What are clinicals "really" like?

Nesher, BSN, RN · Dec 3, 2005

I am a clinical instructor with 8 BSN students in their first quarter. Let me calm your fears. You will be starting out with very limited skills and abilites so no you won't hit the floor running. My students started with the ability to make an occupied bed, bath a person and do vital signs ( blood pressure, pulse, temp). Each week they have built on their abilites and at this point - entering the last week they are giving medications, can do a full assessment on a person, could put an NG tube down if the need arose. They pick out patient assignments for each other and run the post conference time. They are thrilled now that they feel they have something to offer.

In the beginning - and this still continues they each had issues with even entering the pateints room. They have dealt with that as well as the privacy concerns - bathing for example. I won't deny it is hard and scary, but hoepfully you will have a great clinical group that support each other and help when needed - hopefully you will have an instuctor who is sensitve to the needs of thier students. Good luck!

One tip - always prepare for clinical and bring weekly treats to the staff on the floor you are on!

mandana · Dec 3, 2005

Lots of good advice in the post above. One thing my 1st semester clinical instructor did that was wonderful was this: we had about 1/2 the group who had some sort of medical/clincial experience and the other half (like me) had none. She paired each of us without experience with someone who had experience for the first two days. This made entering a client room for the first few times quite a bit less intimidating - and it's very intimidating in the beginning. Now I'm done with my second semester and it's not at all intimidating!

Do you have specific questions or concerns?

Some things I was worried about were privacy violations and being embarassed about seeing people in vulnerable situations. I was also concerned about being grossed out by bodily functions and/or dysfunctions. Turns out that for me, the reality of both of those things is that it can be uncomfortable for both people involved. When you are actually dealing with the situation at h and, whatever that might be, your own sensitivity really takes over. It's easy to see that the person is vulnerable and doesn't want to be in the situation that they are in - it's very easy to be kind and professional and together at that moment in time.

Personal story - I had a client for two straight days that was in a terrible situation and that I became quite close to. The situation was not going to get any better, and I just felt so bad about it. I was FINE for two straight days while I was with this person and I spent a great deal of time one-on-one helping with very personal things, and just being there with them. I didn't think much of it, then in post-conference on the second day it was my turn to discuss my week. I just burst into tears, sobbing, pathetic, runny nose and all tears. The patients needs overode my own during clinical, but as soon as I didn't have the patient to think about anymore, I just really lost it.

Does this help at all? I was terrified of clinical, especially since I had NO experience. I loved it so much. And now that I'm not in school for a couple weeks, I miss having that sort of contact with others so much. It's a really strong and strange relationship.

Amanda

shock-me-sane · Dec 4, 2005

i am just finishing my first quarter. we had 5 weeks in the lab before we went into the hospital. we did basic things, feeding, bathing, physical, wound care and some procedures as appropriate for the pt. i got to do a Foley! :)

they sort of threw us in, but in a gentle way. didn't make it any less scary, but the first day in the hospital was the worst, after that i felt much more relaxed about everything.

Works2xs · Dec 4, 2005

If by "hit the ground running" you mean doing everything from soup to nuts, relax. Your professors and clinical instructors are going to make sure you only do what you've been taught. Both the hospital and learning institution have a vested interest in protecting themselves from your errors. Just keep yourself up to speed on what you're supposed to know. Ask a question if you aren't sure and don't roger up to do something you think you should be able to do if, in fact, you don't know how.

If, on the other hand, you are wondering about the pace (running) then I guess that's dependent on the individual site. Where I was, you were most certainly busy. By the end of a shift, I was amazed at how fast 8 (or more) hours seemingly evaporated before I knew it. So while in the beginning the tasks weren't complex, there were certainly a lot of them!

West_Coast_Ken, BSN, RN · Dec 5, 2005

What will clinicals be like? I'm just finishing my first semester of an excellent ADN program and I can't tell you what my clinical rotation will be like tomorrow (last one this semester).

Each rotation is different because: each student is different, each patient is different as are the RN staff you work with and then there is the instructor, also.

We are in a rural community setting and one day I got to start a Foley (very first time on a human) on a patient who had just come back from radiology where they diagnosed a dissecting aortic aneurysm. As he was getting preped for CareFlight to a major cardiac center I got to start his catheter. It went well and his aneurysm was repaired, too!

This past Monday I was helping my clinical instructor get a pt who had just been brought to the hospital into bed. The pt was past hope really and she called a code on the spot. 45 minutes later and a lot of work on that pt by the docs, RNs, etc and the pt did not survive (long term brain cancer apparently).

I have no idea what I will be doing tomorrow but I am sure it will be thrilling and I will learn a lot--while I try my best to not make 'tupid mistakes.

Rely on your instructors and the RNs you are working with and you will do well.

