Stressed at Clinical

Well you have to be there, so you just deal with it. It's normal to get nervous before the unknown, but you'll never conquer anxiety unless you confront the stimulus on a regular basis. I'm about to graduate in two months [knock on wood] and clinical STILL gives me the stomach flutters when I walk into the hospital. It's because I'm still being evaluated constantly. I'm not nervous about meeting my patients, in fact, when I go into the patient's room, that's usually when I relax.

Oh and I've had MANY clinical days that made me want to walk out of the hospital and quit right then and there. Most of them during my Peds rotation. I HATED that rotation with a passion and it was like pulling teeth every minute. It's gotten better since then now that I'm back working with adults. Still, during my first Med-Surg rotation, I was so out of my element I doubted I would ever become efficient and wanted to quit, a lot. I even cried in the bathroom one of those days. You just keep pushing through.

eta: Honestly, I don't think deep down that nursing is the right field for me. I decided to go to nursing school because I loved science, and wanted to make some money with a 2 year degree. I don't have a passion for it anymore, but the thing is, I will still work my butt off because I see it as just a job, and I will do any job I am given to excellence whether I like it or not. So, no, you don't have to know all the time that nursing is the right career for you, but that doesn't mean you can't be a great student, and a good nurse.

I'm a fourth semester student with only a few clinicals left before graduation. Here are some things I've picked up along the way...

I try to be as prepared as possible. The night before I pack my bag to make sure I have everything ready and I won't be rushing around in the morning. I double and triple check that I have things like my hospital badge, equipment, and all of my assignments. Clinical can be stressful enough without freaking out that you forgot your pen light, etc. I make sure my car has gas and I even run outside about an hour before I have to leave to make sure my car doesn't have a flat tire (yes, I'm that paranoid because it's happened to me before!).

If you get your patient assignments in advance, don't slack off on studying their pathophysiology, labs, and medications. I've seen students try to dodge the teacher all day long because they didn't want to get asked about their patient. Not only does that seem like highly unnecessary stress, it's not great patient care if you don't know what you're doing and why you're doing it. Instructors and RN's like to ask a lot of questions to see if you know you're stuff. Sometimes they'll ask a question knowing you probably don't know the answer but it's just to keep you on your toes. If you don't know the answer to a question - say you don't know! Don't fumble around making things up.

If there is something in particular that you can identify that is causing you stress, try to pinpoint the problem and work on it. Are you anxious about talking to patients? Read up on therapeutic communication skills. Do you freak out about having to start an IV? Go to lab and practice. Personally, I get stressed when I'm asked to hang piggyback fluids because I can get confused easily by the tubing. So, whenever it needs to be done I ask if I can do it. After a while I know it won't be a problem anymore.

Not everyone on the floor is going to be glad a gang of students just showed up for the day. I've seen people roll their eyes when they see us! Don't take everything personally. Be friendly and professional. Show them that you're willing to work hard and don't spend time standing around talking. I've found that it takes about 2-3 weeks for me to prove myself. After that, clinical becomes much more relaxing and enjoyable. The nurses have some trust in me, will seek me out for skills to practice and are much more friendly about letting me tag along.

If the RN you're assigned to doesn't seem very receptive to you it's probably because she's also stressed about having a student following her around on top of her regular assignments. Try to keep up, observe, and ask smart questions. Say "is there anything I can do to help you?" - but remember that sometimes you can help by getting out of the way for a bit and letting her work. Find another nurse or the CNA and see if she needs help for a while.

Lastly, remember that your clinical experience does not make or break your nursing career! I've had great days at clinical and I thought I was on top of the world. The next week it would be awful and I'd want to crawl under a rock and never show my face again. This is representative of how your actual career will be. It's not going to be good or bad all the time, it's a balancing act. Remember why you got into nursing and keep in mind that even the worst days at clinical can provide a learning experience and will eventually be a distant memory.

Thank you for the great advice. I am also a 4th semester student about to graduate in May. It feels good to know that there are other nursing students who feel the same way as I do. The thing I get worried about is the unknown. Not knowing who my nurse will be, how many patients I will have, what their diagnoses will be, what to do if one of them codes while Im in the room,ect. Im like you in the way that I learn by doing (a kinetic learner). I jump at the opportunity to do IV starts, Foleys, wound dressing change, ect. I use to hate not knowing the answer to any questions the nurse or instructor would ask me, but now, I learn from it. Getting my stuff together the night before helps me calm down. I also learned my lesson the hard way to make sure I eat a full breakfast (protein) before my 12 hour clinical shift. Both of your posts have inspired me in that we are all in the same boat, take each day as a learning day and never take things personally. At the end of every clinical day Ive had so far, I always leave feeling very fulfilled and inspired, so I know Im going into the right field. Every nurse has gone through what we are going through right now- Im going to keep that in mind as well :)

How are you doing now with your career?

It wasn't until my 3rd semester at RN school where I finally wasn't nervous for every single clinical. For me, my nerves during the 1st two semesters were on edge for two primary reasons:

• Lack of confidence; faking it until you make it is very hard -- maybe more so for an introvert.
  
• False expectations; I remember thinking the night before my first hospital clinical it would be like one of the TV shows I saw where I would be running around like a chicken with my head cut off not knowing what to do. It turned out the pace wasn't anywhere near what I imagined.
  

As I had more and more clinicals, I learned that I didn't have to fake anything... I could actually do valuable tasks (granted, novice level). I also learned to avoid having any expectations.

What makes you nervous? Do you have post conferences after each clinical? Have you asked your professor how to improve?