Struggling with Clinical

Good day:

I do pretend practice at home for clinicals when applicable. I found that it helps even though things still come up during clinical that wasn't practiced, practiced enough or anticipated. To combat anxiety, I've been trying to get more exercise, drink less coffee (no more than one cup on class days), and eat better. You can get through this situation. Be patient with yourself. Try different methods, and learn what works best for you.

Thank you.

First step is to take a second and take a deep breath.

In a perfect world we would never have a weakness. In the real world we all have weaknesses and you are in a better place than most because you know what your weakness is and you have an instructor who is willing to help you with it.

As as weird as it may sound you may be overthinking things. It sounds like you over prepare (don't take that as a critism-I would much rather have an overprepared student than an underprepared one). If you try to take too much information in it becomes impossible to keep up with it all. Next comes anxiety of trying to remember it all which leads to forgetting something which leads to more anxiety and the cycle repeats. Eventually you wind up in a cycle of "paralysis from analysis". Look back at those cards you made and see if you needed every scrap of info on there As a student you should be expected to show you understand the basics and how to apply them to the real world.

As far as communication I would encourage you to watch Amy Cuddy's TED talk on body language and try it. Amy Cuddy: Your body language shapes who you are | Talk Video | TED.com

Thank you for your tips! My clinical instructor did encourage me to practice explaining my meds and do my patient teachings at home prior to clinical. I'm hoping that would lessen my anxiety. I only have 3 more clinicals till the final evaluation to show her that I'm competent with my basic skills. Wish me luck!

You're right that in some way I do overprepare. I write down every single thing about that med that I was not able to individualize it for my patient. I want to learn how to individualize the meds to my patient, communicate patient teachings in a clear and concise way, and also I want to not black out when my instructor asks me questions. My instructor advised me to practice saying these things out loud prior to clinical. She also said she can go over it with me and we can do a bit of role playing. I only have 3 clinicals left to show her that I'm competent with my basic skills and I really want to prove to her that I have what it takes. Thank you so much for the video I'm currently watching it and I'm learning a bunch about communication!

Something my teacher made us do last semester that was super helpful to me when preparing for clinicals was to write down the disease process the way the book explains and then write how we were going to explain it to the patient with no nursing background. If helped me break down difficult things so that others could understand. Same with meds. Yes it's important to know all the information, but at the end of the day you need to know what the med is going to do for the client and what the contingencies are. All the other stuff is kinda fluff that's good to know for you but may not be beneficial to the patient. Keep your chin up and remember we learn the most from our failures not necessarily always being successful.

I was thinking of making flashcards of each med that has the elaborate mechanism of action on one side (what I would tell my instructor) and my patient teaching on the other side that includes a brief and easy to understand description of it with 1 or 2 precautions like "don't get up too fast it can make you dizzy"

what do you think? I'm trying to keep my chin up when I'm actually freaking out so much on the inside ):

That sounds like a good idea. When you meet with your teacher, ask her how elaborate you need to be. In my experience, they usually want to know the drug class and what they are going to do in a way the patient understands. I could write all the bio mechanisms down for them but if at the end of the day they just wanna know that it's going to lower bp, there no reason for confusing myself and going so in depth.

We also use sheets with columns on it that have drug name, class, therapeutic action, contingencies, dose and admin, relevant labs and client teaching. It's helpful because you don't have to juggle around everything and it's all in one place when I go to present to my teacher before I give them.

You'll get through it! It's common to feel that way! Some tips: know your hospital's reference for meds. Usually there are links to tell you what the med is used for. If you know how to use your resources you know how to practice safely and how to use critical thinking. Do education constantly! Explaining why you are doing something and each step you do to the patient not only helps it stick but helps develop critical thinking and when in doubt look for your hospital policies! Therapeutic communication: I say always pull up a chair next to the patient and take time with them and listen. Usually I do this first thing before assessment and give them a rundown of their day and start building a relationship with them :) you'll get through this! We've all been there and unfortunately it doesn't stop when you graduate. :) just learn to use your resources to develop your critical thinking skills and cut yourself some slack!

