Student Nurse in First Med Surg Clinical

vanilla bean · Oct 10, 2016

I'm really not sure how to handle these situations. I'm actually starting to think that I need to be more confident and assertive, and make it clear what my goals are and what type of teaching I prefer.

The nurses are not responsible for your satisfaction with your clinical experience; they are responsible for patient care. If you don't like the style in which the nurse that day engages with you, try to make the best of it and learn from them what you can. It is not their job to adjust their "style" to your preferred method of instruction.

NewMurse1014 · Oct 10, 2016

The nurses are not responsible for your satisfaction with your clinical experience; they are responsible for patient care. If you don't like the style in which the nurse that day engages with you, try to make the best of it and learn from them what you can. It is not their job to adjust their "style" to your preferred method of instruction.

Agreed. This is something that OP needs to discuss with the clinical instructor. If it doesn't work out between OP and the nurse, the clinical instructor should arrange a different nurse or step up to teach the students himself/herself. I had a bad clinical instructor during med surg 1 clinical. Basically we were dumped on the floor and we had to find the nurses who were willing to take students, while she were gone the whole shift. The nurses are not responsible for students' clinical experience, but the clinical instructors are.

Banana nut, BSN, RN, EMT-B · Oct 10, 2016

Having confidence in your knowledge and skills is important. How often are you going to skills lab? How many times ave you practiced giving subq injections?

crs1978 · Oct 10, 2016

Thanks, really good feedback. I do understand that the RN has a job and their priority should be patient care, not my general experience following them. I think my problem has been, at least with two of the RNs I've followed, is that they seem to be pretty set on trying to instruct (which is a good thing), but for whatever reason, the approach ends up getting me anxious and flustered, which in turn impacts my performance. I understand the counterpoint to that would be, if I can't handle the pressure of a supervising nurse putting me on the spot, how would handle the pressure of patient care when I'm an RN? I'm willing to take responsibility for that, and maybe accept the possibility that I may need to work as an RN in a different setting. Or maybe I should not be an RN period, who knows?

To answer the question about practicing in skills lab and experience with subQ injections . . . I'm not sure if our program is the same as others, but basically, it is a 3 semester accelerated program, so we spent the summer semester doing about 6 weeks of skills lab, learning all the basic nursing skills, then we spent 3 weeks in a skilled nursing l facility where we were able to do a lot of the skills on actual patients. In reality, most of the skills, I got a chance to practice 1 or 2x total before trying on an actual patient. I have probably completed SubQ injections 10 or more times on actual patients. That is more than enough time to understand how to do it the right way. Probably one of my struggles is that I'm not very gifted used my hands or doing anything that requires fine motor skills. I'm just a bit awkward and clunky, and for most anything, I have to actually practice in a real setting a hundred times before I feel comfortable.

vanilla bean · Oct 10, 2016

OP, I too attended a 1 year/3 semester program and I can sympathize with your anxiety about developing proficiency with skills. That will come over time when you start working as a nurse. In reality, you should be *competent* (not necessarily proficient) performing all skills by graduation. Your fine motor skills will improve over time with practice and repetition.

I also understand your bewilderment over being instructed to perform the same skill different ways by different people. I think most people experience this during nursing school/clinicals. Guess what? It will probably happen when you become a nurse and are being precepted/oriented by different nurses too. Unless you think that you are being told to do something that you think will actually prove harmful to the patient, you should perform skills the way the person supervising you tells you to. A simple, "OK, thank you" can move you beyond the situation.

Irish_Mist, BSN, RN · Oct 10, 2016

Hey guys,
Just wanted to vent some concerns and observations about my first experience in clinicals. I'm currently in an accelerated post bacc and am set to graduate in May 2017. We completed our psych clinicals and did some skills lab and a briefly went to a skilled nursing facility during the summer, but this is our first time doing clinicals on an actual hospital unit doing med surg stuff. Anyway, I'm getting pretty overwhelmed by the idea of ever being an RN in the hospital. I just lack intuition, and I get too flustered at times. Each week I'm on a new hospital unit following a new nurse, and thus far, my results have been a bit mixed. With some of the nurses, I'm put on the spot constantly, and have been somewhat humiliated when providing care for patients on a few occasions. One of the nurses was quizzing me constantly while I was trying to concentrate on scanning medications, and then when I went to administer a heparin shot, he did not like the location I picked on the abdomen or way I was pinching the skin, and abruptly suggested that I start over. He kept telling me to relax and calm down, which got me even more anxious. I got so flustered that I nearly pricked the patient with the needle when re-wiping with an alcohol pad, and he yelled at me. Anyway, I think the problem I'm having, besides getting too anxious when provided feedback, is each RN I follow seems to have their own ways of doing skills and tasks, so it's like each week I have to figure out a new style, and then deal with feedback on how I'm doing it wrong, even though I am just following what I was taught previously. I also hate being put on the spot and quizzed in front of patients. Some of my RN's have been really awesome and not done this at all, but some have the style I do not like. I'm really not sure how to handle these situations. I'm actually starting to think that I need to be more confident and assertive, and make it clear what my goals are and what type of teaching I prefer.

