Clinicals Advice

Updated | Posted

marquisdelafayette

184 Posts

In clinicals, you're fortunate to have some control over your education. Be the first to volunteer to step up to try things, always ask questions, ask for more opportunities to see and do things if they're not being given to you. Don't let the fear of not knowing what you're doing or not being comfortable get in your way. This is your chance to learn while you have the safety net of other nurses and faculty so don't let discomfort hold you back. Get comfortable being uncomfortable! 

CamperNurse, ADN, RN

Specializes in IMCU. 17 Posts

Congrats on starting clinicals! Here are a few things I wish I had known/ learned the hard way/ knew but was still taken aback by in my first semester of Clinicals:

1. Even if you can't administer a medication, if your nurse is willing to directly watch, you can prepare it. (For us it was mandatory that our instructor supervised ANY and ALL medication administrations, but preparing meds, even programming pump, was permitted so long as it was the actual RN who administered/turned the pump on). You can get a lot of experience this way, but just double check your school's specific policies. 

2. I think our schools clinical paperwork was a little weird, but in my first 2 semesters of clinicals it was not due at the end of the clinical day, but instead a few days later. This is a great time to learn everything you can about the disease process(es) you encountered that day (and make your write-ups/care plans really good). My paperwork always took me until the day it was due, but the amount I learned from taking the time I had was invaluable. 

3. ASK QUESTIONS!!! Also, keep a "note sheet" with you to jot down little things you learned or things you want to follow up on later.

4. Volunteer/request to do things. One of the things I told my assigned nurse at the beginning of my shift was that I really wanted to be able to do as many hands-on things as possible, like preparing meds and performing nursing skills (maybe pick one or two that you would really like to try and name them specifically). If she knows this at the beginning, it is more likely that she can accommodate you. As not all schools are the same, if you need to have your instructor present for med administrations and invasive skills, make sure you also tell your nurse this. 

5. Do not let the nurses intimidate you. Sometimes you may have the unfortunate experience of getting a nurse who does not want you, or worse you may outright experience nurse bullying, do not let it get to you. Stay professional at all times no matter how your nurse acts. Communicate with your instructor if needed, and make sure you get what you need to do your job. Also, do not do things you know you are not allowed to do or you do not feel comfortable with. I would suggest learning what CUS (Concerned, Uncomfortable, Safety) words are and how to use them early on just in case you ever find yourself in a situation in which you need to use them and to help prepare you to use them when you become a nurse. Here is an article that can give you a little more information about CUS if you are interested: Safeguarding patients: The courageous communication solution

Also, on a side note, if you have zero hospital and/ or medical experience at all, it is OK just to do more observing than actually doing on your first 1-2 rotations, but after that, get in there! Just ask questions and try to do things you can! Whew! sorry that was so long!

1. ALWAYS be visible and ready to help

2.  If you see a nurse scrambling around, ask if they need anything and offer to help.

3.  If call lights are going off and you’re not in the middle of something, poke your head in and see what’s going on, even if it’s not your patient. 

4.  The menial tasks are not beneath you.. Making a bed, walking a patient, getting them a new pitcher of water..  

5.  In most circumstances, avoid “I can’t do that skill/assessment” and instead say “I’ve never done that, do you mind showing me?”

6.  If a nurse asks for your help, never say “that’s not my patient”.  

Sorry if those seemed random, just my thoughts from med-surg, where by the end the floor nurses and my instructor were giving me a fair amount of autonomy.  I really do feel that by doing the above, my clinical experience was notably different than other people in my own clinical group, and I had a semester that I feel actually prepared me for floor nursing.

Next semester will be Peds and psych, and I plan on taking the same approach..

Phoenix94

28 Posts

On 1/2/2021 at 2:58 PM, marquisdelafayette said:

In clinicals, you're fortunate to have some control over your education. Be the first to volunteer to step up to try things, always ask questions, ask for more opportunities to see and do things if they're not being given to you. Don't let the fear of not knowing what you're doing or not being comfortable get in your way. This is your chance to learn while you have the safety net of other nurses and faculty so don't let discomfort hold you back. Get comfortable being uncomfortable! 

