First-Time Clinicals --Looking for Advice

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I've been an AllNurses reader for quite some time, and while I know that many perennial topics have been "discussed to death," I also know that new threads often elicit fresh thoughts from particularly nurturing colleagues both seasoned and new.

Soooo... what advice do YOU have for a BRAND-NEW, highly motivated, super-excited mid-life career-changing nursing student soon embarking on his/her first clinical assignment/adventure?

In an effort to connect you [virtually] with my current range of emotions,

please note the following: :eek: :blink: :nurse: :D :woot: :wideyed: :) :p :nailbiting: :bookworm: :snurse: :cool: :wacky:

There's no "Gary Busey meets the Amazon Fire Stick" emoticon, so please form your own mental image for purposes of this thread. (smile)

jadelpn, LPN, EMT-B

9 Articles; 4,800 Posts

Look, listen and learn. Take notice of how nurses do what they do. It will be a buffet of a little of this, a little of that. Some of the best stuff you can learn is by taking what you need as far as pointers, advice, practice and utilizing all of them for your practice.

Stay SUPER organized. Use a paper brain. Learn a really good assessment. Know your patient's baseline going in. Know your orders. Make note of the unusuals--meaning treatments, or medications that are given at different times.

Learn to spot the weird stuff--does the patient's IV flush? Is the foley draining? Is the patient eating/drinking/peeing/pooping? Can they ambulate? How? Do they have pain control? Do they have support at home? Are they TRULY alert and oriented? If they are not, is this baseline or do they need a higher/alternate level of care? Can they reasonably function at a level compatible with safety and life after discharge? Are their vitals stable? Do they understand the importance of taking their medications? Can they take them safely, or do they need a prepour?

If there's a question on the questions--then you should find out the answer from your information source (and your clinical instructor).

Absorb everything, and I wish you nothing but the best!!

See a patient as a total picture.

blondy2061h, MSN, RN

1 Article; 4,094 Posts

Specializes in Oncology.

Ask questions, but try and make them intelligent questions. Use resources at your disposal. Don't ask, "What side effects does lasix have?" Look that up. Ask "Should I be concerned about giving this patient lasix when his potassium was 3.3 yesterday?"

Never pass up on the opportunity to watch or assist with something. Emptying a foley isn't exciting, but if you enthusiastically jump at that opportunity, they're more likely to seek you out when they're putting in that chest tube next week.

Never leave a patient's room with asking if there's anything else you can do to for them. On the same note, encourage patients to do what they can for themselves.

Treat at all patients with respect- knock before entering, introduce yourself, and always remember to provide for their privacy the best that you can.

Your attitude sounds excellent, which is most of the battle, so I'm guessing you'll do just fine.

iPink, BSN, RN

1,414 Posts

Specializes in Critical Care, Postpartum.

Smile! Yup, a smile can go a long way for your patients.

Stay motivated and enthusiastic. Don't spend your time on the floor looking at your cell phone, instead ask the nurses if you can watch a procedure, help them with anything.

Keep in mind real work nursing is going to be a little different than textbook nursing. Remember you're a student and a guest on their floor, be respectful. You're solely there to learn and network.

Specializes in NICU.

:yes:Take policy and procedure rules very seriously,don't fret if you get out later,finish your work,try not to leave any loose ends.Do not answer your phone at home if it is work,you are entitled to rest and peace of mind after working so hard.Set your boundaries from the beginning dont let co workers call you at home with stupid questions like was this test done?They can be big girls and look it up.Good luck I hope you have a great ride an hopefully the nasty ones that I had to deal with are no longer around.lol

allnurses Guide

JBudd, MSN

3,836 Posts

Specializes in Trauma, Teaching.

Be mindful that having a student slows a staff nurse down.

Do your best to keep up, ask pertinent questions, but not delay things.

Sometimes it is awkward to explain why things are done in a particular way in front of the patient, so wait until you both leave the room if you are confused about something, doesn't do to appear to challenge the nurse inside the room. Key word, appear. Some folks are touchy that way.

RunBabyRN

3,677 Posts

Specializes in L&D, infusion, urology.

Eyes and ears open.

Take notes.

NETWORK. If the nurses like you, have them mention you to their managers!! This got me a job offer!!

Take EVERY gross opportunity as it comes, because you will have more opportunities to learn this way.

Rope in your classmates if you get something cool (and they can sneak away, and the pt is cool with it).

