Seriously hating clinicals - please help

anonymous1919, LPN · May 22, 2010

As a nursing student you are not there to do the nurses or CNA's job for them. The nurses are going to do their routine assessments regardless of whether you do yours or not, and CNA's are going to their vital signs regardless of whether you do them or not. You are there to learn on your own. I think you should have done the assessment because it would have probably been a great experience to have with that kind of patient. All you need to do is explain that you are their student nurse today and that you would like to do an assessment. If they say they just had one explain to them that you have your own documentation for school so you'd like to go ahead and do one anyway (you aren't doing the assessment for the nurse, you're doing it for your own practice). In my experience they usually love students and wont mind this. They love students because you have a ton of time to spend with them. Use it to your advantage. Talk to your patient and get to know them. Go through their chart and see whats really going on. Look at their lab values and understand why they are out of wack and then research why and what is going on to fix their lab values. Look up their medications and gain an understanding of why they are on each medication Teach your patient something about their diagnosis or something they can do to help get better faster (ie: anemic patients teach them about what foods are highest in iron and why it is important for them to incorporate those foods in their diet). If you see the nurse go in the patients room go with and observe (just as her in the begining of the day when she gives you report if that is ok) her passing medications, drawing blood, talking to the patient. You'll only learn as much as you want to learn in the clinical setting.

I use to go to clinicals and mindlessly do the paper work and assessments.

This quarter I finally have an amazing teacher. She asks us in the middle of the day: What can we teach our patient, what kind of care plans would we create for this patient, and what is the biggest focus for the day for this patient. At the end of the day she asks us what we have learned. I don't know what your teacher does but think about those questions through out the day.

choc0late · May 22, 2010

Don't forget they ask the patients if they would allow a student even before your on the floor for the most part. So don't feel funny as they know your coming and they agreed to have you! I also always feel like a bother especially since it took me 4x longer to do an assessment and at that sometimes I'd finish it come out to chart and realize "oops I forgot turgor" so would go BACK in to do that! Finally I wrote myself an index card of what to do and stuffed it into my scrub pocket. That helped a ton. But really, get yourself right in there, and do what you think you should. Best of luck to you

dudette10, MSN, RN · May 22, 2010

I've had two patients reject me (before I had done anything) because they didn't want a student nurse "bothering" them. Being a student, it comes with the territory. We have to get over it to learn anything. I mean, we're not in their rooms the whole shift just to hover, but we have a tendency to walk in and out a lot because we're disorganized, and everything we do takes 10 times as long. Most patients, especially the nonverbal ones, are really cool about students. (That's a joke, btw.) Most nurses are too. They like their students nonverbal. (That's also a joke.)

As for not assessing the patient going through heroin withdrawal, well, maybe you can start thinking of your clinicals like a real nursing job with a major safety net and lots of resources. If that patient was yours, you would assess them. Putting myself in your shoes, I would ask my CI if there were any special considerations I have to think about for those going through withdrawal. I don't know about you, but all nursing theory I've dealt with didn't include drug withdrawal, so how are we supposed to know if we don't ask?

All this is to say, your feelings are shared by many a nursing student, but your actions need to be a bit more assertive. A lot of it falls on us to grab our learning opportunities when the occasion arises, keeping our patients' needs our highest priority and doing our best.

Good luck to you.

shannahan · May 22, 2010

My first clinical rotation I felt like a bother because I knew I wasn't contributing anything very useful to the patients or nurses. I was just there to practice. I didn't like clinical days at all.

This is my 3rd clinical rotation and I feel much more comfortable. Now that I know a little something I feel like I am there for a reason - when I'm doing an assessment I really am looking for potential problems. I really am trying to elicit information I can use to help them. Granted, their nurse will likely find all these things without me, but this is what I tell myself so that I will feel confident.

When nursing doesn't come naturally it takes time to feel comfortable. It will come in time. Just keep showing up and doing your best.

happy2learn · May 22, 2010

I think you should just ask the patients, with a big smile. Just politely ask them and explain that you're a student and if they reject you, then move on to another patient. I'm sure there are plenty of patients who would love the company, and there are plenty who just want to be alone. It never hurts to ask and if you put off a pleasant, yet confident attitude, they may be more receptive.

noyesno, MSN, APRN, NP · May 22, 2010

I just finished my third round of clinicals and, like you, I felt like a bother throughout my second semester (and also during my first). Towards the end of third semester, the whole "I'm a bother" complex seemed to disappear. I believe this happened for a few reasons: 1. I had more experience/exposure to hospitals and a greater knowledge base 2. I was responsible for doing assessments and administer all meds to two patients and had to chart in the hospital's computer system 3. I worked with extremely awesome RNs and PCTs 4. My instructor was extremely tough and held us to the same expectation of a RN

I think its difficult to really get into clinical during your first two semester because you aren't allowed to do that much and because of this sometimes the RNs and PCTs don't see you as much of an asset. It's also easy to feel like a bother when your instructor is laid back and tells you assessments are optional.