Thank you for the helpful tips! There are many things to learn, and sometimes, I don't know if I'm asking the right questions. One moment, I'm asking about medications and their purposes but when I turn in my report to my clinical instructor, they come up with questions like, "What makes this medication better than ____ or _____?" or " Would it be better for this patient to have scan A or scan B?" and I would have never thought of those questions. Do asking these more in-depth questions come from experience or is this kind of thinking expected from the get-go?  Thank you in advance!

Phoenix94

28 Posts

On 1/2/2021 at 6:31 PM, CamperNurse said:

Congrats on starting clinicals! Here are a few things I wish I had known/ learned the hard way/ knew but was still taken aback by in my first semester of Clinicals:

1. Even if you can't administer a medication, if your nurse is willing to directly watch, you can prepare it. (For us it was mandatory that our instructor supervised ANY and ALL medication administrations, but preparing meds, even programming pump, was permitted so long as it was the actual RN who administered/turned the pump on). You can get a lot of experience this way, but just double check your school's specific policies. 

2. I think our schools clinical paperwork was a little weird, but in my first 2 semesters of clinicals it was not due at the end of the clinical day, but instead a few days later. This is a great time to learn everything you can about the disease process(es) you encountered that day (and make your write-ups/care plans really good). My paperwork always took me until the day it was due, but the amount I learned from taking the time I had was invaluable. 

3. ASK QUESTIONS! Also, keep a "note sheet" with you to jot down little things you learned or things you want to follow up on later.

4. Volunteer/request to do things. One of the things I told my assigned nurse at the beginning of my shift was that I really wanted to be able to do as many hands-on things as possible, like preparing meds and performing nursing skills (maybe pick one or two that you would really like to try and name them specifically). If she knows this at the beginning, it is more likely that she can accommodate you. As not all schools are the same, if you need to have your instructor present for med administrations and invasive skills, make sure you also tell your nurse this. 

5. Do not let the nurses intimidate you. Sometimes you may have the unfortunate experience of getting a nurse who does not want you, or worse you may outright experience nurse bullying, do not let it get to you. Stay professional at all times no matter how your nurse acts. Communicate with your instructor if needed, and make sure you get what you need to do your job. Also, do not do things you know you are not allowed to do or you do not feel comfortable with. I would suggest learning what CUS (Concerned, Uncomfortable, Safety) words are and how to use them early on just in case you ever find yourself in a situation in which you need to use them and to help prepare you to use them when you become a nurse. Here is an article that can give you a little more information about CUS if you are interested: Safeguarding patients: The courageous communication solution

Also, on a side note, if you have zero hospital and/ or medical experience at all, it is OK just to do more observing than actually doing on your first 1-2 rotations, but after that, get in there! Just ask questions and try to do things you can! Whew! sorry that was so long!

Thank you for the tips! For my school, we can touch medications this semester (we couldn't do it last semester) so I will keep these in mind. I noticed that mixing certain medications can be tricky since some can't be crushed and mixed with either a puree or a liquid. For tip #2, my report is due at the end of the day, but I make notes of what I want to ask and what I can research in my books and online when I get home. The third has been my bread and butter, but I have a challenge of writing all the information without getting too bogged down by the details. I should be able to administer medications this semester (last semester we weren't allowed to do so), and I'll keep your words in mind. I'm very lucky to not have encountered a mean nurse, but I'll read your article to be bettered prepared. Thank you for your nuggets of wisdom! Many blessings and good health to you.

Phoenix94

28 Posts

16 hours ago, FiremedicMike said:

1. ALWAYS be visible and ready to help

2.  If you see a nurse scrambling around, ask if they need anything and offer to help.

3.  If call lights are going off and you’re not in the middle of something, poke your head in and see what’s going on, even if it’s not your patient. 

4.  The menial tasks are not beneath you.. Making a bed, walking a patient, getting them a new pitcher of water..  

5.  In most circumstances, avoid “I can’t do that skill/assessment” and instead say “I’ve never done that, do you mind showing me?”

