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I should have just gone to med school
February 21, 2012 1:36 PM   Subscribe

Calling all nurses and non-nurses: I hate clinical, what do I do?

Hi, everyone. I feel really silly posting about this. As you can see from my previous questions... school is tough for me.

I'm in the midst of the first year of a two year nursing program. I already have a bachelor's degree and previous to the nursing program I was managing a restaurant. My program is set up so that after our first year we are LPNs and after our second year we are RNs.

I wanted to go into nursing because: I like being hands-on with people, I like working with elderly people, I like being on my feet, and I like being busy. We have had a rotation at a nursing home which I really enjoyed.

We have clinical two or three days a week: a full 7-3. Previous to the shift we have to do a lookup on medical dx, meds, labs, etc. It takes me 4-5 hours. At clinicals we do everything independently except for giving meds (we each only give them 1 out of 4 shifts, with our teacher) and things like inserting or removing a catheter, which we do with our teacher. Most of our day is spent taking vitals, checking blood sugars, giving bedbaths, toileting, ambulating, charting, etc. We kind of take over the CNA's job, but we take on LPN tasks as well.

All this is to say that I am SO STRESSED OUT at clinical. We rotate between three hospitals and just started a new one last week. After spending forever looking up my patient the day before, I hardly sleep and get to the hospital sooo anxious. Once I am there I feel like a complete idiot. I feel as though I'm a chicken with my head cut off and like it's a giant scam that I'm even there in the first place.

Here are specific things I would like advice on:

-How do little things become second nature? Like, today I was helping someone into the shower and I forgot to wrap their cast in a bag until the patient told me! Little things like that just aren't stuck in my brain, but I had never showered someone with a cast before. I don't know when I will again. How long does it take?

- A big source of anxiety are the staff nurses. I am going to sound like a baby but many of them are so nasty and unpleasant to us. I know that they are incredibly busy. I am very un-assertive so I hardly ever ask them for anything and I think they appreciate that and help me when I do ask. However, I see them snap or yell at my fellow students and it makes me so mad! But I can't do anything about it. When you are a staff nurse, does it get better? Are the nurses like this to new nurses? (I am NOT trying to be mean to nurses. Some of them are very nice)

Some of the other students in my class are sooo into clinical; they say that they love it and they want to take their patients home with them. Is this a learned attitude? I don't think I will ever feel this way. I want to shoot myself at around 0800 each day. I want to throw up and cry multiple times a day. It is getting a little bit easier but not much.

Despite this I get very good evaluations in clinical but I feel like I'm playing a giant trick on everyone. Each time I take a blood pressure or listen to lung sounds I'm thinking "I CANT BELIEVE YOU TRUST ME TO MAKE SENSE OF THIS."

Many nurses I've talked to say it's a good idea to work on a med/surg floor straight out of the RN year to get experience. The idea of prolonging this stress terrifies me. What's strange is that I am normally very even-keel; I have really chilled out about the rest of our classes. They are difficult but I study my butt off and do very well without worrying about it. Clinical is a whole 'nother beast, and deep down it makes me worry that I don't want to actually be a nurse. I do enjoy my one-on-one time with patients, but it's overshadowed by the stress.

Please, give me some insight, words of encouragement, anything. My fiance has to deal with me crying multiple nights a week and my friends don't seem to get how difficult it is. Some of my fellow students are right there with me and we comiserate, it's literally the only thing that makes me feel better. I'm considering taking a year off after June and working as an LPN at a clinic or nursing home, just to get my feet wet and regroup. Any advice?

I realize this is all over the place but I'm in the middle of another lookup and feel like a robot. Oh, and I'm on sleeping pills.
posted by pintapicasso to Education (13 answers total) 12 users marked this as a favorite
 
I feel like I'm playing a giant trick on everyone. Each time I take a blood pressure or listen to lung sounds I'm thinking "I CANT BELIEVE YOU TRUST ME TO MAKE SENSE OF THIS."

