Today we have a guest post about nursing clinicals from Sam Akers RN who writes at Scrubed.com. I invited Sam to share some tips for nursing students as she recently graduated and passed the NCLEX herself and her blog is a ton of fun to read and is full of insight and advice for the nursing student and new nurse alike. Nursing clinicals are one of those things that made us all a bit nervous while in school. In this post Sam shares five great tips to overcome that fear and have a great time on your clinical rotation. – Jon Haws RN CCRN
The only thing that is able to evoke as much terror as it does wonder and awe in a pre-nursing or brand new nursing student is clinical rotations.
I have to start out by letting you know, I had no clue what I was doing when it came to clinicals.
My first clinical experience was during nurse aide training where we were paired up to tackle activities of daily living. My partner was an 18 year old guy, straight out of high school who had ambitions of being a nurse, just like me.
We were assigned a wing and had to answer call lights, appropriately. One patient, on hospice, was extremely elderly and frail. She had mats strategically placed around her bed in case of a fall, roll or tumble.
. . . I Think She’s Dead
After about a half a day, my partner and I were increasingly confident. We answered call lights with a quickness and had full control over our wing, or so I thought. I rounded the door to the room of the elderly woman mentioned before. Her body was limp, my poor future murse partner was pale and shaking next to her. He stammered, “I think she’s dead, what do I do Sam?”
My reaction?
I ran like crazy down the wing screaming “HAAALLPPP” at the top of my lungs.
I am happy to report the aforementioned patient wasn’t deceased, she just had slow respirations. The nurses at that facility definitely got a huge laugh out of that.
I have some good news. Nursing school clinical is NOTHING like STNA clinical.
Most nursing programs start you on a geriatrics rotation. I was given one patient per week. Due to census, many of us partnered up. Here’s are some tips to excel during clinical, and if you run down a hall screaming for help, it’s okay. Just make sure your patient is safe and be sure to hit the call light first.
1. Be Prepared
The Night Before Clinical:
- Gather all of your supplies and have your clinical bag ready to go
- Lay out your scrubs / nursing uniform
- Get quality sleep – Patient safety is extremely important and you will need a good night’s sleep to make sure you’re on top of your game. You cannot think critically with a foggy mind.
The Morning of:
- Eat breakfast, even if it is something small. You do not want to risk passing out or getting sick. I have seen it time and time again.
- Listen to a pick me up song on your way to clinical
- Arrive early – 15-30 minutes early is ideal
- Breathe and relax
2. 6 Things you must know about a patient
- Know the patient’s code status. Are they a DNC-CC or DNC-CCA? Are they a Full Code?
- DNC-CC or Do Not Resuscitate Comfort Care
- -DNC-CCA or Do not Resuscitate Comfort Care – Arrest
- Full Code
These can be different based on the state you live in and I highly recommend speaking to your nursing clinical instructor to verify what each code means.
- Activity / Are they a fall risk?
- Diet
- Why they were admitted
- Primary and Secondary Diagnoses
- Medications – You probably will not be passing meds this early into the nursing program but it is still important to know what medications your patient is taking to alleviate any complications. A big one is falls since tons of meds cause orthostatic hypotension.
3. Ask For and Offer Your Assistance
Offer help to other students when you are able to. This will be your family for the next 2-4 years and it is important to build relationships.
- Your clinical instructor will appreciate you being honest and humble rather than putting patient safety at risk
During geriatric clinical rotation, the patients sleep often. Some will even be close to, if not, fully independent.
- Do not stand around – help the STNAs with showers and baths. A friend of mine was an aide while in school, she racked up major brownie points helping the aides when there was down time.
- Clean rooms – the housekeeping staff will adore you for this and offer advice and assistance when you are in a tough spot.
- Turn or ambulate your patient every 2 hours. This will alleviate bed sores.
4. Document, document, document
If you do not document, it simply did not happen
- Wounds – many patients in a long term care facility will have wounds. You need to document them.
- Size, measure
- Odor
- Drainage
- Bandaging
- Any interventions
- Input and output
- Activity
- How the patient tolerated any interventions
5. Above All Else, Remain Positive
- Your attitude is contagious and will help immensely if you have a good one
- Know that every day will not be easy, but it will definitely be worth it
It is not going to be easy, so give yourself time to absorb everything. You will not know everything, asking questions is a part of learning. Allow yourself to familiarize with everything. Surround yourself with people that can help you through these. It is not as easy as it seems, but at the end, it will all be worth it. – Armi Stobinski, RN Class of 2016
Conclusion
Nursing clinicals are scary for all of us the first few times, but with the five tips above you will at least be sure you are doing the MOST important things and caring for your patient.
Do you have any other tips? Share them below in the comments.