6.  If a nurse asks for your help, never say “that’s not my patient”.  

Sorry if those seemed random, just my thoughts from med-surg, where by the end the floor nurses and my instructor were giving me a fair amount of autonomy.  I really do feel that by doing the above, my clinical experience was notably different than other people in my own clinical group, and I had a semester that I feel actually prepared me for floor nursing.

Next semester will be Peds and psych, and I plan on taking the same approach..

First, thank you for your wisdom! 

I didn't know we could go inside rooms with call lights on. This is super helpful! As someone who has never been in the medical field, I practice making beds, checking vitals on a routine and keeping patients comfortable as much as I can. It becomes second nature once I do it enough times. Your 5th tip is awesome! I'll definitely make a note of that! You're absolutely right on the last one. My colleague told me that having an extra patient to help is an extra opportunity to learn. Thank you again and many blessings and good health to you!

marquisdelafayette

184 Posts

20 hours ago, Phoenix94 said:

Thank you for the helpful tips! There are many things to learn, and sometimes, I don't know if I'm asking the right questions. One moment, I'm asking about medications and their purposes but when I turn in my report to my clinical instructor, they come up with questions like, "What makes this medication better than ____ or _____?" or " Would it be better for this patient to have scan A or scan B?" and I would have never thought of those questions. Do asking these more in-depth questions come from experience or is this kind of thinking expected from the get-go?  Thank you in advance!

Those sorts of things definitely come from experience! Your clinical instructor is asking you those things so that in the future, you start to think about them. No one expects you to know everything from the start! Thinking like a nurse takes time and practice and some guidance at first. But now you know next time you run into those meds, to consider those questions before being prompted! 

Phoenix94

28 Posts

On 1/4/2021 at 4:43 PM, marquisdelafayette said:

Those sorts of things definitely come from experience! Your clinical instructor is asking you those things so that in the future, you start to think about them. No one expects you to know everything from the start! Thinking like a nurse takes time and practice and some guidance at first. But now you know next time you run into those meds, to consider those questions before being prompted! 

Okay! That's good to know. Thank you!

GrumpyOldBastard, MSN, RN

Specializes in ICU + 25 years as Nursing Faculty. Has 40 years experience. 91 Posts

Welcome to where the “rubber meets the road”.... the bedside!

I absolutely agree with all the “DO IT!” suggestions already offered.  That behavior is good for all of the obvious reasons... and for a less obvious reason.  While there is no doubt that your instructor has a huge impact on your clinical experiences.... so do the staff nurses.  If the staff nurses like you, and see you as well prepared and eager.... THEY will connect you with opportunities that your instructor may not know about. (Caveat:  “DO IT” is within the limits set down by your instructor and the institution.  I am advocating courage... not recklessness.)

When I was a student, I found it useful to write out a 3x5 card with the assessments that I needed to do for a specific patient... I could take that to the bedside and use it to keep me from missing things.  When doing assessments remember:  “If god didn’t put it there... you are responsible for it.”  In other words, your assessment is NOT limited to the patient... but includes ALL the equipment attached to the patient too!

Pull back the covers and LOOK.  It is very common for nursing students to be uncomfortable pulling back the covers and REALLY looking at the patient.   Unfortunately, there are a great number of bad things you will miss if you don’t look there.  Remember: “As a nurse, you have the authority and responsibility to look where Momma taught you not to look!” (Of course, you do this in the context of providing privacy and asking the patient for permission.)

Remember that a huge part of a nurse’s job is to prevent, detect, and intervene to prevent REALLY bad outcomes.  As you think about your patients, ask yourself...

  • What are the really bad things that could happen?  
  • What can I do to prevent them?  
  • How would I know if they are happening?  
  • What do I need to do if they happen?

Knowing what your school’s reputation is among the staff can help you understand their response to you.  For example, there is a school in my community that has a reputation for most of their students being quite clueless and useless at the bedside.  As a result, the strong students from that school have to fight past that reputation with the staff.  Knowing that can better prepare you to understand the situation and overcome it.

