Sleep Deprivation & Clinical

MQ Edna · Nov 29, 2007

If you feel that you will be a danger to either yourself or your patients you must do what is right and not go in. I would try to talk to a supervisor or whoever does your schedule to see if you can switch something around. Sleep depravation is not something that you want to mess with when you're responsible for other peoples well-being... including your own.

If you keep on forcing yourself you are going to risk burn-out.

MB37 · Nov 29, 2007

I was worried about sleep deprivation myself, because I've had horrible insomnia for several years, and I finally got a scrip for meds after I fell asleep at a red light driving home from class one day - I was afraid I'd kill someone at clinical too. How is your relationship with your instructor? Why do you have a lab that other students don't? Isn't your semester almost over, or is your schedule different up where you're at? If everyone is in the same boat, and your relationship with your instructor is good, perhaps you could work something out where she could reduce the amount of paperwork that has to be done before you get to clinical on each patient, and you could turn in your complete care plans the following week - that's how my school does it, they figured that forcing students to be responsible for human lives on little to no sleep wasn't good policy, so a few years ago they started assigning us patients the morning of. Otherwise, how necessary is that lab? If the semester is almost over, just power through it, but try talking to someone if you feel like you can't work safely on what you're able to get. Maybe at least your instructor could help you to find a way to finish your paperwork more efficiently. Good luck!

futurecnm · Nov 29, 2007

Hi all,
Just looking for advice or similar experiences..
Ok to summarize: I have a full day of classes on Weds, then clinical Thurs & Fri. I feel like I cannot get a good night's sleep Weds & Thurs nights because of the amount of research we have to do on our patients. I am at a disadvantage compared to most students, as I have a Weds lab running until 1630, THEN to the hospital to pick up patient assignments. Not to mention the icy driving conditions common up North here. Even after a full day of classes Weds I'm exhausted but drag myself through research. I am expecting next term to be much more difficult.
It also states clearly in our syllabus, under our expectations "students are not to show up 'incapacitated' in anyway, including sleep deprivation." Well I'm not superwoman, so I don't know how to get around this. Coffee can keep me alert, but it makes me twitchy and nauseous if I have too much.
I am afraid of
a) hurting someone on the road while driving (so many studies on driving & sleep deprivation). I am considering taking a taxi, because I am tired even driving home after wednesday, never mind on thurs and fri
b) hurting someone in clinical practice, how easy is it to make a med error or hang the wrong IV sol'n? Of course I would pay extra close attention knowing I'm exhausted, but there are so many other things that require close attention.. obviously the nurses can't monitor every single thing I do.
Has anyone been in a similar situation where everything is packed in so tightly? How do you function? Is there anyway I can convince my instructors that this is physically impossible? Maybe some people can handle a schedule like this, but I am not one who functions well on little sleep.
If this isn't clear I guess it's just evidence of how exhausted I am :trout:

I guess I don't see what is different than most other programs. We have to go in Friday to pick up our patient assignments also, we aren't allowed on the floor until after 5pm. We then have to go home, usually around 7pm and then stay up to write our care plan. I refuse to stay up past 1am so I work fast :) I then am up around 5am to get there by 6am. Work sat and sun 630am-3pm. I wouldn't ask the instructor for an easier schedule. our instructors would probably laugh. Not that they aren't supportive, but nursing school is supposed to be challenging. It is supposed to be a lot of work. I would try to focus on the important aspecst of your patient and know your meds. Our instructors take out meds with us and we check them at least 3 times before giving. I am sometimes tired but that is part of the deal.

caliotter3 · Nov 29, 2007

When I found myself in a similar situation I was forced to get a hotel room that was nearer to my clinical site. I did this every week until the term finished. Thank goodness I had a credit card at the time to charge the room to.

LaceyRN · Nov 30, 2007

I have been in a similar situation, and until about 8 weeks ago I was trying to perform in clinical with anywhere from 3-6 hours sleep on the nights before clinical. I just couldn't keep it up and found myself really dragging! I finally made a decision that giving myself a good night's sleep was the best gift I could give myself the night before clinical and I designated a bedtime of no later than 9pm, even if my pre-clinical prep was not completed. I would get up about an hour earlier than usual to finish up in the morning if necessary. I have noticed a big difference in my mental alertness, my attitude and ability to problem solve now that I am well rested. I also tend to be a perfectionist and would spend hours on my pre-clinical paperwork, so with the deadline I was forced to work faster to finish it in a timely manner. I also came to except that it didn't have to be perfect.

