Simulation Woes and Anxiety Nursing Student

[RedScrubs]

Hello, I am having difficulty with simulation and the improvisation expectations. Example, I hooked a patient up to what I believed was a monitor and it was a static vital sign display, I was visually checking for updated vitals as a response, while verbally assessing the patient. I flunked my second test, the first one was during one of the lowest points in my life, literally, and is on film. The well-being of a loved one was uncertain and I would never have attended work under the circumstances. The frustrating part is that I was told I would have passed if my performance was the same the prior day.

I have had ongoing anxiety with the simulation tests because we don't have any written guidelines of how to meet the improvisational targets. Another thing mentioned, although no written remediation was ever given, was that I didn't verbalize that now I was doing the six rights. I did the six rights, verbalized each one by one as I was doing them, but that didn't hit the target.

I have been reading about the simulations and best practices these issues have been addressed in many settings, but not our school. There is not check list and how the targets are met, which is a huge part of my anxiety. I am a good test taker, but I need to know what the expected response is.

Can anyone give me any insight? I want to right a feedback report, non specific to me, so these issues are addressed, and I know how to achieve my goal of becoming a nurse and don't suffer retaliation.

One of my thoughts was a possible webinar or online orientation and quiz about how to meet the targets so that it is very clear. Any other insights would be greatly appreciated.

[JBMmom, MSN, NP]

I had a little trouble following the sequence of events in your post. I understand that you did not pass a first test due to some family issues, but then the second one was another simulation? Where was there a static vital sign display that looked like a monitor? And unfortunately, even if there are things going on, sometimes you have to go to work no matter what you're dealing with outside of work.

Even though I asked, I think those details are a little beside the point. Nursing school isn't all about the black and white, there are moving pieces to everything. Maybe their expectations could be expressed more clearly, but unfortunately, as a student, in many cases you have to accept what is there as the criteria and work with it. Can you ask someone how you didn't pass the six rights portion if you're sure that you performed them? The world of nursing doesn't have clearly defined parameters either. When a patient comes in you have to assess everything, with unclear goals in many cases.

If the underlying issue is an anxiety that affects your work, you should try to find some help to address that. Sometimes schools make accommodations for students to assist with similar things. As the student it's your job to be as proactive as you can. Do you have someone that runs the simulation lab? Can you get extra time there to run scenarios? Can you find youtube videos of similar assessments to watch successful ones?

Good luck.

[RedScrubs]

The point is, if nursing is a science, it should be treated as one. Best practices suggest several things so the simulator and remediation have the best possible outcome. The grading rubric was something of a pig in a poke and vague with lots of latitude. The use of the equipment and verbalization expectations were not oriented and there is no consistent written reference for the students and faculty to access as a common guide. I must say, I could have asked specifically about what they were looking for, but I was told I would have passed the day prior, so the expectations seem to migrate. I am not sure that is appropriate if nursing is a science. At this point, I just want to survive the unspoken and take an objective test.

[cleback]

Sorry... I wasn't a fan of simulations either. They can be learning experiences but are generally awkward. I remember going through one scenario for work and my mannequins mouth starting glowing blue... I remember thinking wth is he radioactive now? Then my instructor tells me that's cyanosis... haha... not sure if I would've made that connection.

So yeah, I sympathize with using simulation as a test. At this point, I would connect with your instructor to clarify expectations and how to remedy particular concerns. Try to be as humble and open to suggestions as possible. You just have to get through this...

[JBMmom, MSN, NP]

I understand your frustration, but while nursing is a science there is some room for subjectivity. I don't really understand your statement that you would have passed the day prior. How so? If it was because a different instructor was doing the grading, unfortunately, that's one of those things about nursing school that just happens. I can't think of why a day would make a difference other than that. Not saying it's fair, just that it's how it is. And I didn't find many of the tests in nursing school to be at all objective. When three of the four answers are mostly right and only one is the best *most* right, it's frustrating. Good luck.