Research before asking.

Make sure everyone has water (unless they're on fluid restriction!).

Clean bedside tables and anything else you can during downtime.

If your nurse has her own brain sheet, ask for a copy. You'll see what works for her and what does and doesn't work for you, and eventually develop your own style.

Be friendly and eager, but know your limitations. Don't be afraid to stretch your wings and push the boundaries, but patient (and student) safety comes first.

Yup, they have it :)

Thank the nurse who corrects you or 'educates' you, especially if the tone is (or seems) snotty. Express gratitude for the nurses who take time away from their duties to focus on you.

I did a lot of precepting, and many nurses don't like it because it is 'more work'. IMO, it is more work but GOOD work.

You can ask why a med is being used, but if you want to know what it's for or side effects, look them up instead. For procedures or complex treatments, go ahead and ask questions, but also turn your brain on high focus and think about what the nurse is doing and how she's doing it. Once you know what a procedure or treatment IS, you can put most of the rest together while watching, simply using your own common sense. TRUST your common sense unless you are specifically told not to in this case.

Be very, very helpful! If you are sitting around watching your preceptor chart, ask around if anyone needs you to do something for them. If the call bell goes off and you aren't busy, jump up and attend the patient if appropriate. At least you can tell the RN what the patient needs and save her some steps. You can hear the patient wants pain medicine, you can ask them to rate the pain, and where it is quickly and take that to the primary RN. That's an example of taking the initiative. Being bright, interested and very eager to help or observe will likely endear you to the staff more than not.

Some staff are curmudgeons. Smile at them, thank them, compliment them "You made that look so easy!" lol. Usually they just need a little positive attention :D

Just KNOW you will feel like you said the wrong thing, did the wrong thing, almost did the wrong thing, didn't react right. Know in advance you will experience these feelings so you can learn from them and move on. You won't know what you need to. Nursing school never has and never will prepare you for real life on the floor -- no fault, it just can't. In fact, it will astound you how little you know, it could be an overwhelming feeling. This is just your brain adjusting, it's a lot of anxiety but it keeps you alert and safe as a new nurse.

A brand new RN who is all relaxed is a danger to herself and others. You gotta tolerate that anxiousness, it really is your friend, not your enemy.

Good luck! My 'little sister' is starting nursing school in the spring (crazy woman). She'll be just like you in three years. Your life experience and common sense that comes with age will really help you through the rough spots, you have perspective and more realistic attitudes. The hard part will be feeling like you are five years old and just wet your pants when you miss something. Take it in stride, learn from it, and move on.

Specializes in psychiatric.

Practice a good poker face for those code brown moments and super bad yeast infections.........

Specializes in Psych, Substance Abuse.

This was a mid-life career change for me, too. My advice:

Follow the rules: If you're not allowed to give meds, do not allow the nurse to hand you medication to give the patient and do not allow the nurse to let you spike an IV bag.

Stay calm: If the instructor comes in the room, sits down, crosses her legs, and tells you do an assessment, don't get nervous, or at least don't let her know you're nervous.

Be thorough: Do your assessments as you were taught. Your instructor might go behind your back and ask your patient if you really listened to her/his heart, lungs and bowel sounds.

Keep your distance: If your patient is physically combative, stay out of striking distance and watch your back.

Ask for help when needed: This is not a sign of weakness.

And always be on time and prepared.

LoriRNCM, ADN, ASN, RN

1 Article; 1,265 Posts

Specializes in Hospice.

Haha!!!! I love your sense of humor. Hang onto that, that's my advice!

Every bit of advise given so far on this topic is 'spot on'.

Not a whole lot to add, except be on time and show a willingness to stay late if it is busy. There may be some downtime, and it seems that students group together during down time and do pretty much nothing, DON"T DO THAT! Ask the nurses if they need anything, not just your preceptor (but do ask her first) but all the nurses on the floor. Volunteer to answer call lights for all the nurses, get things from the supply room, empty bedpans, help to lift patients, or whatever is needed. Unless you are charting, don't sit down. They will have 5 or 6 students, you want them to remember YOU!

Every preceptor in every clinical is a potential job reference, so show your awesomeness, and in the last week request a reference. If you find yourself on another clinical in that same facility, stop by after shift one evening to say hello (I took cookies).

You have two goals:

1. Learn as much as possible

2. Make yourself memorable

The connections you make now can help you get a job in a tough market later!

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