Been there! Most of my clinical instructors were very caring and therapeutic in their teaching style which made me feel at ease...except one. This instructor was very assertive and blunt with everything. She asked questions and put each of us on the spot and if we didn't know the answer, she had this special way of making us feel stupid. When I feel judged, I get anxious and forget things I know. She pulled me aside during evaluation and told me she was concerned about my communication. She asked if anyone had ever told me I was quiet and there was something wrong with me (I've only heard this s thousand times growing up and used to believe I was inherently flawed). I'm an introvert and am more observant than talkative. I have accepted this "flaw" long ago and refuse to let it stop me from achieving my dreams. But to hear it from an instructor was extremely discouraging. I can take criticism but to hear that a piece of my personality, something I was born with, is bad and needs to be fixed is a huge blow to my self-esteem. Change what can be changed and work around your weaknesses. Sometimes all you can do is your best and the performance anxiety inhibits growth. Imagine how you act one-on-one with your patient vs. with your intimidating instructor present. The former is more representative of how you'll actually be as a nurse. I remember during clinical as a last semester student, I was far more relaxed. I was with my nurse preceptor passing a decent amount of meds and the patient asked me what they all were for. That was after they were out of the packaging into the cup. I managed to remember the names of all and recited what they condition they were for automatically. Its amazing what you really do know when you have confidence and aren't intimidated by a scary instructor! Trust me, it will come in time.

You are lucky. At my school, if we do a med administration without our instructor we automatically fail the semester and could get kicked out of the program. So feel grateful you didn't get an automatic fail. Teaching is a huge part of nursing. It is very important to explain everything before you do it. An example is when I gave a shower last semester, I explained everything to my patient before I did it. Why I was washing them, why I was putting lotion on them. It will put your patient more at ease with you. You will look knowledgeable with the patient and they will trust you. Plus, you might actually teach them something!!

When giving a med, you don't have to know every single aspect of it. Know why you are giving it, what the side effects are, what is it contraindicated with. With insulin know your onset, peak, and duration. I think you are trying to cram too much knowledge in and you are forgetting the important stuff.

I'm a first semester nursing student. It was always my dream to become a nurse and I finally got in the nursing program in my university! I was so motivated in the beginning of the semester. Most of the time I would get the highest grades in my theory classes and I was so excited for clinical. I made one big slip up in clinical that caused me to be on probation though. I administered meds with my nurse without my clinical instructor. Everything went downhill from there. Going in to clinical made me really scared of messing up. I would go pick up my patient's information, make the most thoughtful careplan I could and still make common sense mistakes. I prepared for my meds and even wrote them down in flashcards for a guide but I still looked unprepared and unorganized when I was administering them in front of my clinical instructor. My clinical instructor pulled me off to the side and said that I needed to "step my game up". She said I do really well in exams but I need to work on therapeutic communication. She also said that I need to be more assertive and confident when I speak to my patients. I asked her for any tips or suggestions she could give me so I could be successful and she agreed to coach me after class next week. I received my midterm evaluation and it was not so glowing. Although she still gave me a satisfactory mark with the condition that I improve my medication administration and communication. I really want to improve but the nerves and anxiety are very paralyzing. I can't even focus on studying for theory anymore because I'm so worried about failing clinical. Has anyone gone through the same thing? Or have any tips for me to survive?

Hi Cherry,

By any chance have you had any previous experience with working in the medical field? Maybe as a CNA? It seems to me your doing fantastic, just nervous when you have to talk to your patients. Im the complete opposite, I do great on practical situations and struggle with written exams.

I first make my initial contact "HEY!! ms/mr so and so"

do what i have to do _____insert skill_____

all the while maybe asking how their day was or some random chatter here and there to keep the energy going where they know you see them as a person and not as a task.

You sound like you have some pretty bad anxiety and you seem like a perfectionist.

It's okay to make mistakes during clinicals.

Your professor is there to guide you and make sure you make no mistakes. And if you do, I'm sure it's not going to be life threatening. It'll just be a great learning experience.

The best way to stop making small mistakes (like forgetting the name of a drug even though you just looked it up, or accidentally dropping the pill in it's packaging 3 times while trying to open it up, or forgetting to get water for your patient to take their pills with -- trust me. I've done all of these and things are are even more arbitrary. Then I break into a cold sweat and freak out over it) is to think it through beforehand, and go in with a sense of calm. Know that your professor wants to help you become the best nurse possible. Make a mental checklist of the things you need to have on hand. If you forget something, don't make a big deal out of it - fix the small snag, and move on with helping your patient.

I promise: you will not look silly or stupid to your patient or instructor!

I find that talking and genuinely listening to my patients helps me communicate better. Ask questions specific to them. I always make it a point to ask my patient if there's anything that I can attend to for them before I start doing an assessment/administering medications. This helps them feel more at ease with you and starts to build rapport quicker and right from the beginning!

Your ultimate goal for each day is to come out with more knowledge than you started with.

I wish you the best of luck through nursing school.