Turns out, I'm an idiot. Rotten clinical

[PCTerrific]

I need to vent. I've made it to the last semester of nursing school never having cried over a clinical day (yay?). Well, broke that streak-- spent an entire hour sobbing when I got home. Icky, ugly crying, folks.

When people say academics don't matter, it's true. All my crap resume stuff (scholarships, job offer, clinical evals, grades, externships) got me....unable to put on sterile gloves, apparently. Twice. I mean....really? Really? (As they'd say in SNL). So, honestly, when people say all the crap that goes on paper (GPA, etc) doesn't really matter-- trust me, they are very right. I have tried to really not to ever let my peers know or be a jerk about it all, because I honestly know the classroom has very little to do with the real world, but wow, is it more true than I thought.

I was called in to do a procedure today. I had never seen it, my nurse had never seen it, and the patient has a lot of anxiety around it. He was a tough one-- insisted on things a certain way, quick to roll his eyes, pretty critical of all of us. I don't blame him-- he has every right to insist on things done a certain way when it is his body, and he was in a stressful environment-- but I felt like I was one mis-step away from a serious dressing down.

So, I went in with the nurse, and asked that he please walk me through the procedure-- he knew it better than anyone on the floor. He kindly agreed, and was great about it (at least I know what I don't know, I guess?). I tried to put on sterile gloves, and I guess I absolutely bungled it? It's been a few months since I'd last done it in a lab (I've probably only done it 3 times in the hospital), but I didn't think I had screwed it up, which was the worst part. We do the procedure, it goes well, great job. But, yeah, not able to put on sterile gloves? We get out, my preceptor says great job, before looking at me like I am stupid and she cannot believe this is happening "do you even know how to put on sterile gloves? because that was a total mess." I guess she tells the instructor, to, who comes over to me about "my comfort level with sterile gloves". It's basically like asking "Are you ok dressing and feeding yourself?"

My wonderful instructor talks me down a minute-- I'm my own worst enemy, one of the best students she has had (and she's been at this for 30 years), yadda yadda. That would be very nice to hear, if I had not then proceeded to prove I can hardly walk and chew gum at the same time.

So, she watches me do it, I do it no problem, I go obsessively practice a few more times, and then we go back in to do the second half of procedure? who manages to somehow screw it up again? Yep.

I know it was largely anxiety, but...really? Really? It's a skill I've practiced at home a bunch, because for some reason it's just not one I do very well. Well, the dressing change just seemed like a joke from there, with my professor coaching every. single. step (which didn't help me looking competent any). I felt like such an idiot. And then the patient's partner asked again if I was really from the (theoretically prestigious) school I told her I was attending. Ye-ouch. The patient asked if it was my first time on the floor. Yep. delightful.

So...yep. And then the professor and I gave meds, and apparently we didn't scan two, which the nurse only found out when she went to administer them again. Great-- that's safe of me. And then I made time to take a patient outside, only to have her lose her glasses case (which, thank the lord, was on her wheelchair). I mean...seriously? I felt like I should have been put in a time-out box.

I had a less-than-stellar day last week in a different clinical...it was orientation, so it wasn't horrid, and I caught a med error, but I still looked like an idiot running lost and confused.

I hate this. I've never had a single nurse talk to an instructor with a criticism, but here it is. I can't believe I'm going to be taking the NCLEX in 3 months. I feel like I need another two years. And how can I do this job when I get so stressed at not-so-critical errors? The anxiety is at a point where it is just working against me. And the more I bungle, the worse it gets. Does it ever feel better? Talking to nurses, it seems like this feeling never goes away, and I cannot deal with 40 years of this terrible stuff.

So, it's a night of practicing sterile gloves and youtube videos, if I can bring myself to deal with the ick feeling of total failure right now. I honestly feel like the dumbest person who has ever been in nursing school.

Bottom line is all the critical thinking in the world doesn't help you any wh//en you can't do the most. basic. tasks. I know, whatever, motor memory, practice, etc, but....yikes. I can see why the BSN degree gets so much crap. I'm great at patho, sure, but can I handle an IV start? Nope. So, everyone is officially allowed to gloat at how the nerds/BSN/etcs are actually gonna be incompetent messes :)

god, sorry that was so long. It felt good :)

[Dranger]

Where or what unit are you precepting? I could do an IV start blind by the end of my rotation in the ED. Skills are important but not everything. Are sterile gloves a big deal? Fundamentally yes but can they be tricky sometimes? With my big hands yes...

I wouldn't worry about it you are a student after all. I had ZERO stress in nursing school because I acted like I didn't give a **** about anything besides the obvious things like meds etc. I let nothing or anyone stress me out. I took correction in stride and just told my self I would do better next time. Crying shouldn't ever come into play.....

[BostonFNP, APRN]

It is a humbling job. You will always have days that are rewarding and you feel on top of the world, other days you will feel like everything is a struggle. Everyone makes mistakes from CNAs to RNs to NPs and MDs, we just learn from them and try hard not to repeat them.

My first scrub as an assistant to my new attending MD I broke sterile field about 2 mins into the procedure. The circ nurse grabbed me and tossed me to rescrub. I was horribly embarrassed but we laugh about it now.

As far as IVs, it's a technical skill anyone can learn with practice. You will learn it quick when/if you need to. It's the knowledge behind it that makes you a nurse.

[swansonplace]

Great thing on correcting your sterile technique!!!

The core information is what you really need to learn now. The stuff you are good at. Patho for med surg, nursing interventions, and side effects of major diseases.

