Prepping for Med-Surg I clinicals

[citylights89, BSN, RN]

So I'm pretty sure this question has probably been asked in another form somewhere else on this site, but I got tired of searching for an exact answer:

Since I'm getting ready to start Med-Surg I clinicals, I was wondering how do you pick out your patient and what info is necessary to have before you leave the hospital? When it comes to prepping the night before for clinicals, what exactly needs to be done and looked up? I want to know because I want to be as prepared as much as possible and not risk getting below a 3 on my CPAT and having the instructors look at me with fire in their eyes.

Also, what do you once you arrive to clinicals? What duties are vital for getting through the day? What absolutely needs to be documented? We have 1 patient the first week and 2 for the remaining weeks. For one week we actually get to go to the OR so no direct care that day, just observing a little surgery and practicing a little sterile technique.

I get pretty nervous so I need some mode of organization or list of duties to get me going. It makes me feel like I'm not doing enough and I hate looking like slacker when it counts! I don't want to be like a chicken with its head cut-off like I was in Fundamentals. None of this was really explained to us.

[AOX4RN, MSN, RN, NP]

Don't your instructors give you guidelines and goals for day/week? In general we go the day before get a census report from the charge nurse about who will be discharged and who might be good cases for the students to take. Then we go about picking our 2 for the week. We have to know their basic info (name, age, gender, code status, admit date, etc.), their admitting dx, PMH, course of events, meds, labs, radiology, surgical info. Then we go home and write up concept maps, research their meds, labs, and sleep Then we tackle caring for them in the morning.

We aim for accuchecks and VS done and charted by 8am ahead of breakfast, assessments and flow chart done by 10am. ADLs and such started then and done by noon. We pass meds, hang IVs if we have been assigned that and have instructor supervision or approval.

I don't know what you mean by your scoring because I don't get scored, just "checked off". I pick my patients according to the likelihood they will stay for the next two days I need to care for them. Also according to what needs to be done and what I can do for them as independently as possible. I also like to choose patients who can communicate with me while I have the luxury of picking them since there is so much paperwork documentation I need to do about subjective data.

I have given up picking "easy" cases because they always end up complicated

[silverbells_star]

Our instructor has a list of patients that are appropriate for students and we just grab someone off the list. If I can I try to grab someone that has a diagnosis that I have not worked with before. We gather information on the H & P, current condition, lab work, test results, surgery, and meds. Go home write up as much as we can, especially the meds and labs, start thinking about nursing diagnosis and interventions, we have to do a concept map, write up about their current condition, etc. However every clinical has been different on what has to be done for the packet so I would not get too worked up until you see the information.

My clinical is in the afternoon so the pace is different. When we arrive we usually just check in the with the nurse and PCA, check with the patient and then recheck charts for updated labs, plans of care and that days assessments to see what has changed. Then the rest of the afternoon is spent passing meds, assessments, answering call lights and trying to find procedures to help the nurses out with. This semester my clinical instructor does not have set times she wants us to have things done by so we just go with the flow of the floor. We also have our patients for 2 days which helps.

What you have to document will depend on your instructor. Every clinical I have been in the instructor wanted different things, but the basics revolve around basic assessment, Input Output, any personal care provided. Some clinicals I have done the falls risk and skin risk too.

Your instructor should tell you exactly what they want you from you. My first week of clinicals after fundamentals semester I felt like a complete idiot, I just felt lost and dumb, but by the end of day 2 I was getting back into the groove and by week 2 everything was coming together. Hopefully you have a great instructor, I have had nothing but great clinical instructors which helps a ton.

[citylights89, BSN, RN]

We have a little bit of info, but I just wanted some general guidelines to go by. I don't like to be behind the curve so to speak. Just using my resources!

We get scored according to our clinical instructor's perception (and I little bit of our own input) of our clinical performance. It's on a scale of 1 to 5 and you have to get a least a 3 average on all 12 subscales to even be considered ready to sit for the final. It's all subjective so that's what sucks. You can entirely fail on clinicals alone - it has happened in the past just last semester. I thought that happened at other nursing schools too.