Classic Imposter Syndrome! This feeling is really, really common: You are not alone! Take deep breaths, roll with it & try and accept that if other people think you're doing OK, then maybe you actually are OK.
posted by pharm at 1:43 PM on February 21, 2012 [2 favorites]


First of all: IT GETS BETTER. IT GETS EASIER. CHILLAX.

I think a lot of your anxiety might be coming from the same place it came from for me (I'm in the last semester now of an identical program):

They are difficult but I study my butt off and do very well without worrying about it.

There's a certain amount of preparation you can do for clinical, but it is so entirely different from the classroom, where you really have a good amount of control over the outcome. It's kind of akin to being the gifted kid in elementary school, always being able to skate by, but then suddenly you're faced with something you're not inherently good at, and it's unsettling. I know that feeling!

Believe me when I say that it gets better. The more you do the basics, like ambulating, bathing, wound care, med pass, etc, the more it becomes second-nature, and you can then focus on the new, cool stuff, like starting IVs, or doing extensive neuro exams, or whatever.

If it happens that you don't end up liking the med/surg inpatient setting, that's okay! There are sooo many routes you can go with a nursing license, and if you end up somewhere that you dislike, keep looking! As far as mean nurses, you're getting good experience now for dealing with them once you're in the workplace setting. I'm sure you had to deal with snippy waitstaff or GMs when you were managing a restaurant, so you know that people like that exist in every industry.

Let me know if you have any questions! I love blabbing about school.
posted by scarykarrey at 1:49 PM on February 21, 2012 [2 favorites]


It will get better. Really.

I'm not a nurse, but I live with two staff nurses and am an advisor to students in an RN program that sounds similar to yours. My roommates, my students, my sister, every nurse I know (which is an above average number) felt this way during school at some point. Most of them are VERY GOOD NURSES. Nursing is hard. Learning everything you need to know in two years is just not possible, and really, no one expects you to.

It sounds to me like you are probably doing really well and doing everything you can to prepare yourself. Eventually much of this stuff is going to be second nature, I promise. I think the other students who seem to be enjoying this more than you might have spent a bunch of time being CNAs or something and maybe feel a little bit more comfortable in a patient environment than you do right now-I think that gap (between people who have spent a lot of time around patients versus those who haven't) evens out pretty quickly,but I know it can seem pretty profound in the beginning.

Honestly, I think you should finish the degree and not take a break. An RN with management experience (like you have from the restaurant) and a bachelor's degree is pretty marketable, even if you end up doing something other than regular med/surg nursing. But I also think if you stick it out you'll be surprised how much easier it all gets. Feel free to memail me if you want to chat more!
posted by mjcon at 2:03 PM on February 21, 2012


I am a new nurse and I'll tell you that I felt a LOT like this when I was in school. I've been working on a med-surg floor for seven months and there are days I still feel like wtf are these people doing trusting me with their lives?? In school, we were told that it usually takes 18 months to be fully comfortable on a floor. EIGHTEEN MONTHS. I learn new things every single day and of course you're going to make mistakes and feel dumb about stuff but you know what? You're learning what not to do. And in a way I think that's more important than learning from a book what to do.

I never worked in a hospital until I got hired as an RN. I worked at a restaurant all through nursing school and it was one of the things my hiring manager said she liked about me. You know how to deal with people and you have experience with multitasking and keeping things straight in your mind and that is going to be an asset to you in your nursing career.

Don't be so hard on yourself. You know so much more than you think.

Regarding the floor nurses, I think some of them have been out of school so long that they must have forgotten what it was like to be new and nervous and insecure. Not all nurses are like this, I promise.
posted by likeplus at 2:25 PM on February 21, 2012


I'm an RN, almost an NP (SPRING!!), and a RN instructor at a ginormous state university college of nursing. What you've written here, I want you to know, I hear every single day. You're going to be just fine.

