Seeking Advice/Encouragement for nursing school and beyond

[hopefulstudent223]

Hey there! 

I wanted to reach out on this forum in hopes of obtaining some advice/feedback/encouragement. I am in semester 3 and getting ready to enter semester 4 of nursing school in January.

Last semester (semester 2) we had to complete the second half of our clinical experience online due to COVID and this year we have shorter hours on the floor than normal for the same reason.  I have spent A LOT of time talking with my other classmates about skills that they've had the opportunity to perform and what they feel comfortable with.

At this point, I have only be assigned to up to 2 patients and this was only for 2 clinical days. Therefore, I have not really had the opportunity to practice multitasking or prioritizing patients and tasks. I have not inserted an IV, started a foley, given an IM injection, placed an NG tube, amongst other skills. I HAVE initiated one continuous tube feeding, given subcut/oral medications, and hung IV medications twice although I don't feel that I would be able to fly solo on this if I had to do it again. Meaning, I still feel like I would need some prompting or small reminders. The pump itself I feel may take some time to get comfortable operating. I've been advised by seasoned nurses to seek out a PCT or CNA position while in school but due to taking care of my family and ill mother, I cannot add that to my plate. I know my capacity for stress and I still need time for self-care as I deal with my own mental health issues.

I am continually told that the experience and comfort with skills will come when I am actually working on the floor and not to worry about it. HOWEVER, yesterday on the floor I asked a nurse if she needed help with anything and she offered to let me flush a dophoff ngt. I was excited to help as I am eager to learn. When we went to perform the task she states "You should be familiar with this at this point, right?". The answer was no. I was not familiar with this because I had only flushed one ngt prior and that nurse had me remove the plunger and do it by gravity. PLUS, that dophoff did not have a lewis valve on it (side note: can anyone explain why one would have a lewis valve versus not???). 

Anyways - I went to flush with the large syringe using the plunger as she had instructed and I was meeting resistance, so I looked at the nurse and she simply stated: "it's okay". I proceeded to try to flush and due to the buildup of pressure within the lewis valve (clearly due to a clog) the water sprayed everywhere. All over me, the nurse, and the patient's bed. I was mortified and apologized profusely and even though she said it was okay, I could tell by her face that it was not. She did not make any eye contact and instead, the nurse left me at the bedside and sent another nurse in to help me troubleshoot the issue. Meanwhile, I felt like I was unraveling or like I had done something terribly wrong.

I came home and searched videos on ngt flushing and did see that it could be done either by gravity or the way that we had tried it but it did not make me feel any better. At the same time, I am faced with questions on basic procedures. If a patient has a continuous tube feeding, how often and I flushing? How often am I replenishing? Do these protocols become second nature with time? Just looking to know that how I am feeling is normal(??).

I want to be the best nurse that I can be and I want to take care of these patients the best that I can (and I would like to stop feeling so incompetent). Everyone keeps telling me to worry about passing the boards and the other stuff will come later but that just doesn't feel right.

Anyways, I know this post was long-winded but hearing from people who understand where I am coming from would help me the most. 

If you are inclined to be passive-aggressive (or plainly aggressive) or discouraging I would kindly ask you to refrain from commenting. I promise you, I beat myself up enough for the both of us. 

Signed, 

Disheartened but hopeful

[LovingLife123]

OP, you are making way too big of a deal out of this.  I, to this day, have made a mess of flushing a feeding tube when it’s clogged.  It happens.  
 

You are not going to come out of nursing school with your skills down pat.  That does not happen!!  Ever.  You learn skills on the job.  You will go through an orientation.  You will learn then.  I never put in an IV or foley in clinical.  To this day, I’m not the best at getting an IV in.  I’m great at art sticks.  Just not ivs.  You won’t be great at every, little thing.

Work on your assessment skills.  That is the most important thing you can master. Truly.  The tasky skills will come.  The ability to do a good assessment is what is going to save your patients life, not flushing a feeding tube.

[hopefulstudent223]

3 minutes ago, LovingLife123 said:

OP, you are making way too big of a deal out of this.  I, to this day, have made a mess of flushing a feeding tube when it’s clogged.  It happens.  
 

You are not going to come out of nursing school with your skills down pat.  That does not happen!!  Ever.  You learn skills on the job.  You will go through an orientation.  You will learn then.  I never put in an IV or foley in clinical.  To this day, I’m not the best at getting an IV in.  I’m great at art sticks.  Just not ivs.  You won’t be great at every, little thing.

Work on your assessment skills.  That is the most important thing you can master. Truly.  The tasky skills will come.  The ability to do a good assessment is what is going to save your patients life, not flushing a feeding tube.

I hear you. Thank you for taking the time to read the post and reply. It's just so hard not to feel disheartened. I want to do well. Not only that but due to a low census on our floor, I've not had the opportunity to take care of more than 1 patient (except for the 2 days that I have had 2 patients - which felt completely overwhelming). Although, several other students have had a couple of days with 2 pts and even a day to two with 3 pts. Am I expected to be able to just jump into last semester with a preceptor and take care of 5+ patients and know how to prioritize patients/tasks? 

