How To Select Patients for your Student Clinicals
Student clinicals can be very stressful for students. Some clinical instructors will pre-select the patients for the students. However, other clinicals will require that the students select their own patients. Often these students are instructed to select a patient that has conditions related to the conditions they are studying in the classroom. Rarely, are they told the pitfalls they may encounter when given the opportunity to select their patients.
During clinicals, students need to protect themselves from being taken advantage of by nurses, certified nurse assistants (CNA's) and patients. Often when a student is on the hospital floor reviewing charts for selection, a seemingly kind nurse will tell the student about a great patient they should select.
This can be a trap.
That one patient may have so many needs that they are actually like having three patients. The patient may be hostile or very demanding.
A student should carefully review the charts and question why the nurse doesn't want the patient. An easy way to handle the situation is to thank the nurse for the suggestion and inform them that a decision has already been made.
There are, of course, many kind and helpful nurses that would never dream of unloading a high maintenance patient onto a student.
CNA's can also be a challenge for student nurses.
Sometimes the CNA's will not help out the student or act superior to the student. Many CNA's don't realize the student was once a CNA or know how hard the student has worked to be accepted into nursing school. Students are often required by their schools to do the work of the CNA in addition to the work of the nurse. This is very demanding for the students.
Students are required to clean soiled patients and take vital signs. CNA's are supposed to help the students when needed. All too often, when a student needs help turning a heavy patient or cleaning up an incontinent patient, the CNA cannot be found. If the student must provide care for several patients then it would be wise for the student to mix high care level patients with low care patients.
Try to select the patients based on your best judgement not on the suggestions from others. If you know you will need to provide care for several patients try to select a range of low need patients with higher need patients. Look at the medication list for the patient. If it is much longer than most, then the patient will need more care than the others. If you are interested in working with that patient, then it is a good idea to try to also select a patient with lesser medication needs. Balancing high need patients with low need patients is a wise decision for the student nurse. It is also important to use caution when a patient is "advertised" to the student. A student nurse that is close to graduating will have learned the pitfalls of patient selection, but for a newer student nurse good advice may be the only advice.Last edit by Joe V on Jan 10, '15
May 10, '08Thanks for the advice. We are almost finished with our clinicals and can relate to CNAs disappearing when you need them. More than once we had to decline the CNA requesting us to take vitals or clean a patient, so we could do our meds or other tasks on our patient.May 11, '08That is 100% the truth. Half the time we arrive on the floor and never see another CNA for the rest of the time....!!!!! Been there done that. I think sometimes it boils down to the CNA's being envious. Not always - but sometimes. I love CNA's...I couldn't function without them! And on a side note - alot of them really should move on further into nursing they are so good!May 11, '08Quote from SnarfGirlI agree, some of them are wonderful. There are a few that are so nice and actually appreciate someone else doing vitals for them. Unfortunately, most (in my experience) never say thank you, are mean to the students and create a really bad image for themselves. In my school all of the RN students have to take a CNA class and get licensed before the school begins, but the non student CNA's still think they are a better than the RN students.That is 100% the truth. Half the time we arrive on the floor and never see another CNA for the rest of the time....!!!!! Been there done that. I think sometimes it boils down to the CNA's being envious. Not always - but sometimes. I love CNA's...I couldn't function without them! And on a side note - alot of them really should move on further into nursing they are so good!May 11, '08Quote from loudleoCongrats on almost finishing your clinicals!!!!Thanks for the advice. We are almost finished with our clinicals and can relate to CNAs disappearing when you need them. More than once we had to decline the CNA requesting us to take vitals or clean a patient, so we could do our meds or other tasks on our patient.May 14, '08Congrats to everyone about to finish up clinicals. I am about to start my first clinicals in the hospital. Last semester was is the nursing home and the CNA's seemed to really appreciate us. Thanks for the advice about the future. I have already seen a little of the jealousy but I try to over-look it and portray that I am also trying to help everyone with the patients.May 15, '08That really shocks and saddens me to hear about CNAs
I shadowed a CNA one day during a clinical to get my CNA certification and told me she loved her job, she was doing it for 33 years and she would not think of doing anything else. Not all CNAs are jealous or envious, they just love what they do and it is a choice that they stay a CNA and not go to nursing school.May 15, '08Hmmm...I am still quite a ways from clinicals, but will tuck this gem away for when the time comes.Jul 12, '08Thank for that article. All that you have said is true. I've witness this at PRN-CNA job over the past few months. The 7-3 CNA's love to get out of doing their work.
I truly appreciate your thoughts on the selcetion of patients during clinicals. This will diffenitely help when the time comes for me.
(2010 LPN graduate)
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