I am an instructor and would love to see the perspective of any and everyone who interacts in the clinical setting: students, fellow instructors, and staff nurses.

What are your best hints, tips, and tricks for excelling at clinicals? Not just in terms of skills, but in getting along with staff, and making the most of your clinical day.

My advice is as follows:

1. Find out what your instructor expects by asking him/her if you are not provided detailed guidelines. Don't rely just on the advice of others as every student's experience with a given instructor is different.

2. Don't pretend you know something if you don't. You are there to learn. It is expected (or should be!) that you don't know everything.

3. That said, prepare as much as possible. Make yourself skill cards with pictures for common skills, and review them often.

4. Don't allow yourself to fall into the pattern of doing CNA/tech work. Critically think about all data you see. What does this mean for the patient?

5. Think to yourself "What is the worst-case scenario that could happen to this patient?" and "What would my top interventions be if this occurred?"

6. Ask for practice doing "real-life" nursing tasks such as giving report, pretend to call a physician using a chart and know where to find the information, practice charting as much as possible, administer meds. Try to find a nurse that will let you safely perform as many things as possible.

7. If you see a patient deteriorating and your nurse quickly acts on the patient's behalf, ask him/her how they made their decisions later when things are calm. What signs and symptoms did they see that led to their decisions?

8. Get really organized.

9. Ask a lot of questions!

10. Care for each person in the manner you would want your favorite family member cared for, even if it makes you want to scream!!!

11. Have a sense of humor.

12. Realize that you can't be perfect. In school we are teaching you an ideal standard of care. We don't always work in an ideal world. Do your best always, but don't beat yourself up on the days when you aren't the "perfect nurse."

13. Look up some common diagnoses prior to clinicals. For example, if you are going to the med-surg floor, you might review CHF, pneumonia, hypertension, diabetes, asthma.

1. In the morning greet each patient with a smile and a warm washcloth.

2. Remember Maslow's heirachy. If you aren't meeting there most basic of needs, then it doesn't matter to them if you are meeting the more complex needs.

3. Step up and volunteer for every thing you can.

4. Stay busy. Assist your fellow students. The more you do the more you learn. And they may repay the favor by inviting you when they have some very interesting procedure.

5. Ask questions.

6. Remember there is something to learn from every nurse even if it is NOT how to do something or what kind of nurse you don't want to be.

7. Come prepared and organized.

8. Be nice to the aids, housekeeping and HUCs. They make things happen, know where everything is located, and can help you out.

I would like to always remember my empathy. I want to always keep in my mind that this patient is someone's dad, mom, sister, brother, daughter or son.

Clinical superstar huh? Well, my best piece of advice is:

1. Stay calm-your no good when your paniced or nervous!

2. Don't be surpised when that poo really stinks.

my advice is as follows:

1. find out what your instructor expects by asking him/her if you are not provided detailed guidelines. don't rely just on the advice of others as every student's experience with a given instructor is different. - absolutely! relying on what you're told by other students will get you into a lot of trouble - and make you look like the unprepared one.

2. don't pretend you know something if you don't. you are there to learn. it is expected (or should be!) that you don't know everything. - however, try not to ask the same question every time! get yourself into a routine, and then if something comes up, ask. but don't be the student that asks where the water fountain is every clinical day - it makes you look like you weren't paying attention the last time your instructor answered.

3. that said, prepare as much as possible. make yourself skill cards with pictures for common skills, and review them often. - check out some of the small pocket guides for the clinical course you are currently in. i carried these for all my clinicals and they are wonderful! helps for those things that you just can't remember or need to look up quickly.

4. don't allow yourself to fall into the pattern of doing cna/tech work. critically think about all data you see. what does this mean for the patient? - as a first clinical student, you will do a lot of tech work. but while you're doing it, think about the nursing implications. ask your lead nurse later about what you saw and your thoughts - they are generally impressed if you are already thinking that way!

5. think to yourself "what is the worst-case scenario that could happen to this patient?" and "what would my top interventions be if this occurred?" i always did this! you always want to look around the room, at the chart, patient, etc and think "what could kill them first?" kind of morbid i know, but it puts things into perspective. once you have identified the problem, then you know how to prevent/prepare.

6. ask for practice doing "real-life" nursing tasks such as giving report, pretend to call a physician using a chart and know where to find the information, practice charting as much as possible, administer meds. try to find a nurse that will let you safely perform as many things as possible. or if you can't find a way to do this, follow the nurse and pay attention/take notes while they do it. one day very soon you will have to do it by yourself.

7. if you see a patient deteriorating and your nurse quickly acts on the patient's behalf, ask him/her how they made their decisions later when things are calm. what signs and symptoms did they see that led to their decisions? or better yet, observe and then say "i saw you doing (blank). was it because of (blank)?"

8. get really organized. - post it notes will become your best friend.

9. ask a lot of questions!

10. care for each person in the manner you would want your favorite family member cared for, even if it makes you want to scream!!! there are times when you will want to cry, scream and throw things, but you have to remember that they are in a lot of pain and are usually anxious about their stay so just do your best. best advice ever was given to me by an experienced nurse - if you need a break, take 10 minutes to yourself to chart or just get a glass of water (provided you have that time). it will release some of the stress and prevent meltdowns.

11. have a sense of humor. nursing is funny - just remember not to laugh at people.

12. realize that you can't be perfect. in school we are teaching you an ideal standard of care. we don't always work in an ideal world. do your best always, but don't beat yourself up on the days when you aren't the "perfect nurse." and believe me, at times, you will be disappointed with yourself because you can't do what the other nurses can. it's normal. all those nurses were us once upon a time, and as we gain experience we will gain expertise as well. just stick with it and be determined. attitude and determination are half the battle.

13. look up some common diagnoses prior to clinicals. for example, if you are going to the med-surg floor, you might review chf, pneumonia, hypertension, diabetes, asthma. again, get a pocket guide. they are life savers!

hope this helps!

amber n.

Make sure you communicate clearly with your RN and CNA what you plan on doing with the patient that day (are you focusing on one aspect of their care, are you doing full care for the day, are you passing meds, etc). If they hear you verbalize to them what you'll be responsible for the day, it avoids miscommunications later.

Learn what your instructor expects from you.

Make sure you are prepared before you get your clinical instructor when performing a skill.

Have all pertinent information at your fingertips, to make the med. pass check faster. For ex. know the Potassium level before having the teacher check the Lasix order.

Be open to constructive criticism, don't get defensive as soon as the teacher points out a weakness or something that needs to be worked on.