New to clinicals? Here's help.

[nerdtonurse?, BSN, RN]

Hi. I'm nerdtonurse? and I'm an LPN, starting my RN bridge in (gulp!) 1 week. I've seen a lot of "nurses eat students" comments across various postings, and I thought I'd give some tips for those new to clinicals.

What I want from you as a nursing student:

1) Understanding. If you come in and someone's snappy, keep in mind we can all have a bad day (night in my case). If I've just unsuccessfully coded a pt I've had a lot in the last 8 months, I'm not going to feel like chitchat. I'm going to be calling the family, the doc, Lifenet, the funeral home, the NH they came from, etc. I'm going to be prepping the body, and taking someone I may really care about on our last journey together down to the morgue. I may be dealing with family members who are grieving in the room. The difference is, they get to cry and grieve. I still have 6-7 other patients to look after for the rest of my shift, and since I now have an empty room, I will probably get an admission. Not about you. Really.

2) Be tough. If you get easily offended, get over it. We're much nice to you than the families and the patients will be. Get tough on the interpersonal skills, and you'll survive. Wait until you get someone trying to choke you, swing at you, kick you in the face, and threatens to sue you because you just pushed the Narcan and ruined their high. Or you catch their visitor in the nurse's station, trying to get into someone's purse, and they threaten to "meet you some night in the parking lot" because you call security. Or a patient pulls a knife on you, and all your nurse manager wants to know is "what did you do to make the pt feel threatened?" Uh, nothing, the guy's a paranoid schizophrenic who's been off his meds for 5 weeks, and all I had to do to "upset" him was stick my head in the door and say, "hi, I'm nerdtonurse? and I'll be your nurse this evening" Nursing, unfortunately, can be a contact sport.

2) Don't take me redoing/checking your work personally. Just because you've got one of my 7 patients doesn't mean I still don't have to do a full assessment, look at wounds (which means I may have to redo the dressing you just changed), and double check the meds were given on the patient we share. When you've got your license, you'll do the same thing.

3) Ask Questions, but Listen! I really do want to answer your questions, but I also expect you to act like you're interested in my answer. If I tell you the liver failure patient's got to have lactulose, and your first remark is "why, he doesn't have diarrhea?" instead of "yes, I saw his ammonia level was XX, and it was YY at admission, so it's coming down" I'm going to suggest you relook at the labs and re-read the patho for liver failure, and wonder what else you've missed.

4) Know the Labs and vitals. If I suggest you look at the pt's lab work, vitals, etc., DO IT. You're missing something. I want you to get good grades and pass and come to work here, because I can't do 20 hours of overtime a week and go to school, too. If the patient's O2 sat is 80, come tell your instructor AND me.

5) Don't ask me about the boards. If you ask me what was on the boards, I CAN'T TELL YOU. You sign a document to that effect. I may suggest that you know your lab values left right and sideways, and that you know Maslow's not a type of external fixator, but that's nothing you won't read in a NCLEX study guide. We're not trying to "hide the answer" from you.

We want you to suceed, we really do. But unless you see something over the top, like someone hitting someone, don't judge whether a nurse is "good" or "bad" until you've been one for a while. I know I did, and I will tell you frankly, I didn't have a freakin' CLUE what it takes to be a good nurse until I was one.

[spider11]

Great post!!! I'm an LPN starting my transition program on the 25th. I also work on a PCU/CCU floor. It's going to be strange going back to being a student on the floor. Good Luck!!

[nerdtonurse?, BSN, RN]

Good luck to you, too! We actually do some of our clinicals where I work, and that could get awkward -- I mean, you're doing everything for the pt one day, then the next you've got to wait for the instructor to pass meds, etc.

[Daytonite, BSN, RN]

there are 2 sides to being understanding and "getting over" the way people treat you; what's good for the goose is good for the gander. there in no reason for any professional nurses to be "snappy" or "eating students"--at any time--for any reason. that is just a cute way of saying someone is exhibiting bad behavior. that kind of behavior is never acceptable no matter what the circumstances. having a bad day or being upset over the death of patient that was unsuccessfully coded and taking it out on an innocent person isn't justification for being nasty to someone who has no idea what a nurse just experienced. neither is going home and kicking the dog or beating up one's spouse. remaining calm headed and finding other outlets to release stress is the correct way to handle the stress. expecting people to stand there and take the brunt of someone else's anger and upset is absolutely outrageous and wrong.

[myhalo]

YIKES Lactulose for diarrhea???? Someone is confused! Yes you are right, every RN student should know that Lactulose is used not only for constipation, but also to LOWER ammonia levels in liver failure pt's with high lab values of ammonia. The ammonia is excreted when the pt has a BM, (usually in the form of diarrhea BTW).

But thanks for the help anyway.

[nerdtonurse?, BSN, RN]

Yeah, I actually had a student say that one. I told them to look up what lactulose is for, and also to read up on the patho of liver failure. I'm not being hateful. If I have to look something up, I remember it better than if someone just spiels off a bunch of stuff to me.

And I reiterate what I said about being tough. I've never seen a nurse as mean/nasty/snappy to another nurse as patients and their families are to us pretty much every day. If you internalize this stuff, you burn out. A nurse snaps at me, it rolls off my back, and I now have a reputation as being one of the calmest nurses on the shift.

The only way to win the game is to choose not to play -- Joshua, in the movie WarGames