First, the profession field of nursing is vast and and benefits from RNs who follow their passion, not those that listen to anything "they" say about what to do with a nursing education or career. If you love gero, and are good at it, and happy in that spot, for Florence's sake, work in gero! They need you and your happiness there.

Pay attention to the clinicals you love (long term care), and the ones you hate (med surg). Then, understand that you have the right to use your education to pursue your happiness and achievement in the specialty of your choice. If you follow some party line into med surg, you may never lose the stress or truly achieve, either. Pay attention to what clicks. Clicking is what leads to higher levels of education, increased professional development, publication and research opportunities, and meaningful connections with other nurses and healthcare providers. Ignoring the click and following the herd because "you're supposed to" predicts misery, mistakes, and limited career.

But, just like I had to (count me in as someone who does not enjoy med surg. I am ALL peds, all the way), you do have to get through the med surg clinical rotations. Worry less about some of the psychomotor things like what you've described (patient bath snafus, etc). Focus on rationale and slow down. For example:

*Instead of getting caught up in the soul-killing rush of monitoring, documenting, counting, and emptying intake/output on your patient--take a long minute to use your good skills in the lecture didactics to put it all together. Is the ratio normal? If it is, what explains the reason this patient has good fluid balance? If not, what could be wrong--meds? hydration status? diet? Kidneys? Cardiovascular status? For each clinical shift decide you're going to connect ONE of the fundamental skills to pathophysiological skills as a personal mind challenge. For bonus points, ask your clinical instructor or nurse to take a minute to talk through it with you.

*If there is something like a VS task (BP, lung/hear auscultation) that challenges your confidence, ask your clinical instructor if you can have a half hour or hour to listen to every patient on the unit, room to room. A good time to ask for something like this is when you have a patient who can handle some of their own ADLs, and when you can make the request in advance. This kind of thing can break up your shift and provide focus and confidence.

*Ask your instructor if you can make a goal of providing one piece of patient education/shift. So, if it's your pass meds day, put real effort into making a patient connection and educate the patient about the med. Give yourself time to work up your little piece. Perhaps your patient is resistant to ambulation--spend a few minutes putting together something about mobility for the patient. These are the kind of things RNs wish they had more time for and like to see students do. And it's fun, and will likely appeal to the things you like about nursing.

*Ask your RN one open-ended question/shift when they have an obvious moment. Something like--how did you choose your specialty? What is the best use of my time as a student on your floor? What is the part of patient care on this unit that is most rewarding? Just like regular people, RNs like the opportunity to talk about themselves and their professional achievements a bit. It's not that they hate students, it's that they are often not given enough meaningful professional development opportunities and are expected to "teach" students while the clinical instructors get all the credit. Look for ways to make them look awesome and talk them up as often as possible to everyone around you.

*Say YES when asked if you want to try some hard thing. Don't be afraid to say YES and then say, my patient still needs X,Y, and Z how can we fit that in?

*Remember that clinical rotations that you don't like are simply an opportunity to learn about yourself and about people and to observe live demonstrations of pathophysiology in action. Your goal is safe learning. The end. You don't have to love or master it. And you know what? Those "adorable patients" do NOT want nursing students to "take them home." Your classmates are simply responding to vulnerability in a emotional manner--it's a kind of way of saying "I want to protect because this vulnerable person unsettles me." When you're scared, anxious, and feel completely overwhelmed by the importance of doing what you're doing the exact right way, you are having THE SAME reaction to THE SAME feelings they have. It's just that you respond to patient vulnerability with highly motivated frontal cortex activity telling you to HELP THEM RIGHT AND HELP THEM RIGHT NOW. Neither is anything to really worry about, because both reactions will mature into patient responses that have experience and education-created boundaries.

Honestly, assessing what you've wrote, you're doing fine. I would encourage you to share more about your anxiety with your clinical instructor and take some ideas to him or her about how to mediate it so you can learn and observe as confidently as possible. What's nice about rotation is that "however it is now, it will not always be." It will end, and if you did not like it, there are jobs and opportunities in many other aspects of the field that you have every right to pursue. All of us make these choices about fit in every profession. Med surg nursing is not, in fact, nursing. The breadth will narrow down into what your love of it is with each rotation.