Put down the clipboard!  There is one behavior that often telegraphs a whole set of the wrong messages to the staff...... holding your clipboard to your chest with your arms folded across it.  Having a clipboard may be OK.... using it like a shield makes you look scared and useless. Perhaps a story will help put the above in context:  My wife was a nurse in an inpatient hemodialysis unit.  As you can imagine, it was really busy.  As a result, she didn’t have time to mess with unprepared, scared, or useless students who were there for an observation experience.  She used to give students about 60 seconds to show “signs of life”.... if the student was engaged and eager, she would bring them into her activities.  If the student was unprepared, scared, or disengaged... she would move the student aside and carry on without them.  You might wonder: “How can I show “signs of life?”  Simple, put down the clipboard, and ask: “How can I help you?”

Understand the value of asking GOOD questions.  You can’t know everything.  Nobody expects you to.  However, we do expect you to TRY to learn.  Sometimes we know that things are confusing and if you ask about them... we know that you tried.  For example:  If you were with my wife in the hemodialysis unit and she said “What do you know about hemodialysis access sites?”  If you say “I don’t know”.... that is not a great answer.  On the other hand, if you say “I am confused about the difference between an AV fistula and an AV graft.”  That is a GREAT answer!  How can it be a great answer if you are saying that you don’t understand?  The reason is that you obviously TRIED.... or else you could not have asked such a great question!  (The AV fistula and AV graft are similar and easily confused by the novice.)  In other words, often your questions tell us that you tried or you did not!  Another hemodialysis example regarding access:  You say: “I have read about assessing the bruit and thrill... but I don’t really understand.”  It is VERY likely that at that moment (time permitting) you will be dragged to the bedside and shown what those are!  You would be amazed by how much staff are willing to invest in in you..... IF you show interest and are trying to learn.  Of course, the best questions go beyond “What” into “Why”..... “If an AV fistula is so desirable, why would a patient have a hemodialysis catheter?”  BINGO!  That sort of question is GOLD!

Understand the first hour.  Many students find that staff can be abrupt and unfriendly during the first hour of the day.  Why is that?  There can be many reasons but some key reasons are:

  • Feeling a need to get organized before getting behind with tasks.
  • Feeling an urgency to see all the patients and determine that they are not trying to die.
  • Feeling an urgency to check a zillion things in the patients’ rooms. An example is identifying any IV bags that are almost empty.
  • Acute caffeine insufficiency.

Often staff are more approachable and friendly after they get through those immediate tasks at the start of the shift.

  • GET A GOOD NIGHT OF SLEEP BEFORE CLINICAL!
  • EAT A GOOD MEAL BEFORE CLINICAL!
  • SMILE, BREATHE, RELAX.

 

Phoenix94

28 Posts

12 hours ago, GrumpyOldBastard said:

Welcome to where the “rubber meets the road”.... the bedside!

I absolutely agree with all the “DO IT!” suggestions already offered.  That behavior is good for all of the obvious reasons... and for a less obvious reason.  While there is no doubt that your instructor has a huge impact on your clinical experiences.... so do the staff nurses.  If the staff nurses like you, and see you as well prepared and eager.... THEY will connect you with opportunities that your instructor may not know about. (Caveat:  “DO IT” is within the limits set down by your instructor and the institution.  I am advocating courage... not recklessness.)

When I was a student, I found it useful to write out a 3x5 card with the assessments that I needed to do for a specific patient... I could take that to the bedside and use it to keep me from missing things.  When doing assessments remember:  “If god didn’t put it there... you are responsible for it.”  In other words, your assessment is NOT limited to the patient... but includes ALL the equipment attached to the patient too!

Pull back the covers and LOOK.  It is very common for nursing students to be uncomfortable pulling back the covers and REALLY looking at the patient.   Unfortunately, there are a great number of bad things you will miss if you don’t look there.  Remember: “As a nurse, you have the authority and responsibility to look where Momma taught you not to look!” (Of course, you do this in the context of providing privacy and asking the patient for permission.)

Remember that a huge part of a nurse’s job is to prevent, detect, and intervene to prevent REALLY bad outcomes.  As you think about your patients, ask yourself...