You need to talk to your clinical instructor and ask to be paired with someone who doesn't yell at you or humiliate you. This type of behavior does not facilitate learning and it is unacceptable. I don't care what anyone says. Yes, these nurses are there to provide patient care but if they have agreed to precept students or have been assigned by their supervisor to do so, they can at least be professional. No, it is not professional to yell at your or humiliate you. If that nurse had an issue with the way you were giving a heparin injection, he should have pulled you aside and given you instruction or just have you watch him give the injection.

Practice your skills in a simulation lab and get confident at them. If you are not confident, precepting nurses and patients will see that. Unfortunately, there are people who will see your lack of confidence and not be so nice about it.

Banana nut, BSN, RN, EMT-B · Oct 10, 2016

Thanks, really good feedback. I do understand that the RN has a job and their priority should be patient care, not my general experience following them. I think my problem has been, at least with two of the RNs I've followed, is that they seem to be pretty set on trying to instruct (which is a good thing), but for whatever reason, the approach ends up getting me anxious and flustered, which in turn impacts my performance. I understand the counterpoint to that would be, if I can't handle the pressure of a supervising nurse putting me on the spot, how would handle the pressure of patient care when I'm an RN? I'm willing to take responsibility for that, and maybe accept the possibility that I may need to work as an RN in a different setting. Or maybe I should not be an RN period, who knows?
To answer the question about practicing in skills lab and experience with subQ injections . . . I'm not sure if our program is the same as others, but basically, it is a 3 semester accelerated program, so we spent the summer semester doing about 6 weeks of skills lab, learning all the basic nursing skills, then we spent 3 weeks in a skilled nursing l facility where we were able to do a lot of the skills on actual patients. In reality, most of the skills, I got a chance to practice 1 or 2x total before trying on an actual patient. I have probably completed SubQ injections 10 or more times on actual patients. That is more than enough time to understand how to do it the right way. Probably one of my struggles is that I'm not very gifted used my hands or doing anything that requires fine motor skills. I'm just a bit awkward and clunky, and for most anything, I have to actually practice in a real setting a hundred times before I feel comfortable.

Ok so you need to read what you typed there. You just said you have done 10 injections and that should be enough, then you said you have difficulty with fine motor skill. If you have trouble in a certain area you may need MORE PRACTICE. This mean to me that 10 times is NOT enough. You need to practice more so that you feel safe and secure under duress/pressure when giving patient care. Your energy will be picked up by everyone in the room, the patient, the nurse, and family members all need to trust you and if you don't trust yourself they will feel that. Best of luck to you, I would encourage you to force yourself to step up to a challenge and not back down from it. I do not mean be challenging to the nurse you are with, what I mean is if they put you on the spot, step up and give it your best answer and don't back down. If you are wrong its an opportunity to learn and nothing more.

FutureNurseInfo · Oct 10, 2016

Hi,

let me first start by saying, I am a long way before I will be in such an amazing place like you, having to do clinicals.

But straight to the point, feeling the way you feel is very normal. You are contemplating to become a nurse and you tend to feel anxious because you want to do everything the right way. However, it is not going to happen most of the times. And, it is not a bad thing. You are still learning! I also know having to be guided by so many different nurses every other months is very challenging.

When I was doing my degree in education, I had 4 different sites for my student-teaching. I had four different head teachers who were always over my shoulder, just like all those nurses that you are under. I also had problems with the way they taught and required me to follow their steps. I was dissatisfied with all of that. However, I developed my own teaching style and stuck with it. Now, years later, I am teaching in similar ways.

My advice to you is, just go with the flow. If you do not like the way they do their work, that is fine. They have a right to do that. When you will finish your program and become a nurse, you will do your job the way you think is right. So, for the time being just try to "please", and do as asked, while still developing your own style for caring for patients and doing other pertinent work.

Good luck!

crs1978 · Oct 10, 2016

Yeah, and a lot of this might just come down to performance anxiety for me. If I sense that I'm being watched with a critical eye, it tends to throw me off and I get nervous and shaky. I know that I need to get over that and adopt a more confident attitude, even when I'm around a person I perceive to be critical. I do realize that confidence comes from experience and a genuine recognition of self-ability, but for me at times, there seems to be a gap between what I can do and my confidence that I can do that particular task well. Meaning, I'm fully capable of doing these tasks with competence, but for whatever reason, self-doubt creeps in and it messes me up. I'm a licensed mental health therapist, and fully understand the faulty thinking that goes into that process, but have not fully conquered it myself yet.