Totally discouraged by clinicals Totally discouraged by clinicals | allnurses

Totally discouraged by clinicals

  1. 1 We started our clinicals last week...We had one full day of orientation about the floor, how to work the beds, the iv pumps...etc. But aside from that we had very little guidance on what my instructor expects from us. So day two was getting our assigned patient. We had to fill out a ton of paperwork, which i expected. then we introduced ourselves to the patient and pretty much thrown to the wolves. The RN I had didnt have the time of day for me to ask questions, or even give me something to do. I did an assessment on my patient, vitals, and he was pretty much self care so I had NOTHING to do all day, I went in and checked on him every 10 minutes so I could look busy. My instructor pretty much treated me like an idiot all day. We learn skills in lab and class, i thought clinicals were supposed to be about fine tuning those skills and learning. Neither of those happened and the clinical instructor doesnt seem to be interested in doing it. I know its only week one and I will get more confident and more familiar but right now I feel awful. Maybe I have abnormal expectations of what my clinical experience should be? Any tips on how to prepare better and show more initiative without getting in the way?

    **On the up side, I did do a successful foley and my patient told me he wanted to marry me, so I couldnt have been all bad **
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  2. 23 Comments

  3. Visit  BelleNscrubs04 profile page
    #1 3
    I'm not sure what semester you are in but it sounds like you might need to adjust expectations. Most schools build up to doing more at clinicals over time but preceptorships are more comparable to nursing. In clinicals you're usually expected to learn about various disease processes, get a few skills on live people, and get use to interacting with patients. Do you or will you administer meds? Do a good job advocating for yourself for procedures when possible but if you are given just one patient then do your best to really care for them. Somedays your patient will need a lot less but on other days your one patient will keep you hustling all day long.
    Congrats on the foley!
  4. Visit  LoriBSN2b profile page
    #2 14
    If you put in a foley on your first clinical day, then you are way ahead of the game.
  5. Visit  applesxoranges profile page
    #3 1
    In my clinicals, I started about eight IVs and put in one foley in 2 years. I would round on your patient every 30 minutes and make sure things like bed/bath are done. Offer to help any nurses. Your instructor should be making sure that they know what skills you are allowed to do in case something like a foley or IV pops up (if you're allowed). I'd spend the rest of the time learning more about the patient and different treatments proposed or planned for the patient. Read progress notes.

    I used to joke my instructor sent me to the ER my first semester so she could brag her student started IVs during the IV lecture (we completed IV skills lab a week earlier, somehow with snow days the lectures/skills were a different week). The census was low so as a medic I was okay to send to the ER so we didn't have to cancel clinical as she sent two people to ortho and one to their stepdown/ICU as she was a CNA at that particular hospital who worked that unit.
  6. Visit  nursefrances profile page
    #4 1
    If this is your first clinical you are honing your beginning skills: bed baths, blood glucose checks, starting IVs, vital signs, learning how to communicate with patients, learning how to do a physical assessment on your patient. Your first patient was "walkie talkie" and didn't really need much assistance. Maybe you can ask for a patient who needs more assistance with bed baths, etc. You will be learning and also taking some of the work off the the RN on duty.

    If you have a care plan assignment you can also start looking up possible nursing diagnoses for your patient. As someone else said you will not do everything right away. Different tasks and learning opportunities will come around. Good luck to you.
  7. Visit  KellyMLS profile page
    #5 0
    I know Im not going in guns blazing and saving the world quite yet, Im just unsure of whats expected of me since my instructor seems to think we should be saving the world right out of the gate. She kept asking us about different meds and skills sets we havent learned about. Our school switched to a brand new (and not at all improved) curriculum starting with my class, so I dont think those in charge of clinical sites have any idea what weve been taught. I would just like to be a little more prepared to care for my patient as independently as I can, in the sense that I can know what to do and when to do it. Im not getting alot of direction. Thanks for the input everyone. I do have some ideas now of how to keep myself occupied and get a little more out of my day.
  8. Visit  ChristineN profile page
    #6 4
    I hope you realize that all the "cool" skills you learned in skills lab aren't always being done everyday on the floor. There may not always be a pt who needs a Foley or a NG tube or has a trach. Some weeks the floor may be full of more independent pts, and in those situations you have to try to get the most out of your educational opportunity including getting to know their meds, researching their diagnosis, and fine tuning your assessment skills
  9. Visit  loriangel14 profile page
    #7 1
    You could try and make yourself useful on the floor. Try asking if the nurses need help and answer call bells.
  10. Visit  applesxoranges profile page
    #8 0
    Well, I think someone should bring in a lab syllabus. As for the meds, we were always responsible for the meds we were to give as in knowing about them.
  11. Visit  sadiemae1123 profile page
    #9 3
    Don't forget about the less task oriented skills a nurse needs. You could use your walkie/talkie patients to practice taking a thorough history, doing a full head to toe exam, teaching pts about any procedures, labs, diet, disease process, medications, etc. If the patient is ambulatory then they may be ready to discharge - has any follow up been planned, consults made to community services? Try to make sure you have a holistic approach to your pt since these are things that can be neglected in a busy hospital environment.
  12. Visit  caliotter3 profile page
    #10 0
    I was also discouraged by my clinical experiences. I countered the feelings of 'no progress' by discussing procedures, rationales, and questions with my nursing supervisor on my full time nursing assistant job. My supervisors were all too happy to assist me to make sense of the clinical education I was not getting from my school experience.
  13. Visit  RunBabyRN profile page
    #11 1
    Quote from Kellyb10
    I know Im not going in guns blazing and saving the world quite yet, Im just unsure of whats expected of me since my instructor seems to think we should be saving the world right out of the gate. She kept asking us about different meds and skills sets we havent learned about. Our school switched to a brand new (and not at all improved) curriculum starting with my class, so I dont think those in charge of clinical sites have any idea what weve been taught. I would just like to be a little more prepared to care for my patient as independently as I can, in the sense that I can know what to do and when to do it. Im not getting alot of direction. Thanks for the input everyone. I do have some ideas now of how to keep myself occupied and get a little more out of my day.
    Your patients will likely have meds you haven't covered otherwise, and if you administer those, you are required to know them. If you have downtime, this is a good time to research meds, go through the history, sit down with the patient and get a thorough history (I've learned SO much about my patients this way, even if they didn't require me to use my "skills").

