How do I know what to do and what not to do in clinicals?

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    Opening statement: Maybe I'm being too much me rather than an RN Student or I just don't have work experience.

    Being the nursing program takes up ALL of our time. Some instructors have even told me that the nursing program is a job; one that you need to be committed to 24/7.

    Previous clinical days have been "interesting." You really find out instantly who are the good nurses and who are the not-so-good nurses. It's like I have to be on alert for the sharks in the water. (1) i'm never watching what I say or do. I just be the "nice" me and help out with anything I can. Whenever the patient I'm assigned to needs something, I tell their nurse because somethings I may not be in scope of practice, well within the scope of being a RN student. One nurse, I just went up to because that's the nurse. She was at the med cart and the first time she answered me. The second time, she said, "Look, i'm kinda busy at the moment and i can't be distracted. I'm handing out meeds. Come back to me in 30min." It was a firm statement. No harsh tones or a smile, just firm. Although, part of me thinks she was annoyed by me. I don't know. Should I not be coming to the nurses so often?

    Anyway, to make this short…i have to many experiences…

    one major problem is i don't know when to speak and when not to. Anyone can just take what i said and twist it around to make me look bad when i don't mean bad at all. two recent clinical stories: my instructor called for a meeting and two of our students were not present. The instructor GENERALLY asked, "where are they? has anyone seen them?" I have this unconditional urgency to help people when help is not asked for or when a question is asked by one of my classmates not towards me and I answer anyway. So, I speak up and say, "I don't know where they are. I haven't seen them. I don't know where they are." Honesty. My instructor went on with the meeting. My classmates show up late and all seems well… until my classmate pulls me aside and tells me, "When the instructor asks 'where are these people?' don't say you don't know. Saying, 'you don't know' makes us look bad. It's like we've just walked off our shift being lazy and not doing work. We could have just gone on our 15 minute break and forgot to let someone know. You don't know. But don't say that. Either say nothing or say 'they might be on their break or in the bathroom.'" After that, I felt so stupid. how could what I say you look bad? really? if you look bad, that's on you.

    How was I supposed to know that??! grrr.
    Well, lesson learned.

    Then just last week i freaked out over a new patient who was diagnosed with pneumonia and was breathing in my face all during the head to toe assessment. Within the hour, I started have a weird feeling in my throat. I told a classmate and she started freaking out with me. I tell my instructor shortly after and the instructor starts laughing and saying "an infection does not happen that fast. I know you are smarter than that." and goes on and on about it…well for the next 5 minutes, which felt like forever. then she shares this with a nurse who works on the floor and now she laughs at me.

    I wanna just not speak at all unless spoken to. A CNA hates me now for not following her orders… well then again my instructor says i don't have to do what a CNA tells me because they have a tendency to take advantage of RN students and give them jobs the CNA should be doing.

    So, what is like the basics of how to act in clinicals? How do I handle certain situations?

    I know this was long but any insight is great! thanks!
    Last edit by Joe V on Feb 27, '12 : Reason: spacing
    Joe V likes this.
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  4. 7 Comments so far...

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    For me, clinicals are the hardest part of nursing school. I always feel like I am in the nurse's way. However, I have found that I can help them by showing that I am willing to help and offering. I answer call lights and get water for their patients. If I help them, they are more likely to take the time to help me. One thing that is important is when you get to the hospital, get with your nurse and introduce yourself. Tell her what you can and can't do. If they won't answer your questions or give you any help, call your instructor and have her assist you. I have said some really dumb things and my instructor says she's going to make a book with all the funny things students say! Don't worry, I'm sure they laugh at everyone. I'm sure I'm in her book more than once. Don't give up, just keep trying and study hard.
    ♑ Capricorn ♑ likes this.
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    When a nurse is handing out meds, you leave them alone. Distractions can contribute to errors.

    At clinical, everything is fair game regarding your patient or helping your fellow classmates and other RN's. You can also be helpful by knowing your pathophysiology of disease so you won't freak out. Most of my patients had pneumonia, some had VRSA or MRSA, C-Diff, Hep B, Hep C...I have never contracted any of these diseases. Wash your hands frequently.
  7. 1
    I wouldn't take the direct, blunt comment from the one nurse personally. She was doing meds and that is generally a time you don't bother a person just because it is prime time for errors.

    As a rule of thumb, you should be doing most of your patient's cares. Things that you should/need to inform someone about (and usually it's your instructor, not the primary nurse) are meds, inserting a catheter, and other things that you haven't performed yet. Things you don't normally have to inform someone about are things like ambulating, baths, assisting the patient if they need help with the toilet. Accuchecks are an iffy area, most of the time the techs do them before we get on the floor, and some instructors prefer that you get them first so they can see you do it once before they allow you to do it alone.

    You are there do the job of the appropriate nurse level that you're in school for- of course some things require assistance. And yes cna's can take advantage of you, and if they have issues with it, then you're instructor needs to know and talk to staff about this. The patient I am assigned takes priority and only if there is major downtime do I assist other patients. I'm not saying ignore a patient if you're walking down the hall and they need something, but you shouldn't be doing the work for others when you're there for other reasons.
    seashelleyes likes this.
  8. 1
    At clinical I introduce myself to the nurse who is assigned to my patient. Sometimes they have time to give you a report on the patient, sometimes they don't. I ask if it's okay that I go introduce myself to the patient on my own. I've found that some nurses prefer to walk you in there themselves for the introduction. I tell the nurse if she needs help with anything, to please let me know, and sometimes they ask what skills I'm allowed to perform. Then I find an out of the way spot around the nurse's station and get all the info I need from the chart.

