floor every week or so) can sure hamper efficiency. Counting all actual clinical days in the semester, it amounts to 18 days on the floors. Thanks for your response, Tait.

Yes, I have decided to find a job as a CNA or tech. I think it would be good for me to get used to the hustle of a caseload. As for my clinical experience, we work with primary nurses that we depend upon to get meds out of a locked pixus for us...so I find that a fair amount of the time, this impaired my flow of care if they had other priorities with their other patients. After report, I would wait for a computer to look up labs, admit. and hx, and care plan and plan it out on my brains. Daily weights, I/O's, q4h pain assessments, finding my primary nurse to get me patient meds, turning pts, glucose, insulin on pts due at the same time, etc. Bed baths and trash changes are done by auxiliary staff; however toileting/changing is our duty if we see it first. I don't spend much time talking but I did find that charting on a new system I wasn't used to was pretty slow going. Also, getting used to a new hospital with new supply rooms and such also added on extra time so the beginning of my semester I wasn't a "hustler". The policy for giving meds is one hour before or one hour after the due time; however, I found that my clinical instructor was harsh with me if they were 15 minutes after the due time...so I felt pressured there, especially in a new med room and calculating and preparing IV push meds for the first time this semester. When she pressured me, I once made an incorrect calculation. I felt I wasn't safe at the speed I was being pressured to achieve. New IV pumps...I needed help the first couple of times to operate, then after that I could do on my own but I wasn't quick with it; if I tried to go quickly, I would catch myself about to make a mistake (and my instructor was good at seeing the imminent mishap a second before I would!) and this all contributed to my instructor's sense that I was incompetent without her presence. Very demoralizing and it mentally got to me so that my natural learning became impeded by my fear. Anyway, I do feel like I could have benefited and still can benefit from advice on how to tackle a caseload of 3 the first half of the semester, work up to 4 by the end of the semester and be ready for five for the final semester. I had 7 weeks under my belt this third semester which added up to 11 clinical days total so at least I will have that as I start fresh at the beginning of the same semester again...and definitely with a different clinical instructor that I mesh better with. I think my biggest challenge is seeing the whole picture of what each pt needs at what time and who to see and what to do first especially when they have things due at the same time. I am told that this takes experience to perfect; however, I was feeling pressure to achieve a competency level too quickly to be safe. I have worked so hard to get this far that to think I could be weeded out because I'm not building that focus and organization as quickly as I am expected to (I DO believe I can get there) often wakes me up in the middle of the night. Like I said, Hopefully CNA experience will get me used to the hustle of a caseload. Thanks so much for replying to me.

Wow, that is great feedback! The most reassuring thing you shared with me is the experiences of "near" failures that ultimately turned into successful nursing careers like yours and your classmate. I have just withdrawn from my third semester not because I am not "smart" enough but because my confidence was shot and by the end, I was beginning to make silly mistakes which compounded the criticism from my instructor who already had me in the cross hairs. Again, a mental focus issue. So like you, I am now set back a semester but am trying not to lose hope and to believe that just because I have hit this wall, I can still go on and be a good nurse. I know I'm salvageable ! I welcome any other feedback and additional suggestions from others who have walked the path or from other clinical instructors. Thank you !

I am a 3rd semester RN 'A' level student. I have discovered that though I am good with theory learning and do well with NCLEX study questions, I am struggling with my clinical performance. It seems that in carrying out patient care, I am "behind" schedule and need a better system of approach to my shift responsibilities. One barrier is that I am experiencing nerves and anxiety symptoms that I haven't had before because of the demeaning methods of my clinical instructor. My heart starts pounding as soon as I see her. I want to learn, I'm eager to become a good nurse. I spend more hours in campus lab than anyone else to master skills. However, I believe my weakness is an organized execution of my duties. We have been told that this is the semester is the semester to "show them what we got" meaning we should somehow have this organized approach to multi-tasking down already. Some of us do - like the ones who were CNA's for years. That Isn't me. And I don't seem to be learning how to develop this when I am barraged with criticism rather than offered support and true teaching. I wish there was a blue print or flow chart that teaches folks like me how to approach prioritization of care in an atmosphere of multiple priorities; I'm not getting it through mentorship - I just feel like I've been dumped on the floor and expected to perform beyond my current capabilities, under pressure, and without a road map. I was told by my advisor that some students like myself just hit a wall in this semester and can't continue. I've worked too hard! I'm a good critical thinker! Does anyone have any suggestions for remediation? Books, videos, etc. that address this and might help me help myself? Thanks so much. I know I can do this with the right help !