SRNA struggling with clinical

[JV2000]

I just finished my first semester of an integrated masters program. While I don't have straight A's, I feel comfortable with my grades. I've been struggling with clinical and am hoping for some words of wisdom to help me improve/survive. We finished our first 3 months of clinical (2 days per week) and will be starting clinical evaluations two weeks from now. I feel childish for saying all of this, especially since my classmates all seem so confidant.

I don't know what's happened to me since starting clinical. I was a strong ICU nurse prior to this. I have never been the typical type A ICU nurse. I have always had anxiety with new people. It never was a problem while on the job, but now I feel I've psyched myself out. It doesn't show on my face. Instead I just freeze up. Once I step foot into the clinical site, it's as if I forget how to be a nurse.

I was a preceptor/charge and now have trouble with decision making/jumping in without being told. I still rely heavily on preceptors. I was a go-to for IVs and now I'm about 50%. I'm only about 40% after 30 intubation attempts and my technique doesn't seem to have improved at all. Focusing so much on what the staff thinks of me and a fear of mistakes is causing me to screw up even more. Even though it is frustrating dealing with various techniques of different preceptors, it's not their fault. Compared to my classmates, I lucked out with my clinical site. They've all been great. Instead of telling me to suck it up, they've actually pulled me aside to try and talk through it. I'm the only one to blame for my performance.

I've done many things to help but have only noticed a slight improvement in my clinical performance. Seeing a therapist/starting propranolol has helped with the anxiety/fear of failure. Talking through each step of the cases while driving to/from clinical helps to keep me on track intraop. I always ask to review what went well/bad with the preceptor at the end of the day. I go over their advice in my head, but can't seem to follow through in the moment. I do feel I can identify my own weaknesses pretty well, but can't improve them. I've gone through many forums on here/reddit/head of the bed podcast.

The preceptors say I'm doing fine. I feel the complete opposite. No preceptor or instructor will give me a timeline of expectations. I don't know where I'm supposed to be at this point. I don't know when I'm expected to stop relying on the preceptors. I've heard and read that many students go through trial by fire and it seems to work. At this point, I am 100% certain that wouldn't work for me and that I would fail without the frequent help from the preceptor. I know I need to be better.

Sorry for the rambling post and thanks for getting through all of that.

[loveanesthesia]

How many years were you an RN before the anesthesia program? 5 or more?

[JV2000]

5 years. I was accepted to both programs I applied to. Took the cheapest/fastest.

[loveanesthesia]

I’ve seen more experienced RNs take longer with technical skills and also be more anxious than younger less experienced students. Here’s my theory-you’re more aware of all the things that can go wrong. In the end you’ll pull it together and be stronger than some who seem to have it all figured out right now. Trust your preceptors, do you think they are lying to you? It’ll get better when you start spending more days a week in clinical.

[JV2000]

Thank you. That helps and I hope your theory is true. You're right, I should trust what they're saying more. I guess I'm not meeting my own expectations. I'm concerned about falling behind from where I should be and having preceptors continue to tell me I'm fine. It's hard for me to gauge my abilities since i'm the opposite of my classmates who seem to be much more confident in their clinical performance. Thanks again.

[Dem7191]

When you measure yourself against anyone you will always come up short. Keep your head where your feet are, and take it day at a time.

[DreameRN, BSN]

I often feel similar...10 years experience here. I am acutely aware of how proficient the CRNAs I am with and my deficits compared to them. I have about 90 intubations under my belt but I've missed a good share as well and every time I feel like an incompetent idiot and kick myself the rest of the day. They all say I'm doing fine and am right where they expect me to be. I try to align my mindset with that and take it on faith that I'll get there. I also think of when I trained new grads in the ICU, how long it took them to do tasks that were cake for me and second nature---IT WILL COME. One of the CRNAs told me too, it's just experience. Do a 100 of something and it starts to come easier. 100 intubations, 100 art lines, 100 blocks, 100 IVs, etc... I can also guarantee that most of your classmates feel similar even if they don't show it (I try to hide this insecure feeling as well)...If I'm feeling this way, and other people in my class feel this way, then people in your class do as well, they just hide it. You got this!

[ProgressiveThinking, MSN, CRNA]

Just keep showing up everyday and continue to do your best while you immerse yourself into anesthesia. It gets easier with time. I think a lot of people share very similar feelings when they're first starting out. At my clinical site our CRNAs rarely did their own cases (SRNAs did everything, CRNAs come for induction, complications, and maybe emergence). I remember my first month of clinical where a CRNA had me sit back and watch their induction sequence and all I could remember was how smooth they were. I thought I would never get to that point.

Fast forward to the end of my program and that same CRNA asked if he could induce in order to keep his skills up since he rarely had to. All I could think of was how rocky his induction sequence was, and how I could have done some of the smaller things smoother than he did. On the same day a junior SRNA asked me if she could watch me induce. After I induced, her only word was, "goals."

Now I could sit here and pretend like I'm clinically superior and blah blah blah, but that's definitely not the case. The fact is, I improved by showing up everyday and practicing anesthesia. I tried to ignore the fact that I had a CRNA critiquing me (having somebody looking over your shoulder can do a lot to your psyche), and everyday my goal was to become more smooth and more efficient (slow is smooth and smooth is fast).

As time went on, I slowly got better with repetition, and I think that's the biggest factor: Time. Show up everyday, practice, and things will get better, just like it is with any hobby or skill. Some of my classmates with the rockiest starts ended up graduating as some of the strongest while some of the people that started out the strongest became complacent and plateaued.

[murseman24, MSN, CRNA]

There is a good podcast on emcrit titled "Beat the stress fool". It's podcast number 220. They go over some techniques you can use to reduce your stress level and focus on the task at hand. Maybe try listening to this on the way to clinical as a routine and using some of the techniques illustrated in the podcast during clinical. I think after about 200 intubations it starts to become a lot easier. If your preceptors tell you you're fine I'm going to assume they are telling the truth. CRNAs aren't known for hand holding anyone.

[RicRock, MSN, CRNA]

Trust your preceptors.

If struggling, always go back to step one... position.

Most SRNAs that I see who are struggling with intubations aren't setting themselves up for success.

Everyone struggles from time to time.

[NoelleP]

I feel for you.I am also an SRNA here in Florida. Unfortunately , my school is very strict and unreasonable. I have only been exposed to clinical for 3 weeks , two of which involved insertion of LMAs. So I only have 1 week exposure to intubate with an endotracheal tube and of course what do you expect with newbies? I was given a professional clinical contract by 1 preceptor out of many for not recognizing that the tube was not in even though I know and I said something. How can I not recognize that when we repeatedly had to do it in the laboratory? The school said there is no camera so they have to just depend on the preceptor's words and mine.

The school is nitpicking and wants to eliminate students they dislike even if that student is doing very well academically. I am curious if your school implements rules like this that are unreasonable and what can a student do to protect oneself from this unfair treatment? Students have no rights at all in this school and they can expel you at their discretion even if reasons are unreasonable like this. I feel that this is unfair but what can I do as a student but to accept? I have heard that this school also allow students to move on close to graduation and then terminate you so you will waste a lot of money in the end without a degree. It even came to a lawsuit with one of the student whom they are trying to terminate towards end of graduation and stopped because they were threatened with lawsuit.

[apocalypsenow]

Hello. I feel for you. I have the same experience in my program.

I am just curious- are you a minority? This tends to happen to minorities a lot.