Get some sleep, have a tea. Memail if you'd like.
posted by rumposinc at 2:35 PM on February 21, 2012 [11 favorites]


I just made it through my first year working as an RN, and I graduated from an accelerated program after having a previous bachelor's in computer science. I hated clinicals, but I love my job as a med-surg nurse. And it's only within the last month or two that I've stopped feeling like I'm totally clueless on the floor. This is normal and expected, so please don't worry that something is wrong with you!

I wanted to go into nursing because: I like being hands-on with people, I like working with elderly people, I like being on my feet, and I like being busy. We have had a rotation at a nursing home which I really enjoyed.

This is perfect for a nurse. I bet one thing you don't love is feeling like you're not good at something. Lord knows I HATE that feeling. Clinical practice is so much different from classroom and home study, because you can't cram for it. You just have to learn it by doing, and by forgetting things sometimes, and by doing things wrong sometimes, and by asking other nurses for help, but most of all by DOING it over and over and over. The point is, the thing that is stressing you out right now isn't nursing work, it's that feeling of unsureness. And that will dissipate with time and practice.

Another thing about nursing, especially when you've come from another career, is that it's really easy to feel like suddenly everyone's LIFE is on the line. Like, if I mess up, this person could DIE, compared to before when their TPS report might be late or their appetizer might be cold. But the reality is, it is super unlikely that you would mess something up that would actually do major harm. And if a situation does seem to be going bad quickly, call your instructor and the staff nurses and whoever else is around to help.

One thing I really noticed when I started working as a nurse, compared to being a student, is that I actually felt like I had MORE support when I was unsure of myself. As a student you have to either track down your clinical instructor or deal with your (possibly grumpy) staff nurse, and it can feel very isolating when you're in the moment. But on my unit, I can ask any other nurse working, or I can ask my charge nurse, or I can call the pharmacist or the PT person or whatever if I have questions. Once you're working you have so many more resources, even though you don't have a dedicated instructor anymore.

-How do little things become second nature?
Practice, practice, practice. Time, time, time.

A big source of anxiety are the staff nurses. I am going to sound like a baby but many of them are so nasty and unpleasant to us.
The old adage is that "nurses eat their young." I've found that to be true of some nurses, but not of others. The older nurses tend to be worse, but it's not a hard rule. Ask around (any friendly staff nurses you manage to find, CNAs, fellow nursing students, family members who have been in the hospital) and take notes if you hear of any units that have really good or bad unit culture, as this can really make or break your experience when you get a job. I was lucky to get randomly assigned to an amazing unit for my final semester internship, and even though there are plenty of hospitals closer to my house, I took a job there because I knew I was lucky to have found a place with nurses who are friendly and helpful and not burned out.

Despite this I get very good evaluations in clinical but I feel like I'm playing a giant trick on everyone. Each time I take a blood pressure or listen to lung sounds I'm thinking "I CANT BELIEVE YOU TRUST ME TO MAKE SENSE OF THIS."

Again, this is normal. Hang in there, don't get sloppy on your assessments, and within a year or so things will start clicking. I still take a couple minutes at the start of every shift to sit down and think about each of my patients' diagnoses, and what things could go wrong with them, and what that means I should be paying special attention to. Sometimes that's bowel sounds, sometimes it's a particular lab value, sometimes it's something as simple as getting some cream for their butt to avoid skin breakdown. While you're a student, if it's not already part of your night-before preparation, take time to think of the most likely complications of your patient's diagnosis, and what you can do to help prevent them or notice them early.

Many nurses I've talked to say it's a good idea to work on a med/surg floor straight out of the RN year to get experience. The idea of prolonging this stress terrifies me.

