PTSD as a result of nursing clinicals?

llg, PhD, RN · Sep 16, 2014

I had some emotional scars from a bad 1st clinical instructor (and I had the same instructor for 2 full semesters!) over 30 years ago... so I can understand how that can happen. Yes, it did trigger anxiety -- and some of the effects of that bad experience have stayed with me throughout my career. Fortunately for me, I was able to overcome that bad experience.

If you feel your level of anxiety from school is more than you can handle by yourself, then I urge you to seek some help from a professional counselor.

workinmomRN2012, BSN · Sep 16, 2014

I also had 2 clinical instructors from HELL!!! here's the kicker...I work at the same hospital that I had clinicals, thank God I had 2 jobs elsewhere to be able to practice my skills and to build up some self esteem. I am not as stressed out when I see then in the hall or even on my floor with students. I do ask the students how there instructors are and they say that they are scary and I try to reassure them that they were the same way with me, so they don't feel alone and that they can ask me questions before they have to do a skill with the instructor. BTW I do still daydream about what I would say to these 2 instructor's if I was alone with one of them on an elevator. They were NOT nice!!! and your right they do favor some students.

ICURN3020 · Sep 16, 2014

Definitely seek professional help for your anxiety. Although some view those with anxiety as "weak" and advise to "just suck it up / tough it out", those of us with anxiety and anyone educated on it know that's not how it works. Anxiety is a horrible feeling and can wreak serious havoc in one's life. I would think that you could be suffering from PTSD if your experience was traumatic for you. We all interpret and experience things differently.....what was traumatic for one person may not affect someone else in the same manner; our experiences are subjective. My advice to you is to address your anxiety/stress issues with your doctor and follow the treatment plan that works for you. Also, in the future (and I know this is much easier said than done), do not allow others, even if they are in a position over you (manager, instructor, etc.) to have that much control over your confidence and emotions. I'm not discrediting your anxiety/panic symptoms, as I know they are just as real as any physiological disorder's symptoms. We have no control over how others choose to treat us or talk to us. We DO have control over how we internalize their actions or words and the manner in which we react. It's not easy by any means, but with help and practice and lots of positive self-talk and reinforcement, it can be done and it's very freeing to not allow others control over your mind, spirit or attitude. Good luck on your NCLEX! ☺

firstinfamily, RN · Sep 17, 2014

I agree with the above, but I think ICURN3020 says it best. Your anxiety is the result of your reaction to what someone else has done or said to you. I will say that in most nursing schools there is a least one instructor who seems to be the witch to target the more sensitive students. They kind of prey on these type of people. Most likely some of your fear/anxiety is due to the way this person made you feel. How demeaning, threatening, vulnerable she/he made you feel. Insecurity and low self esteem can end up causing feeling and symptoms of anxiety. You kind of have to analyze what exactly is it that triggers your anxiety and what you need to do to help re-wire the reaction. For years I would have a sinking feeling around 2:30 in the afternoon when I was working. I finally figured it out that was when I left my house for the 3-11 shift and it was going into work and not knowing what I was walking into that seemed to set it off. I did it so often that I had a conditioned response, meaning my body set off this multitude of symptoms naturally. How did I over-come it? I learned how to do imagery and deep breathing to decrease my anxiety symptoms. It takes a lot of practice and concentration. Having those same sensations that the instructor seemed to bring out will most likey always cause the symptoms of anxiety. You have now a "reference point" to know how that felt and the fear of the anxiety coming back can be very intimidating. I would stay on your meds for awhile, I think everyone gets very anxious about NCLEX and that is normal. Some anxiety can be productive, when it overtakes your normal functions is when you need to get assistance. I do believe PTSD can be caused by any traumatic event----we all interpret traumatic events differently. Perhaps for you being made to feel insignificant and threatened by the possiblity of failing triggered those symptoms. There is an old article from back in the 60's by Zung---Anxiety Scale rating. I have used it with patients who were exhibiting symptoms of anxiety to the point it was preventing them from participating in their PT to fully recover. It made sense to show them the causes of anxiety and how the level of anxiety can impair them. YOu might try to google it. Sorry, I only know it was a study by Zung and titled Zung's Anxiety Scale. Good luck on NCLEX!!

sunshinerainbows · Sep 18, 2014

Not a clinical but...

I had a TA once who failed me in a class (I've never even come close to failing a class). It was a writing class, and writing has never been my strength, but the papers weren't that bad. Anyway, after tossing a few mediocre grades at me, he flunked my final paper. The way he did it too...he took points off for not having components in the paper that were clearly there, and spelling errors that were not.

I pursued the issue of having all of my papers from this class re-graded and got a B+. To this day, I struggle immensely with writing anxiety. It takes me about a full day to pound out a single page even for the most basic class. It's getting better in time.

I know it's not the same as clinicals, but sometimes people don't appreciate the impact of cruel teachers.

Delicate Flower · Sep 18, 2014

I don't know whether your symptoms could be called PTSD, but they are defininitely under the anxiety/panic attack umbrella and are severe enough to get in the way of your work and life. I would make an appointment with your MD ASAP. There is no need for you to deal with these debilitating symptoms. Medications can help.