  • What are the really bad things that could happen?  
  • What can I do to prevent them?  
  • How would I know if they are happening?  
  • What do I need to do if they happen?

Knowing what your school’s reputation is among the staff can help you understand their response to you.  For example, there is a school in my community that has a reputation for most of their students being quite clueless and useless at the bedside.  As a result, the strong students from that school have to fight past that reputation with the staff.  Knowing that can better prepare you to understand the situation and overcome it.

Put down the clipboard!  There is one behavior that often telegraphs a whole set of the wrong messages to the staff...... holding your clipboard to your chest with your arms folded across it.  Having a clipboard may be OK.... using it like a shield makes you look scared and useless. Perhaps a story will help put the above in context:  My wife was a nurse in an inpatient hemodialysis unit.  As you can imagine, it was really busy.  As a result, she didn’t have time to mess with unprepared, scared, or useless students who were there for an observation experience.  She used to give students about 60 seconds to show “signs of life”.... if the student was engaged and eager, she would bring them into her activities.  If the student was unprepared, scared, or disengaged... she would move the student aside and carry on without them.  You might wonder: “How can I show “signs of life?”  Simple, put down the clipboard, and ask: “How can I help you?”

Understand the value of asking GOOD questions.  You can’t know everything.  Nobody expects you to.  However, we do expect you to TRY to learn.  Sometimes we know that things are confusing and if you ask about them... we know that you tried.  For example:  If you were with my wife in the hemodialysis unit and she said “What do you know about hemodialysis access sites?”  If you say “I don’t know”.... that is not a great answer.  On the other hand, if you say “I am confused about the difference between an AV fistula and an AV graft.”  That is a GREAT answer!  How can it be a great answer if you are saying that you don’t understand?  The reason is that you obviously TRIED.... or else you could not have asked such a great question!  (The AV fistula and AV graft are similar and easily confused by the novice.)  In other words, often your questions tell us that you tried or you did not!  Another hemodialysis example regarding access:  You say: “I have read about assessing the bruit and thrill... but I don’t really understand.”  It is VERY likely that at that moment (time permitting) you will be dragged to the bedside and shown what those are!  You would be amazed by how much staff are willing to invest in in you..... IF you show interest and are trying to learn.  Of course, the best questions go beyond “What” into “Why”..... “If an AV fistula is so desirable, why would a patient have a hemodialysis catheter?”  BINGO!  That sort of question is GOLD!

Understand the first hour.  Many students find that staff can be abrupt and unfriendly during the first hour of the day.  Why is that?  There can be many reasons but some key reasons are:

  • Feeling a need to get organized before getting behind with tasks.
  • Feeling an urgency to see all the patients and determine that they are not trying to die.
  • Feeling an urgency to check a zillion things in the patients’ rooms. An example is identifying any IV bags that are almost empty.
  • Acute caffeine insufficiency.

Often staff are more approachable and friendly after they get through those immediate tasks at the start of the shift.

  • GET A GOOD NIGHT OF SLEEP BEFORE CLINICAL!
  • EAT A GOOD MEAL BEFORE CLINICAL!
  • SMILE, BREATHE, RELAX.

 

Hello and thank you for your wisdom and warm welcome!

Your 3x5 card idea is really neat! I'll be able to remember how to do the specific assessments while learning and getting a better understanding of what I'm looking for if something goes wrong. The last 3 questions via your bullet points are definitely going into my list of questions for myself and to ask the nurse.

I think my school was on to something since we're not allowed to have clipboards during clinicals. Only notebooks that can fit in the palm of our hand and a few pens are allowed.

DING DING! You just hit the million dollar question regarding the "asking good questions" department! If I see something for the first time, I make a note to go home and research the types of tests, scans, medication, etc.  and process what they all mean and why one of my patients got it. That way, in the off chance that I see the same test or medication again, I'll have a better idea of what I'm supposed to look for or be cautious of. It never ceases to amaze me when nurses can ask follow-up questions with one another about doing test A instead of test B or giving medication A versus medication B. With some extra studying and attentiveness, I'll be able to ask those great questions and blow another nursing students mind. Hehehe.

Again, thank you for your advice and I wish you good health!