[3peas]

Simulations can be wonderful or just plain suck. It really depends on the day. Nursing is a science 100%, the sim labs costs millions of dollars and are extremely technical. I'm not sure why you have to announce you are going to do the 6 Rights before you do it, if you did them. In our lab we want it as natural as possible and you would never announce "Hello Ms. Johnson I'm going to read you your six rights for medication administration now." I mean we wouldn't say any of it out loud normally, but you have to for the simulation.

Personally I hated simulations, I don't like pretending. But I reached a point where I mentally decided I was going to get as much out of it as I could. I would sit down with your professor and go over the mistakes and ask as many questions as you can about how to improve. Improve is the key. It's about going forward. This system is set up for learning and you might not like it or agree with it, but try to embrace it and it won't be such a hurdle.

[midwifemae]

Most simulations do not have a grading rubric or list because it is a learning environment. You should be getting a "report" of some kind prior and then start with your ABCs, scene surveillance, head to toe, focused and so on. You should be able to take a nurse brain in with you to help as far as a list goes or something to follow because that is realistic for the real world. Also, in sim and comps you need to voice everything. The instructors cannot hear what you are thinking if you don't say it. That is why you can voice when you break sterile technique, say what you would do to correct the error, and keep going. If you don't voice it, you fail, even if you know what you would do. Maybe you can just start practicing at home where you voice out what you're doing, step by step. It also helps you stay organized with your time because we do not get an hour to spend with each patient. Hope this helps.

[Avill, BSN, RN]

The point is, if nursing is a science, it should be treated as one. Best practices suggest several things so the simulator and remediation have the best possible outcome. The grading rubric was something of a pig in a poke and vague with lots of latitude. The use of the equipment and verbalization expectations were not oriented and there is no consistent written reference for the students and faculty to access as a common guide. I must say, I could have asked specifically about what they were looking for, but I was told I would have passed the day prior, so the expectations seem to migrate. I am not sure that is appropriate if nursing is a science. At this point, I just want to survive the unspoken and take an objective test.

Nursing is a science, but it's about the "nursing process". It's a mixture of knowledge and intuition. It's about preventing the worse outcome. Like some of the other members said, you should sit down with your professor/SIM instructor and discuss the SIM where you did not do so well and tell them you would like guidelines. Can't say I remember having guidelines for our SIMs. We usually discuss what was done, could have been done, ect. We got an actually pass/fail on our skill check offs.

[Double-Helix, BSN, RN]

I'm curious what discussions you have had with your simulation instructors or your nursing advisor about these issues? And what response did you receive?

[KrCmommy522, BSN, RN]

You said you had family issues going on during the simulation, which is why you think you didn't pass. Then, you were told you would have passed the day prior. I assume that's because you were not stressed about your loved one, and the next day (the day you were graded on your simulation), you were stressed because you found out the well-being of your loved one was uncertain? If that is the case, that means you were able to practice before you did the graded simulation? If they said you would have passed the day prior, they must have seen you practicing in order to know that?

In any case, in my experience simulations don't tend to have some sort of checklist of this is what needs to be done to pass. When we did simulations at my school, we got a "report" on the pt beforehand, then we got our assigned roles (charge nurse, RN 1, RN 2, etc.). From there, we just winged it. They watched us to see how we did, and after we had a "post conference" and the instructor would explain why our pt died or sometimes would say what someone did wrong. But, for the most part, they asked us how we thought we did and what we might of did differently.

Sometimes the simulations ran really smooth and other times it was like the wild west!! I think it has a lot to do with who ends up in your group, and people sticking to assigned roles. We had 2 simulations at the end where they didn't give us assigned roles. The 1 simulation, 2 of us tried to say right when we started that we should decide who will do what, but the others just wanted to get right at it. The 2nd simulation, we all decided who would do what from the beginning and it ran very smoothly. You just need to think about what you would do in that situation. Things aren't always going to run smoothly or perfect. When you're caring for a pt on your own, no one is going to tell you, "You need to do this, this, and this to keep your pt alive." You just have to figure it out. And that's what a simulation is about. Seeing how well you can handle it.