The last semester is so stressful; keep your eyes on the exit exam. Good job on practicing your sterile technique.

[PCTerrific]

Thank you guys so much! It is so helpful to get it all out, but even more helpful to be reminded that this is a part of the job, and everyone has been there, too. Onward and upward, right? And I'll at least get sterile technique down after this if it is the last thing I do.

[yesnoyes]

We've all been there. Seriously. I remember my very first foley insertion, I was going along doing everything absolutely fine, until it came time to drape the patient. You know when you have sterile gloves on, and you have to pick up the fenestrated drape in that specific way, with the corners between your index and middle fingers, palms facing ahead of you, with the drape over them? So you don't break sterility while putting the drape down? For some reason I just COULD NOT figure out how to hold my hands to get that drape up. My instructor was there with me, she even pulled out a kleenex to demonstrate for me and I could NOT do it. It honestly took like seven minutes for me to figure it out. I was almost in tears. The patient wasn't super impressed either, but thankfully he was quite pleasantly forgetful and managed to forget I was an idiot by the next time I saw him. But oh my god. SO embarrassing. And of course this was near the beginning of the rotation, so my instructor thought I was a total idiot right off the bat...

[Do-over, ASN, RN]

Are sterile gloves a big deal? Fundamentally yes but can they be tricky sometimes? With my big hands yes...

You know what they say about nurses with big hands? They wear big gloves...

Seriously, the gloves that come in the foley and suction kits are ridiculous, got sick of tearing them. I always get a pair of the good ones (in my size!) and use those instead.

As far as your rough clinical day, well, momma said there'd be days like this. I can't think of when I felt as awkward as I did on many clinical days. It was worth to become a nurse though. It gets better. Scarier, but better.

[kgh31386, BSN, MSN, RN]

Careful with the comments about academics not mattering...you may offend some folks very much. Practice, build on the competence with confidence. Being academically strong opens many doors, just saying. :)

[PCTerrific]

Oh, yes, very true-- hope my over-the-top rant about it didn't offend! I think the frustration comes from busting my butt in the classroom, and getting accolades for it in a very academic-focused program, but then going out into the hospital realizing ain't no one looking at my GPA or awards or alma mater when I can't seem to do tasks from first semester (nor should they!). We spend so many hours in didactic courses, and relatively few in skills, and it certainly shows sometimes...but, at the end of the day, I can at least be proud and encouraged by my performance in classroom stuff! Thanks for the reminder that I should remember that.

[llg, PhD, RN]

It sounds to me as if your problem is not so much an issue of performance -- but an unrealistic expectation that you will never make a mistake. It is fairly common for students who have been good in the classroom to "over-react" when they find that they are not as perfect as their classroom experiences have led them to believe. You were probably a good student in classrooms all your life and may not have learned how to handle set-backs and mistakes. You've never developed the skills of "recovering and bouncing back" from failure.

My suggestion is to look at this as an indication that you still have a lot to learn -- and tackle it as a learning challenge. You're good at learning. Read about persistence, recovery from failure, etc. Explore how other people deal with poor performance in a positive way and tackle the challenge of learning those skills. They will serve you well in the future. We all mess up sometimes -- and we all need to learn how to get back up on our feet (or "back on the horse") and keep moving forward.

And do NOT spend the rest of your career denigrating the intellectual aspects of nursing and the need for knowledge just because you, personally are struggling with the performance of some technical skills. BOTH are important for good nursing care.

You seem to be a good person trying to do a good job. Don't let a few mistakes derail you completely.

[nurseprnRN, BSN, RN]

If it makes you feel any better, NCLEX questions have for years and years been derived from mistakes new grads -- all new grads -- make in their first year of practice. Some of these are psychomotor, like having a hard time envisioning how to put on gloves or irrigate a Salem sump; some are assessment-based, some are decision-making errors. All new grads have relative deficiencies in some, most, or all of these.

The traditional hospital diploma programs were famous for turning out grads that could whip through a morning and have everybody all "done up" by lunch, no embarrassment about inexperience in what everybody calls "skills." The more academic programs had the reputation for having fewer clinical hours so their grads were judged as being "unskilled," especially in a time where the great majority of nurses came from diploma programs. This time is passing by. One reason is that over time research has shown that the grads with more academic preparation, like you, may start out with less proficiency in tasks and time management, but you gain those in your first year.

At the end of the first year, the new nurses with better academic education have made those adjustments and become stronger nurses, a difference which increases as time goes on. This is especially evident in the ones that learned more about nursing theory and leadership (every nurse is a manager and has to delegate to others, and know why), research (evidence-based practice requires the ability to separate the wheat from the chaff in "research"), psychocultural awareness (especially if you, like many, had to take psychology and anthropology and sociology semesters), and critical thinking related to scientific concepts (especially if you took three semesters of chemistry, a full semester of anatomy, a full semester of physiology (not a combined A&P semester), and full semesters of micro, pharm, and pathophysiology. Simply put, you can make better assessments and make better decisions if you have more information to work with. Those are the real skills a nurse uses. Everything else is necessary, but subservient to good judgment.

So I hear you on your very bad, sucky, icky day. But it will get better. Five years from now you'll be tooling thru the AN archives and come across it and shake your head and laugh. You are clearly intelligent, a good and perceptive observer and writer, and you will go far. Hang in.

:flwrhrts:

[elkpark]

I guarantee you that every one of us "old timers" here had at least one rotten, horrible clinical day, most probably more than one, and we all turned out okay. Been there, done that, got the license (and subsequent successful career) anyway. :)