The Check-Offs
Oh...the dreaded check-offs! While some schools do not hold these student return demonstrations (boy, those students are missing out!), many schools continue to torture students by forcing them to demonstrate their ability to perform simple psychomotor skills safely. That was a bit of satire, by the way! In all truthfulness, students do believe we professors love the thrill of torturing students, intimidating students, or whatever the current complaint is these days.
The whole point of skills checks? To make sure you can perform them before you go into clinical. The intimidation factor? We try not to be intimidating, but you DO have to ensure us that you're not going to fall to pieces in front of a client, or perform something in such a way that it is unsafe to a patient. Is that unreasonable? I don't think so, but I might be biased because I may be a patient some day! You will be in clinical before you know it, and you will have to perform these tasks on a real-live person. Can you handle that? Will you run away screaming? Some of the things we have to do are things you wouldn't normally do in day-to-day life. Think about it. How often do you insert a catheter into someone's bladder? My guess is never. We want you to be able to do it quickly, efficiently, painlessly, and without humiliating the patient. That is all we ask. Yes, it is intimidating to have someone watching over your every move, scrutinizing every move you make with a fine-toothed comb. We have to be sure you're maintaining the basic principles for patient safety, so that when you DO insert that catheter, you won't increase the patient's risk for infection more than the usual risk.
I've found that most of the intimidation comes from the students themselves. YES, you read that correctly. Students have the amazing ability to place so much pressure on themselves that they become anxious, scattered, and sometimes utterly dysfunctional. I have had students make one small mistake and begin sobbing, totally unable to complete the task. Here's a little factoid you might enjoy: Most instructors will give you multiple chances to make up for your mistakes by just saying what you did incorrectly and then stating what you would have done to prevent or correct the mistake OR have you perform that step one more time. So lighten up on yourself. Relax before you come into the room. If you've practiced the skill correctly 100 times, then you know what you're doing. Prove yourself. Walk in with confidence and pretend the professor isn't right there. It will do you good.
The Lingo
Students love the lingo, for the most part. It is amazing to see and hear the transition happening! The first week, students are asking questions about some of the most common lingo. After about 4 weeks, the students have absorbed a lot of lingo and even work it into their own conversations. I love going around while students are sitting in groups, just to hear how they are using medical terminology without even flinching. Students don't even realize how much they have learned in those 4 weeks until you point it out. Four weeks ago, you didn't know what HOB, ROM, BP, BPM, BR with BRP, or PRN meant. Now you use it in everyday conversation. WHOA!
The Math
Medication calculation. Those are two dreaded words for many nursing students. Some nursing students are determined to make it harder than it has to be. I think it has to do with the fact that many people have had difficulty with some or all types of math in the past, and they have become afraid of it all. I am telling you right now that I had trouble with math in school. Algebra, geometry, trig...they all intimidated me and I had to study so much just to learn the basics. But, med math is very simple for the most part (it does get more difficult later). We also give you specific formulas. The key is plugging the information into the formulas correctly. Once you get that down pat, you're good as gold.
The Insight
Your instructors often will tell you stories about their own experiences in certain situations. Often, these stories will lighten the mood, hit home a serious point, or serve as a lifetime reminder to you. I still remember many of the stories my instructors told while I was in nursing school. I gained insight into nursing through those stories. (Hey...my instructors are real people who really worked as nurses, and they figured out how to do things better because of this situation right here. I think I will remember that for future use!) One story I tell my students (when we start talking about medication administration) is about the time I made a medication error because I took for granted that the pills in the box were what the label on the outside of the box said they were. I neglected to look at the actual package of the single pill. I tell this story for several reasons. One, I am human and I make mistakes. Two, it was my mistake because I didn't look at the individual package to ensure I had the right medications. Three, I wrote myself up because I made the mistake and no one was around to write me up for it. Four, I helped to create a safer work environment BECAUSE I wrote myself up. The pharmacy had labeled the box as 0.5 mg, but had stocked the box with 1 mg tablets. The sign-out sheet still had 0.5 mg written on it. In the past, when the change was made to 1 mg, the pharmacy and all the nurses knew about the change, and the sign-out sheet had been blacked out and 1 mg was written in. However, on this particular night, someone forgot to mark out 0.5 mg and replace it with 1 mg. I was new and didn't realize that someone usually did this, and I knew nothing about how the box was previously stocked. So, in haste, I grabbed a pill, didn't look at the package, didn't think twice about it, and gave it. Oops. It could have been a BAD mistake, and although the box wasn't labeled correctly, it was MY duty to read that package before administering. Nurses are the LAST LINE OF DEFENSE prior to medication administration. Go back and read that line one more time. Yes, I mean every word.
When I wrote myself up, the form asked what occurred, why I thought it occurred, and what my suggestions were to help prevent it from happening again. Of course, my first sentence was, "I was very busy, and in my haste, I neglected to read the package." After that, "The box and sign-out sheet were both labeled with 0.5 mg, though I should have read the individual pill package." Note what I wrote there. I took responsibility for my own actions. I wrote it exactly as it occurred. No blame on anyone else. I did write about the mislabeled box and sheet, but those things, even though they played a small part in my mistake, didn't change the fact that I didn't read that individual package. I then wrote, "In the future, to prevent this from happening again, I will be SURE to read individual packages to ensure I administer the correct medications and dosages. Also, all boxes and sign-out sheets should be updated immediately so that the labels correspond to the respective medication. So, the committee that reviews those things took my write-up and investigated. The result? I was lauded because I wrote myself up (showed integrity) and the box and sheet labels were replaced with the correct labels. They use those write-ups to help improve patient safety, NOT to get someone in trouble. Turns out, even if I HADN'T actually given the wrong dose, but ALMOST gave it, I should have written that up, too. Because if I nearly gave something or performed something incorrectly, others would do the same thing. Patient safety is our #1 priority, so you can never be too cautious.
So...that is a story I tell every single one of my students. You can see all of the different reasons I do this. Also, it's shocking to students to hear that I made a mistake when giving medications, and for such a stupid reason as not reading a medication label. Of course, we pounded it into their heads, "ALWAYS READ THE MED LABEL!!!!!!" about a million times. But when you get out there in the real world, you DO get busy. You get swamped. You get tired. You have so many patients with so many medications. It's actually easy to make a mistake. However, if you do the right thing the right way everyday, you're good as gold.
My point to this long, drawn out story? Listen to your instructors. Learn from their mistakes. Learn from their triumphs. Remember those helpful tips and hints. I promise you, when you are faced with a similar situation, you will be able to think back and remember those stories. It may even make you a better nurse.