So, my advice to you is to try your best to engage with your patients and do assessments to the best of your ability. When you are helping with ADLs and such you can do parts of your assessments then. Be assertive with the staff and tell them what you can do and notify that you want to assist in any way you can. It will get better in the next two semester. Push through this semester and keep that in mind. Another thing, when you sign up for next semester research the instructors for each clinical location and also find out how the staff is at each location. Good instructors and helpful staff can make such a difference.

Lastly, maybe discuss this issue you are having with your current instructor. During second semester, I went to my instructor and told her I felt like such a bother and she went in with me to do a head to toe on my patient (who had told me to go away a few minutes earlier when I was trying to assess her). It was helpful even though my "I'm a bother" complex still remained until recently.

Good luck! It will get better. You'll look back on first and second semester and laugh at how awkward you felt.

shannahan · May 23, 2010

Totally agree with everything noyesno said - I could have written that myself!

epinephRN · May 23, 2010

Have an agenda for every day, something that you personally need to work on in addition to any other learning needs. For example, you might choose to work on time management. This gives you a "work-around" if your nurse is less than friendly.

Some things you can do to help at clinicals in general:

introduce yourself to your nurse, and let the primary nurse know what you can/can't do, and what you would like to do/focus on. The latter part may or may not be determined by your clinical instructor.

Look up your patient's diagnosis and all meds, and be ready to go.

Practice the 30-second assessment each time you go in the room. First and foremost, is your patient alive? Any safety concerns (changes in mental status, bed not low/locked, slip hazards, etc)? Are they in pain? IV site WNL? Fluids almost empty? Due any meds/vitals/labs/treatments? Needing to use restroom/anything else? This can save a lot of time later. Be proactive, and make a plan for the day.

Never leave the floor without telling the primary nurse, and report anything key to the nurse (ex- vitals that are not WNL).

Also, practice some key things that some new grads struggle with. As mentioned, time management. Find a way to structure your day for efficiency. Also, think of the worst thing that could happen to your patient and how you can monitor for it. For example, if a patient has just had abdominal surgery, what are some complications? How would you know if this were happening? If you are bored and your nurse won't interact, you could ask someone to review your charting, practice giving report, or ask your instructor to partner with you to practice what you would say if you needed to call the doctor. As another post mentioned, find out the educational needs of the patient. Any barriers to discharge (ex- transportation, lack of knowledge, lack of money for medications, etc)?

Also, see if you can perform all your own assessments and compare them to those of others. If other nurses don't have assigned students, put out the word for what you want to learn, for example- "I've always wanted to insert an NG tube, if anyone has one today, I would love to do it."

Mell Bell · May 23, 2010

Thank you guys so much for your replies, it honestly made me feel a lot better, I needed it. I'm going to go in there today and try to be assertive and find things to do. I feel prepared, so hopefully today will be better.

allnurses Guide · May 23, 2010

Every day will get a little bit better! I like your attitude. You will be amazed by the end of the semester how much more competent you feel if you just push past those insecure feelings. We all definitely have had them!

epinephRN · May 23, 2010

Things will get better. Just remember that there is a learning curve with anything. I can tell you that you typically feel out of place and rather stupid the first time (or first several times) you do anything new. This has been true of nearly every new job I've ever held, including as a nursing instructor! There are kind people and mentors out there, and there are those that are not helpful. You will find those who are willing to mentor you, it just may take time. Work hard and do your best, and at least you have the satisfaction of knowing you did so. The nurse there did not sound friendly or welcoming, which is their loss. One of the key things I hope you do learn from this is to remember how awkward and useless you feel right now, and do your best when you are a nurse to keep others from feeling that way. Even the most green and awkward nursing student is capable of helping and learning, it's important for mentors to help you capitalize on your strengths and improve your weaknesses.

Sometimes it helps to consider that you are paying for a service. This is your clinical time, you have paid to learn, and no one else will want your own success as much as you do. Of course, the hospital nurses are not paid to have students, so some are great, some not so much so. If yours is not, see what you can also learn from a friendly nurse. Most floors have many of them :)