    If I have questions, I ask my instructor, or sometimes my fellow students if they're just standing around. I do what I can for the patient, answer their call light. If I finish with all my paperwork, and the patient doesn't need anything and seems to want to be left alone, I'll help the techs with changing beds and getting vitals. I generally leave the nurses alone because I know they are busy, but sometimes it's necessary to communicate with them. If the nurse is especially friendly and asks me if I have any questions, I definitely will pick her brain for a bit. You really need to assess the nurse, her mood, the amount of work/stress she has at the moment, and act accordingly.

    In general, keeping quiet and not speaking unless necessary is a good idea. Definitely voice your questions, concerns, issues immediately if it's a safety issue. Otherwise, wait until post-conference. Make notes for yourself so you remember everything you want to ask about. Your fellow students have asked you to not say anything if they're not around, so don't.

    From what you describe, you are doing fine. Try not to over-analyze your behavior at clinical - it will only give you anxiety. Just try to remember that everyone on a nursing floor is busy, sometimes students can be annoying. Try to be as helpful as you can, while remaining out of the way and unobtrusive. Always keep a smile and jump on the opportunity to do something.
    seashelleyes likes this.
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    1. You should have a conversation with your clinical instructor before the clinical even begins. Ask her: "What procedures and skills are we allowed to perform? What skills do we need supervision for? Will we be giving medications? Do we need supervision for the medications?" Etc. That will clarify for you what you are allowed to perform and when you have to get your instructor or the primary nurse. You should be doing most of the "CNA tasks" for your patient. Bathing, toiling, etc. There will be times as a nurse that you won't have a CNA and will need to know how to do these things. No, you don't always have to do what a CNA tells you, but communicate with them. Don't let the think you will do it and then ignore it. Say, "I'm sorry but I have to do X,Y, and Z right now, so I can't help you with that."

    2. In regards to the student and the "I don't know" comment, that's ridiculous and you should ignore that classmate. The instructor isn't an idiot. She knows that they could be on break or in the bathroom. They also could be in the cafeteria or off stealing medications somewhere. She doesn't care about where they could be. She wants to know if someone actually knows where they are so that she can go get them. If you don't know, just say "I don't know" and leave it at that. Saying I don't know is no different then saying nothing. If the students didn't tell anyone they were going on break, that's their problem, not yours.

    3. I'm sorry your instructor was poking fun at you. It probably didn't make you feel very good. Keep in mind, though, that we all remember when we were nursing students and the silly things we thought/did. We've all been in your situation, and there will be a time when you'll look back and see that the situation probably was a little humorous. For the future, though, don't ever let a patient breathe in your face no matter what they are diagnosed with. I don't care if they are there for a broken leg. You never know what germs someone might have and you need to protect yourself. You'll almost never find out that the patient has a certain bacteria until you've already been caring for them. You position the patient and yourself so that they are not breathing on you. It's standard precautions.

    4. Don't be afraid to ask questions during clinicals, when your nurse/instructor is not busy. You may feel stupid sometimes, but you'll learn a lot more than someone who never says anything.
    seashelleyes and on eagles wings like this.
  10. 1
    what kind of things are you running to the nurse for? like an above poster said, if its things like ambulating, toileting, they need some water, or anything you are authorized to do on your own, theres no need to go to the nurse about it. if you feel something is wrong with the patient, like o2 sats are unusually low, iv looks infiltrated, blood sugar is really low or high, etc its appropriate to tell the nurse. make it a habit to go to your instructor first if you have questions or need help with a skill. The nurses are great resources, but they did not sign up for a teaching job, and they have a full patient load they are responsible for, so bothering them in the middle of their med pass for every little thing can really affect their ability to do their job, and probably annoys them a bit.

    also, dont forget you can always ask the cna for help for things like boosting a pt, changing a brief, ambulating.

    clinicals are scary at first, after a while you will begin to feel more comfortable, i wish you luck!
    hello sammi likes this.
  11. 0
    Thank you for your post, Itsdabraane. It made me think about some things in a new and different way. I appreciate that.

    I specialize in nursing staff development (in hospitals) and have also done some teaching at the university level. I think part of your discomfort comes from the fact that clinicals require that students learn in a way that may be new them -- and therefore unfamiliar, confusing, and uncomfortable for them. In a traditional classroom class, students are given material to learn (either through lectures, books, class exercises, etc.). The student is expected to learn what they have been given and then either repeat that information back on the test or use that information to solve problems on a test.

    In clinical, the learning is more "experiential." You are not given a very structured collection of material to learn. You have to "feel your way" through the murky world of spontaneous human interaction to develop "a feel" for what works and what doesn't work in real life. It's kind'a like learning to ride a bicycle. You can learn all the scientific principles involved in balance, bike mechanics, speed, etc. ... but you are not going to be able to ride a bike until you actual practice it a bit and "get a feel" for what it is like to ride over different services, in different weather conditions, etc.

    The same analogy can be made with learning almost any sport, musical instrument, craft, or profession. You can only be given part of the material you need to master to be good at it ahead of time. There is a significant part of the PRACTICE of the profession (sport, etc.) that you can only learn through trial and error -- through practicing and making a few mistakes and developing a feel for different situations.

    For some students, nursing school clinicals are the first time they have been required to learn in this experiential way in a school subject (where it really matters and they get graded). And it can be quite uncomfortable. Focus on the learning and don't get too upset by the fact that you have to make a few corrections/modifications in your behaviors as you go. That's a normal part of the learning process.


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