    I know our instructor would ask us questions about meds that we didn't know, like which labs we needed to know before administering or what to watch for or whatever. We all had the deer-in-headlights look more than once. The best response is never, "I don't know," but rather, "I'll find out." The more stuff you research yourself, the more you'll learn that will really stick. Downtime, if you can't help with other nurses, history-taking, etc, can be used for researching stuff, and there's always something to research!

    Be aware that the nurses (or even those in charge of clinical sites) on the floor aren't familiar with your curriculum and what you do and don't know. Few of them will even ask. I've had only a couple of nurses who have asked specifically at the beginning of a shift what I can and cannot do. You have to stand up for yourself, and ask to be included in learning opportunities. Few floors, even ER, are all Foleys and IVs and suctioning and the like.

    Week one of clinicals for us, we basically did vitals and maybe ADLs, and mostly observed the nurse doing "real" nurse stuff, but I did get to see (and assist a little) with a dressing change with a wound vac. Be patient. This week was slower paced, but as you get further along, your instructor will assign you more complicated patients, and you'll have your hands full!
  14. Visit  Guy in Babyland profile page
    #12 7
    " I did an assessment on my patient, vitals, and he was pretty much self care so I had NOTHING to do all day, I went in and checked on him every 10 minutes so I could look busy."

    I am beginning to sound like a broken record because I have given the same advice to similar threads. Sit down and talk to your patient. If the patient is alone and willing to talk then actually sit you butt down in a chair and talk to them. You will learn to talk to people more confidently, effectively, and efficiently about their health problems. Now is the time to learn to start acting like a nurse. For example, my last clinical we had to do a graded head to toe semi-focused assessment on a patient. After I did my physical assessment, I sat down (instructor was already sitting watching my physical assessment) and asked the patient about when his symptoms started (ulcerative colitis), how often was he having diarrhea before he became to the hospital, consistency of the BMs, amount of blood in the stool, has it changed since coming to the hospital. That lets me know if he is improving or getting worse. If he was improving and then started to have more blood in the stools then he is getting worse again. I asked about his diet. Could he have been avoiding foods unconsciously to avoid having issues with his colon? In addition, you can ask questions about other medical issues and their progression over the years. Now is the time to start building your database of information on the medical issues of all your patients so as you progress in your program and as a nurse so that you will be able to apply it to your current patients. When you start having several patients with CHF or COPD and their signs and symptoms are similar to previous patients with those issues, the disease process and progression will start to click. You have a wealth of information about real people with real issues and not generic descriptions from a book that is only available to you because they are your patient. In addition, start looking at their labs and test results (you should be getting more into this in second or third semester). The labs can tell you a lot about your patient. RBC, Hct, HGB, WBC can tell you if the patient has a bleed or infection and if it is getting better or worse. Buy a lab results book and bring it to clinical. Look up the labs that are high or low and determine why they are out of whack as it pertains to your patient's condition or conditions. No instructor (that is worthy of being an instructor) will discourage you from sitting and getting a health history on your patient. You are at clinicals to learn not only from your instructor or nurse, but from the patients themselves. They are the experts of their disease. They know every minute detail of the disease because they live with it 24/7.

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