It's so worth it. The stress will gradually lessen and go away, and you will have SO much knowledge and confidence to back you up, even if you choose to go to another setting. It's not like you'll feel this terrified for a year and then suddenly everything will be fine; you will literally feel more confident every shift, every time you get another patient with a bowel obstruction or pneumonia or something you've seen before.

Hang in there! It's scary and stressful for a while, but honestly you CAN do it! I think that's the #1 thing lacking in nursing schools, is helping students understand that they're not expected to know everything and feel comfortable about everything, even when they graduate. It takes time and experience, but you will get there.
posted by vytae at 2:55 PM on February 21, 2012 [1 favorite]


I'm not a nurse, but I'll throw in my two cents anyway.

Things become second nature once you've done them often enough. To quote someone's grandmother, practice makes perfect.

Insofar as dealing with the short-tempered staff nurses: rude and nasty people are everywhere, so you can't escape them no matter what you do for a living. Practice being assertive: it, too, comes with practice.

But most important: there is, and will continue to be, a growing need for nurses trained and able to deal with the elderly. Not everyone has the patience, the compassion or the people skills to do it -- let alone the interest. As the power of attorney for a couple of Old People, I've observed that kindness and consideration with this cohort are in short supply, and what they get goes a long, long way. You said you enjoyed working with them. Maybe geriatric nursing should be your specialty? The Old People would be grateful.

Hang in there: you'll get through and be fine.
posted by cool breeze at 2:57 PM on February 21, 2012


I love questions like these, because I remember so vividly feeling exactly like this:

Despite this I get very good evaluations in clinical but I feel like I'm playing a giant trick on everyone. Each time I take a blood pressure or listen to lung sounds I'm thinking "I CANT BELIEVE YOU TRUST ME TO MAKE SENSE OF THIS."

That was eight years ago, and now I feel like this, when I do those same tasks and some resident or other colleague challenges my interpretation of any given situation:

"Heck YES that's exactly how it is! No, I don't want to 'watch him' for a bit and see how it goes! I need you to come down here and take a look at this guy right now, Dr. Resident Internsalot, and BTW, I'll take orders for X, X, and X if you don't mind."


Of course, I don't talk like that to anyone unless it's urgent and I think it's that serious, but that's my level of confidence in my assessment skills and interpretation of the data like labs, signs and symptoms, and vitals, these days. I'd say I felt like I was fooling people with a fake RN next to my name on a badge (as if I didn't put in all those thousands of hours of work and study and do well in school and pass my boards!) for about the first year after I got out of school, even. The great thing about nursing is that you're part of a group. information has to be filtered through many people, and through school and possibly for the first year of nursing, you are just learning how to filter out the unnecessary info and condense down the important stuff to act on it by passing it along to a doc or by doing a nursing intervention, or both.

I love rumposinc's advice as stated: Remember that clinical rotations that you don't like are simply an opportunity to learn about yourself and about people and to observe live demonstrations of pathophysiology in action. Your goal is safe learning. The end. You don't have to love or master it. And you know what? Those "adorable patients" do NOT want nursing students to "take them home."

I'd love to favorite that a million times. Now is a time for learning, and it will not always be this difficult. If only I could transport you back into my brain for the first time I gave an injection and hung an IV med and you could feel how utterly dumb I felt and the millions of second thoughts I had about how much I hated this "clinicals" business and how tedious it seemed to me to try and remember all the minutiae of doing each nursing "task." It takes a while, but eventually the tasks all run together into your whole plan for your day and your plan for your patient and become less jerky, more smooth in their transitions and execution. It just takes time and a lot of repetition.

Also, not everyone loves med surg. My first and last semesters were med-surg and they nearly broke me. heh. I wanted to be in cardiac and that's what I did, first in cardiac surgery and now in CCU. If I had had to take a MS job to get my foot in the door, I definitely would have, but I never would have loved it. I float there occasionally and I still feel like a chicken with my head cut off trying to manage five patients at a time. :) So take heart. As they say, it gets better. :)
posted by takoukla at 3:38 PM on February 21, 2012


There's a lot of wonderful advice within these comments already. I'm sure I'm going to be echoing much of it, but I'm going to say my piece anyway.