I had a clinical instructor who brought me to tears on many occasions. I wasn't like many of my classmates who had worked as aides or techs before going back for RN. I had never even set foot on the inpatient hospital world and I had no idea what to expect. In those beginning clinicals I struggled to answer the question: what does a nurse do, exactly? What is the big picture? I had a vague idea, but I didn't really know.

I made the mistake of asking this instructor to help me clarify the issue. After a brief pre-conference, he gave us our assignment and released us to the floor, telling us to be back in 8 hours. Before leaving the room, I asked him something to the effect of: can I just review something with you? What are the things I need to focus on accomplishing during these 8 hours with my patients? What are my goals and objectives?

Instead of answering me, he gave me a stern look and told me to follow him, then led me to an empty patient room. He shut the door, and then let me have it. He said "There are 12 other students in this rotation. Every single one of them, besides you, knew exactly what they were supposed to do and went out to the floor to do it. Why is it that you have no idea what you are supposed to be doing?" I cried like a baby.

When it came right down to it, I was over-complicating things (I have that tendency). I knew essentially what I was supposed to do. I just made the mistake of thinking my instructor was there to guide me and help me build confidence. I explained to him that I was just a little foggy on what exactly a nurse's day looks like. How does she organize her tasks? How does she manager her time? In those days, we were forbidden from "bothering" the patient's assigned nurse. We were not to ask them any questions or otherwise take up their time. It wasn't like the students I see now who basically get to shadow the assigned nurse.

My "punishment" was that I had to come back on my own time and "shadow" a nurse during her shift at the hospital where we were having clinicals. I had to take a day off work to do this. The nurse used me as a free "aide" and was sending me off to do CNA type tasks and I really didn't even get a better understanding of what the RN shift was like. But overall, it helped me get over myself a little bit and come to realize that I was making things a lot harder than I needed to.

tortorRN · Sep 21, 2014

I truly appreciate everyone's response. I no longer am experiencing any anxiety. I was extremely stressed out last week and I believe that contributed towards it. I do plan to see a doctor about this issue, but will not be until after I move across the country. I want to be able to overcome this and I hate that I can 'hear' my instructor's voices taunting me when I am feeling anxious.

Also, I passed the NCLEX with 120ish questions in just under 3 hours! Woot! It was exactly the confidence booster I needed!

vintagemother, BSN, CNA, LVN, RN · Sep 22, 2014

I already had a dx of PTSD when I started nursing school. I do recall having anxiety during school. My school was very unorganized and had some "interesting" teachers (who couldn't teach).

What worked for me was to seek ways to learn how to learn on my own. Also, "fake it till you make it" this means exuding confidence even when you don't feel confident.

I also had to take meds for anxiety a few times, on top of my regular psych meds.

I proved/showed I was a good nurse. It was obvious. Never let them see you sweat.

Asking questions made you a target. Not fair, but my school was like that, too.

Good luck!!!

Sue23 · Oct 6

Yes. You can get PTSD from nursing school. Especially if you are attending a toxic program where teachers meet together and discuss "problem students". The place I attended did this to students and there were certain students that felt like they had a target on their backs. And they actually did (figuratively speaking). My friend ended up teaching there and the "teachers counsel" actually encouraged her to flunk a student even though the student passed their class. This was all because they determined that she was too weak. My friend quit working there.

I did really well in my schooling until I got to a teacher that decided I was too confident and flunked me for my process paper. She said she thought I cheated on it. I spent hours working on it and trying to make it just perfect and she destroyed it. Failure of a process paper meant failure of clinicals and therefore failure of the class. I had to beg to get back in the program and then I had to repeat my medical surgical rotation over and over again for an entire semester as penance for my failure to pass the class. The teacher even gave me bad marks for using too many gloves. It was crazy and I was a defenseless, young student without the gumption to speak up for myself and contest the mistreatment I was given.

That teacher ended up being my "mentor" (read warden) for the rest of school and I had to prove to her that I did my work correctly. I had to meet with this twisted person every semester to discuss my academic progress.
I developed hyper-vigilance surrounding clinicals and process papers. I was paranoid of something a teacher could do to blindside me. The teachers scrutinized me and evaluated me as if I was a seriously flawed student (even though I was passing my classes and getting really high marks on my process papers). The general consensus from the other teachers by the end of each rotation was that they didn't understand why I was held back. But my "mentor" was bent on making sure I was a "good student".

I developed sleep problems due to anxiety over clinicals and fear of suddenly being flunked out of the blue. It was absolutely insane. Nobody should be made to feel like they are flawed for being confident in their schooling. I always recommend that every student fly under the radar if they want to survive a crazy environment like that. It was straight up emotional abuse and abuse of power.
I battled depression and anxiety and extreme hyper-vigilance in the years to come. And I still battle hyper-vigilance to this day because of the ingrained fear of getting something wrong or failing. I reword everything I say and rewrite sentences just so I mitigate any chance of being misunderstood. I ask questions forward backward and upside down just in case I misunderstood what someone said to me.

My word of advice: If somebody is targeting you in school, report it to a governing body so they do not get away with harming other students too.

And if you have developed anxiety or depression from nursing school, I recommend getting psychological help sooner than later. You need to be able to function as a nurse and battling those mental health issues alone will not help your case.

P.S. I passed my NCLEX in 75 questions.