Trouble in clinical. Prioritizing. Help

[bella14k]

I am told by my professor that I could fail because I am unorganized, unprepared (I don't know anything about my drugs or any other material I have went over in the previous semesters), and I look like a "deer in headlights". I often ask the same question over and I will need more assistance through a skills procedure. Other days, she says, I am on point. She says she's going to fail me if I am not consistently on point, and because she doesn't know what level I'm at (one day I know what I'm doing, time management is good-other days, not so much) she thinks I will be unsafe.

This is my last semester, and I don't know what happened between 3rd semester and now, but I seem to have a brain fog. Please don't respond with ways as to how I can fix this or that I need to identify the underlying problem. Thank you, but for this post, I just want to ask about how to become better as a last semester nursing student in clinical. I don't know what happened between now and last semester, but everything is sort of a blur.

For all nursing students and RN's out there:

-After you receive report on your patient from your professor, what are some general questions you would ask the RN taking care of that patient? I know this is a broad question, since questions are usually specific to your client, but I feel like lately I haven't been asking my nurse any questions. I just go into the room, do my physical assessment, talk, check IV site look at pump and see what's infusing, see if the bag is almost empty, go back to the nurses station, document, briefly look at medical history (if there's time), then move onto the next patient and repeat.

-I think my problem is I'm afraid to ask questions because I feel they're stupid.

Thank you.

[Esme12, ASN, BSN, RN]

Well in order to answer your question we are going to have to tell you how to fix the situation. You need to be organized...I will give you some brain sheets and I'm on the run but I will be back

Brain sheets.......here are a few.

5 Pt. Shift.doc

1 patient Float.doc

MTPMedSurg (2).doc

Report Sheet.doc

FinalGraduateShiftReport.doc

DAY SHEET 2 doc.doc

[SoldierNurse22, BSN, RN]

What do you want us to tell you if not how to fix/improve your practice?

[nurseprnRN, BSN, RN]

I'm sorry, I know you specifically did not want to be told to find out what the problem was ... but if you had a patient who told you he was doing fine a few months ago but now he's developed this intermittent and increasing brain fog that's getting in the way of his job and he's going to be fired if he can't think and organize like he used to, wouldn't you be concerned that something was, like, going on? I am.

[NICU Guy, BSN, RN]

Firstly, YOU need to take responsibility for knowing about your patient, not get the information from your instructor or nurse. We arrive to the unit and our instructor gives a very brief description of a patient (chief complaint, if they are in isolation, fluid restrictions) and a someone volunteers to take the patient. He goes down the list until everyone has a patient. We spend about 30 minutes in the EMR and look at the H&P, ER report, labs, CT/MRI reports. We then go meet our patient and have them tell us why they came to the hospital and do a physical assessment. The instructor pulls each student aside and says "tell me about your patient." He asks about any lab values that are high, low, or pertinent to the reason they are in the hospital; what is causing the labs to be abnormal; what meds they are on and why. We are expected to act like we are the nurse taking over the care of the patient and not a nursing student who is fed all the information about the patient.

Maybe the problem is that you are given multiple patients instead assigned to one patient. You need to become competent at understanding the whole picture on one patient before handling multiple patients.

It seems to be a common theme with a lot of nursing school clinicals: students briefly scan the chart (not really knowing what they are looking at), do an assessment, vitals, some clinical skills, CNA work, and maybe observe the nurse. No real depth of the pathophysiology of the problem the patient came to the hospital for and the comorbidities that affect the problem. The problems the patient has is irrelevant because they treat them all the same, except for looking up the different drugs the patients are on. The instructors are so focused on passing meds or doing skills that they don't allow the student spend time with the patient to have them explain the progression of their health issues and how they are intertwined. Eventually the student talks to enough patients that it starts to click when patients have the same progression of similar health issues (CHF patients develop pulmonary and peripheral edema; which requires a diuretic, which causes hypo or hyperkalemia; which has an effect on the heart).

[bella14k]

WOW! thank you. I totally agree. Clinical at my school is 2 days a week, 6 hour shifts each. My professor often lets us leave an hour or two early due to low census. This is not the experience I had hoped for. I thought my first 2 semesters were great experiences , but last semester and this semester , not so much. I still have myself to blame, and I plan on really turning it around. I need to work on my skills. I have noticed that the professor also doesn't do post-conference. she doesn't really ask questions like your instructor.

[bella14k]

Thank you these are very helpful!!

[Esme12, ASN, BSN, RN]

bella14k said:

WOW! thank you. I totally agree. Clinical at my school is 2 days a week, 6 hour shifts each. My professor often lets us leave an hour or two early due to low census. This is not the experience I had hoped for. I thought my first 2 semesters were great experiences , but last semester and this semester , not so much. I still have myself to blame, and I plan on really turning it around. I need to work on my skills. I have noticed that the professor also doesn't do post-conference. she doesn't really ask questions like your instructor.

Does your program know you are leaving early? There is usually a requirement of a certain number of hours in order to be eligible to sit for NCLEX

[bella14k]

I don't know but i'm not about to find out

[nurseprnRN, BSN, RN]

bella14k said:

I don't know but I'm not about to find out

On the contrary. One thing you describe is that you aren't getting enough clinical time to learn how to manage patients in the clinical setting. Your instructor should be actively finding ways to make your clinical time all count for something useful; leaving early isn't it.

There's a reason why BoN have standards for minimum clinical hours. Your program should know you aren't getting them, and perhaps your instructor will get some ideas from her department head on how to be more effective in her job. Which will benefit ... you.

[bella14k]

At this point, there's not much I can do. She has her last day with us on april 16th,then she'll be leaving the school and off to another state, so I don't think she wants to hear it from the head of the dept.

[NICU Guy, BSN, RN]

bella14k said:

My professor often lets us leave an hour or two early due to low census.

That was my point. If you have an hour to sit in the patient's room and talk to them about their medical history, you can learn volumes of information on patients by listening to their story because it allows you to ask questions and get clarification about the disease process instead of reading it in a book. My clinical instructor is also the lecture instructor for the class. He will bring in a person from the community with cancer or major heart issues into the classroom, have the patient sign a limited release of medical records before class and allow them to tell their story about their illness and allow us to ask questions. They realize that the better we understand the disease, the better we will be able to care for someone with the same problems in the hospital.