First, I want to say that you feeling this way in your first year of your program is so so very normal. Second year will be a bit better, the same with each following year you are in practice. Not only is it a wealth of information that you've got to process, but finding a way to organize yourself and prioritize your patients and your time. You will find what works for you.

Those little things that you forget will become second nature. Like everyone else has said, it takes time. I'm willing to bet that you'll probably never forget to cover a cast again when assisting a patient in bathing. Lesson learned.

While I've been there and know exactly what you're talking about, I'm still sorry to hear the staff nurses are a source of anxiety for you. Does your clinical instructor advocate for you? If someone is consistently grouchy, rude, and just a plain bad preceptor, it's worth mentioning. I remember feeling like a sheep amongst wolves. As your confidence grows, this will change, & you'll become more sure of yourself. If someone is going to be a jerk to you because you're asking relevant questions regarding a procedure or patient care, that's their problem. You are there to learn and take the best care that you can of the patient. Don't let some bear of a nurse scare you away from doing that. It's the right thing to do, you are the advocate for the patient.

While I was in school, we were encouraged to work in med-surg first, as well. I had absolutely zero desire to do this, as I was interested in OB. How were chest tubes, tracheostomies, etc going to benefit me there? I was fortunate enough to be hired to OB right out of school, and I developed the necessary skills just fine. I start IVs, maintain sterile technique, insert foleys etc daily. Go where your heart is, don't begrudgingly look for employment somewhere that may discourage and frustrate you completely just because someone else thinks it's the best idea.

It gets better in time. Memail me if you want. Good luck!
posted by viachicago at 4:45 PM on February 21, 2012 [1 favorite]


-How do little things become second nature?

1. Practice, practice, practice.

and/or

2. Fail memorably. (Bet you'll remember to wrap the cast next time!)

You're in training; you're supposed to be fumbling around like Bambi on ice. When you come out the other end of the factory, finally trained, and you still feel like you don't know what you're doing, then you should maybe worry. Until then: "Sorry. I'm new."
posted by Sys Rq at 4:51 PM on February 21, 2012


I'm in L&D clinical right now (shhh... don't tell anyone.) What you're feeling right now? There isn't one among myself or my classmates that hasn't felt the same way. Hell, I - a male with no children - just had to palpate a postpartum woman's fundus while the staff nurse, clinical instructor and the patient's husband looked on. Think I was qualified? Hell, no. But I want and have to learn this, so I asked for help, looked for reassurance and did what I needed to do to learn as much as possible. We all have to start learning somewhere, and feeling inadequate at the beginning is par for the course.

I don't know. I guess I just wanted to pipe up and say that you're not alone. You also sound like you have the makings to be a great nurse. Just hang in there. Keep going through the motions and this stuff WILL get easier. You're learning much more than you think and when it all clicks together - man, will it be wonderful.
posted by Rewind at 6:09 PM on February 21, 2012 [1 favorite]


Just so you know, you aren't going to graduate and suddenly feel prepared for clinical practice. Medicine has little to do with what you learned in your program and much more to do with the amount of experience you have. You will be scared for awhile. If you weren't at least somewhat nervous that people's health is partially dependent on your capability then I would be scared for your patients.

I'm a PA. Been out of school for almost 2 years and I still am nervous on most days. But the nervousness isn't nearly as terrifying as it was at first. Good luck.
posted by teamnap at 7:08 PM on February 21, 2012 [1 favorite]


I work with nurses every day, and have heard repeatedly that this is a typical experience. You will be anxious, uncertain, and sleepless for a while. You will work your ass off, and eventually, will find your stride and confidence as a nurse.
posted by brackish.line at 11:55 AM on February 22, 2012


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