[LovingLife123]

1 minute ago, hopefulstudent223 said:

I hear you. Thank you for taking the time to read the post and reply. It's just so hard not to feel disheartened. I want to do well. Not only that but due to a low census on our floor, I've not had the opportunity to take care of more than 1 patient (except for the 2 days that I have had 2 patients - which felt completely overwhelming). Although, several other students have had a couple of days with 2 pts and even a day to two with 3 pts. Am I expected to be able to just jump into last semester with a preceptor and take care of 5+ patients and know how to prioritize patients/tasks? 

They won’t have you take care of 5 patients in your 4th semester of nursing school.  In the ICU I have two patients.  My students are never responsible for their total care.  We do it together.  My orientees don’t do total care until I feel confident in their assessment skills.  
 

I think you are thinking you are going to be totally prepared to care for patients when you graduate.  Nursing school prepares you to pass NCLEX and gives you a little introduction into the clinical arena. I would never hand a foley kit to my new grad orientee and say have fun!  I would pull it and I would guide them through it.  

[hopefulstudent223]

2 hours ago, LovingLife123 said:

They won’t have you take care of 5 patients in your 4th semester of nursing school.  In the ICU I have two patients.  My students are never responsible for their total care.  We do it together.  My orientees don’t do total care until I feel confident in their assessment skills.  
 

I think you are thinking you are going to be totally prepared to care for patients when you graduate.  Nursing school prepares you to pass NCLEX and gives you a little introduction into the clinical arena. I would never hand a foley kit to my new grad orientee and say have fun!  I would pull it and I would guide them through it.  

Thank you, you have really eased my mind. On a personal level, I work through severe anxiety. Obviously, it comes through in this post. It helps to hear that the expectation for our preceptor in the last semester is not to have the ability to immediately apply everything that we are taught in lecture and immediately replicate everything that we try our hand at in skills lab.

 

I have had to continue to lay down the need to feel perfect at it all and it has clearly taken a toll on my experience. I try to seek out opportunities in clinical as well and am always offering help to everyone on the floor. I don't care if it's something menial like taking a patient's blood sugar. I just want to participate. 

 

Do you have any suggestions or resources for assessment practice? Also, I'm assuming that identifying adventitious breath sounds and heart sounds is another thing that just comes with exposure and time? Sometimes I feel like I still struggle to identify these things. 

 

I appreciate you taking the time to talk with me. Seriously, thank you so much. 

[LovingLife123]

4 hours ago, hopefulstudent223 said:

Thank you, you have really eased my mind. On a personal level, I work through severe anxiety. Obviously, it comes through in this post. It helps to hear that the expectation for our preceptor in the last semester is not to have the ability to immediately apply everything that we are taught in lecture and immediately replicate everything that we try our hand at in skills lab.

 

I have had to continue to lay down the need to feel perfect at it all and it has clearly taken a toll on my experience. I try to seek out opportunities in clinical as well and am always offering help to everyone on the floor. I don't care if it's something menial like taking a patient's blood sugar. I just want to participate. 

 

Do you have any suggestions or resources for assessment practice? Also, I'm assuming that identifying adventitious breath sounds and heart sounds is another thing that just comes with exposure and time? Sometimes I feel like I still struggle to identify these things. 

 

I appreciate you taking the time to talk with me. Seriously, thank you so much. 

It takes practice.  I used to assess my kiddos all the time.  I would look and listen to my husband.  Make sure when you do have clinical you are using those opportunities to assess.  Do full head to toes.  Look at their pupils, feel the squeeze of their hands, listen to all lobes, palpate pulses, listen to the belly, look at their skin thoroughly.  This is your foundation.  Putting in an IV successfully on the first try means nothing if you don’t know the signs and symptoms of a stroke.  Or when the difference in ronchi or wheezing listening to your pt.

This is why I say homing your assessment skills is so much more important for a new grad.  I want my orientees to at least be able to tell me something is different.  They may not know why it’s different but their pt is different.  

["nursy", RN]

What I'm going to say is not to scare you, but just to give you some reality.  If  you read enough posts of new grads on this forum, the constant theme is one of feeling overwhelmed, and not knowing what you are doing.  Nursing is hard and there is A LOT to learn. You cannot learn it all in  a book.  You cannot learn it  all even during the bet preceptorship in the world.   It takes time.  It takes many experiences repeated over and over.  It takes having to multi task and developing organizational skills, which cannot be taught in a classroom, or during a clinical rotation.  I think your approach is good; it's obvious you are caring and want to do the best job that you can.  You are trying to learn as much as you can, and that is commendable.  And in the long run you sound like you will be a wonderful nurse.  But you will not be the nurse you want to be on day one.   NO ONE is the nurse they want to be on day one.  Keep on doing what you are dong.  And don't be so hard on yourself;  you will make mistakes and you will do dumb stuff.  And you will learn from  your mistakes and be the better nurse for it.  Good luck and hang in there.

[hopefulstudent223]

Thank you so much for your advice and kindness. I sincerely appreciate you.

 

[rachelalexis23]

OP, I am in the exact same boat! I could have written this post myself almost verbatim. I too am in my third semester and feel EXACTLY like you do! Thank goodness I am not the only one, and thank you to everyone that has replied. I hope other students read this and feel some relief as well. Trust me I will NOT be one of those nurses the seasoned nurses talk about coming out of school acting like they know it all 

[MelEpiRN]

"I have not inserted an IV, started a foley, given an IM injection, placed an NG tube, amongst other skills"

I only recall maybe giving IM injections when I went to school? (Sorry, it was a long time ago). You'll learn that stuff eventually, don't sweat it.