Good luck to you and hope you figure out a way to get more sleep! :)

futurecnm · Nov 30, 2007

I have been in a similar situation, and until about 8 weeks ago I was trying to perform in clinical with anywhere from 3-6 hours sleep on the nights before clinical. I just couldn't keep it up and found myself really dragging! I finally made a decision that giving myself a good night's sleep was the best gift I could give myself the night before clinical and I designated a bedtime of no later than 9pm, even if my pre-clinical prep was not completed. I would get up about an hour earlier than usual to finish up in the morning if necessary. I have noticed a big difference in my mental alertness, my attitude and ability to problem solve now that I am well rested. I also tend to be a perfectionist and would spend hours on my pre-clinical paperwork, so with the deadline I was forced to work faster to finish it in a timely manner. I also came to except that it didn't have to be perfect.
Good luck to you and hope you figure out a way to get more sleep! :)

Just to add to this one, that I don't know what the original poster's instructor's expectations are but many instructors that I have had (I've had 4 so far) have been pretty good about wanting you to know what is going on and want you to FOR sure know the meds, but understand if your paperwork isn't perfect. I know that is hard for some people, and we had some students our first year that would stay up the entire night working on a care plan that the instructor really didn't even look at. Most instructors are wanting to see how you think on your feet and want you to know what is going on with your client "right now" rather than knowing their past 2 year history etc etc. I think many students get hung up on trying to get everything on their paperwork that ever happened to the pt. Granted, I know there are instructors out ther ewho expect perfection on all paperwork the first day on clinical but most are pretty realistic. And our instructors this year told us that we should be able to write a good care plan in 2 hr or less. We have up to 3 pt now and so it is crucial to be able to get something done pretty quickly or we would be up all night and still wouldn't get everything done.

NurseNature · Nov 30, 2007

I graduate in May and I have to say the day before clinicals is the most dreadful part of school. Our instuctors put far too much emphasis on paperwork IMO. Besides from a handful of students in our class- most never sleep more than two to three hours before clinicals. We feel stressed beyond belief, tired and emotional... not conducive to optimal learning. One student actually was put on "probabtion" and sent home b/c an instructor heard her say she only slept for one hour. If she wouldn't have finished all her paperwork perfectly she would have recieved the same punishment. Our class is very upset about this, among other things. I feel that if I can make it through this I can make it through anything. It does somehow give me a little comfort in knowing that others have the same difficulties. Until I found this website I felt I had chosen the worst nursing school possible.

Virgo_RN, BSN, RN · Nov 30, 2007

I was in a similar boat first year. I worked full time as a CNA and was enrolled in NS full time. Every week, I had class on Wed., then clinical prep, then I worked Wed. night, had clinical Thurs. morn, worked Thurs. night, then had clinical Fri. morn. Thank goodness I had Fridays off. Basically I had a forty eight hour stretch of either being at the hospital for either clinical or work, and I still pulled As in class. I've been able to cut back my hours this year as I'm working as an LPN now at a slightly higher wage than my CNA wages. Tomorrow, I have clinical from seven to one thirty, then work from three to eleven thirty.

I don't recommend it. If there is any way you can change your schedule around to get more sleep, that would be optimal. But if, like me, that is not an option, I survived simply by focus and sheer determination. I put myself through the wringer last year, and I refuse to do it this year.

Eirene, ASN, RN · Nov 30, 2007

unfortunately it's the same at my college. we pick up our clinical assignments the day before and have to have the meds, data sheets, and careplans written by the time we reach the floor the next day (0630). it really stinks when you've done all of that work and then your patient(s) has been discharged. we are required to have every bit of paperwork finished when we go onto the floors or we are sent home with an unsatisfactory for the day.

i've really not become accustomed to the lack of sleep. i survive on coffee and excedrin.

i try to take a catnap after coming home from clinicals before hitting the material again. it helps a little.

Conrad283, BSN, RN · Nov 30, 2007

If you really want it, you're going to have to deal with it. You're going to be tired

There were good things that were mentioned in this thread:

Work fast so that you can get to bed earlier.

Stay at a hotel so that you can be closer to where you have to go in the morning.

hikernurse · Nov 30, 2007

The hotel idea is a good one--several students did that when the hospital was far from their homes, esp. in the winter. Plus, no early morning storm surprises.

Are the other students having difficulty? Have you talked to your instructor--not to complain, but to see if she has any suggestions. One of our clinical instructors overheard us talking the first morning of that particular rotation about how little sleep we'd gotten the night before r/t working on care plans. She told us to start with the medication part of the care plan and then get as much done as we could, but she didn't want us working after midnight at the latest. Another instructor had us turn in the meds portion first thing, and then we could work on our care plans (labs, etc.) during the day if we had any spare moments, and not turn it in until the following week.

I also made my own template (with the instructor's permission) that was easier to fill in (and correct) than the "official" one and the other students ended up using that for their careplans, too.

If nothing else, just know it does get easier. You'll get to the point you can knock out care plans without a second's thought.