Nursing Student...final clinical rotation before graduation

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    Hello everyone. I'm in my final weeks of nursing school and during this time, students have extensive clinical training working directly with a designated RN at the hospital. I'm rotating in med/surg, where a nurse can take up to 5 patients during her 12 hour shift! Sort of reminds me of my serving days as a waitress on a busy Saturday night (sort of...). I'm finding that the extensive amount of blood, sweat, and tears that I have spent with all my fascinating lecture notes, books, and interactive software about Pathophysiology of illness, what to look for, assess for, monitor for, teach and encourage (not to mention the offering of great therapeutic communication), has taken a less critical role because of the amount of tasks I need to do for each patient in order to be on time with all my patient care and documentation. Iím struggling with this a bit and have been wondering if anyone else has experienced this as well. Or, if the veteran nurses out there know what Iím talking about and can offer their thoughts about this.

    Taking care of as much as 5 patients as a student nurse has meant that I spend less time discussing the etiology and new signs and symptoms of my patients' conditions with anyone who scarcely has 5 minutes to listen to me with THEIR busy case loads so that I effectively develop, goal oriented care plans specific to my patient, has been shadowed by the mounds of documentation and meds administration, not to mention discharges, admissions, telephone calls, etc. I tried to share this enigma with a close relative of mine, who mind you is not in the medical profession, and my relative thought I was trying to do the doctorís role because Iím not there to teach the patient about his illness, Iím there to just give them their meds and help them get better. Hmmm. It then dawned on me that unless youíve been sick and hospitalized in an acute care setting, you really do not know how knowledgeable RNs absolutely MUST be in order to, what was that, oh yes, ďhelp you get betterĒ. But aside from that, I wanted to post a thread here because I feel like Iím not spending my time understanding WHY my patient is getting better, or what is making him get sicker! According to RN school, that is what nursing is about Öyet, when does the nurse get to analyze all this with such a hefty case load? I donít want to forget why I got into this profession. I donít want this to be another busy Saturday night job where I need to get things out in a timely manner and worry about my patient when things get really bad. But until then, as long as he or she has his meds on time, is comfortable, and is not calling me with any distress, I can move on to the next proverbial table (from my serving days).
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    The idea is that ... as you get more experience, it will all come together so that you can take care of those tasks efficiently whily you simultaneously think about the underlying physiology, rationale, etc. You should eventually get to a point at which most of that stuff come automatically and you don't have to "take a lot of time out" to think about that stuff. Once you "really know it," it is just there in your head to use.

    That process takes a couple of years -- that start with nursing school, but continue on through the first year or two of actual practice. The need to go through that process is why many of us recommend that new grads actually work for a little while as a staff nurse before moving on to advanced education and advanced roles. It's stressful, but its a normal part of the process of moving from a beginner -- and having to consciously think through every step of what you do -- to being a competent (and eventually expert) professional. It takes time and practice as well as book-learning.

    Of course, having said that ... we all know that actual working conditions in most hospitals are less than ideal. Most people are too busy to practice as they would prefer to in an ideal world. In the "real world," we all make compromises and do the best we can with what we have and hope to be "good enough" knowing that "perfection" is rare.
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    lol. Think of it this way....when you first started as a server you were probably given less than 5 tables at a time, could barely get your act together to not **** off your co-workers and customers, and sat down at the end of the night thinking "what the hell happened, and how did I get from shift meeting to check out.."

    Eventually, you just did it. You knew which expo was going to get your food faster, which bartender to sweet talk into making your ticket first, knew how to order food so the kitchen couldn't possibly mess up and even remember the complete order for a table of 7 without writing anything down. With no mistakes.

    I too, look forward to the day when the nursing skills I am learning will synthesize to the point where I am accomplising tasks and teaching, and taking care of my patient in ways that utilize my hard won knowledge of physiology. I remember the feeling of confidence and ability so well that the feeling I now have of incompetence is ever more furstrating. I think a lot of it right now, is that we have to THINK about every step we take, and consciously direct our bodies to move in ways we are not used to. In years I suppose, keeping one hand sterile while the other manipulates trach suction or a catheter will feel natural. Right now, it feels awkward. That body response, of action without thought is what I find to be most elusive at the moment.

    So nursing and serving aren't the same, but the basics- knowledge, practice, repetition and learning from your mistakes all apply.
    At least that's what I keep telling myself.
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    I will be watching this thread closely for tips. In some ways I wish we got a heavier patient load in NS so after graduation it wasn't such a shock to the system.
    SAHMStudent likes this.
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    I hear ya. 5 patients as a student nurse is difficult when all the people you are supposed to delegate AM care and changing bed linens disappear off the floor!

    So its 5 patients, assessments, AM care, changing bed linens, administering X amount of meds. Knowing what the medication is, the nursing implications for EACH med for EACH patient times 5.

    You get on the floor at 7, meds start at 8 10 12 and 2pm. Your patient is SOB, other one has a saturation at 89, and the other one is confused trying to climb out of bed.

    Yeah some help would be nice

    IIIIIIIIIIIII hear ya.
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    You miss my point. I want a higher patient load than 2 in NS. I suspect our instructor's head would explode if we had more patients.
  10. 0
    Thanks everyone - this was very helpful for me, and your comments even therapeutic as I journey onward to gaining more knowledge and experience so that I can spend more time analyzing my patients' change in condition.


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