Ken, SN

NJNursing, ASN, RN · Dec 6, 2005

What were my clinicals like when I started? In nursing I, we did basic assessments and bed baths. We were glorified butt wipers. We got a lot of the patients who were incontinent and elderly. It was general med-surg: they were either chronically sick, were quite a while post-op, had diarrhea and vomiting or other sorts of illnesses. I really hated Nursing I clinicals. Nursing II started off the same way but we picked up dispensing meds and doing injections, but just got better at bed baths and changing beds. I'm in Nursing III and we're still doing butt wiping, bed baths, changing beds (all things that techs do in a hospital these days and seldomly the RN) but we also do meds, dressing changes, hanging IV's, injections, IV drip rates and accompanying them to various diagnostic tests, but the patients are more acutely ill and have more severe illnesses.

I'm not sure Nursing IV will change much except we're doing ICU/CCU and Trauma rotations as well. Plus more psych and peds.

You'll learn your foundation in Nursing I, but you won't learn more about "real nursing" after your first year of clinicals. But mind you, each program is similarly different.

wonderbee, BSN, RN · Dec 6, 2005

I too wasn't crazy about my Nursing I clinicals. I remember bathing, bed changing and assessment being the primary tasks. We'd hit the floor at 8am. There would be a run on dynamaps (the blood pressure machines), thermometers and sheets. There were never enough of these essential items to go around. It was first come, first serve that meant that some of us would be late getting off the floor. The techs loved seeing us coming. It meant less work for them. The nurses on the other hand weren't that happy to see us. Until we could give meds which was more toward the end of the semester, and then only PO meds and injectibles, we were mostly under foot. We learned the essentials of giving and taking report. At preconference we'd get our assignments and cues from our instructor. Post conference lasted about an hour and we'd discuss each of our patients in report form.

I didn't start feeling like a nurse till third semester clinical when beds and baths were tech territory again, and we were to concentrate on medication administration and putting the whole picture together.

*green · Mar 10, 2011

What were my clinicals like when I started? In nursing I, we did basic assessments and bed baths. We were glorified butt wipers. We got a lot of the patients who were incontinent and elderly. It was general med-surg: they were either chronically sick, were quite a while post-op, had diarrhea and vomiting or other sorts of illnesses. I really hated Nursing I clinicals. Nursing II started off the same way but we picked up dispensing meds and doing injections, but just got better at bed baths and changing beds. I'm in Nursing III and we're still doing butt wiping, bed baths, changing beds (all things that techs do in a hospital these days and seldomly the RN) but we also do meds, dressing changes, hanging IV's, injections, IV drip rates and accompanying them to various diagnostic tests, but the patients are more acutely ill and have more severe illnesses.
I'm not sure Nursing IV will change much except we're doing ICU/CCU and Trauma rotations as well. Plus more psych and peds.
You'll learn your foundation in Nursing I, but you won't learn more about "real nursing" after your first year of clinicals. But mind you, each program is similarly different.

What is real nursing?

I can tell what sort of nurse you will turn out to be...

CNM2B201? · Mar 10, 2011

What were my clinicals like when I started? In nursing I, we did basic assessments and bed baths. We were glorified butt wipers. We got a lot of the patients who were incontinent and elderly. It was general med-surg: they were either chronically sick, were quite a while post-op, had diarrhea and vomiting or other sorts of illnesses. I really hated Nursing I clinicals. Nursing II started off the same way but we picked up dispensing meds and doing injections, but just got better at bed baths and changing beds. I'm in Nursing III and we're still doing butt wiping, bed baths, changing beds (all things that techs do in a hospital these days and seldomly the RN) but we also do meds, dressing changes, hanging IV's, injections, IV drip rates and accompanying them to various diagnostic tests, but the patients are more acutely ill and have more severe illnesses.
I'm not sure Nursing IV will change much except we're doing ICU/CCU and Trauma rotations as well. Plus more psych and peds.
You'll learn your foundation in Nursing I, but you won't learn more about "real nursing" after your first year of clinicals. But mind you, each program is similarly different.

you know...basic needs of the patient should be met by everyone including the NURSE...not just the "lowly" tech...sheesh... if you think you are going to get away from "butt wiping" after nursing school because its beneath a nurse..think again. Who do you think did all the butt wiping before the CNA came along and there were only nurses...were those not REAL nurses then? Years ago when the rooms were void of beeping machines in the room to monitor and all those meds to dispense..nursing was about BASIC care..butt wiping, baths, cleaning up vomit..taking care of the patients every need...not just the ones "important" enough for a nurse to get involved in. off my soap box now.

turnforthenurse, MSN, NP · Mar 10, 2011

Lots of good advice in the post above. One thing my 1st semester clinical instructor did that was wonderful was this: we had about 1/2 the group who had some sort of medical/clincial experience and the other half (like me) had none. She paired each of us without experience with someone who had experience for the first two days. This made entering a client room for the first few times quite a bit less intimidating - and it's very intimidating in the beginning. Now I'm done with my second semester and it's not at all intimidating!

My instructor did this too! It really helped. We were also "eased" into everything - we weren't just thrown in and hoped that we would stay afloat :lol2: As some of the other users mentioned, you will be starting off with very limited skills. We learned the very basics of nursing - therapeutic communication, how to make a bed (both occupied and unoccupied), vital signs, how to give injections, giving O2, I/O, and basic morning care (bathing, etc). We also learned how to transport patients and ambulate and to do sterile dressing changes.

as each rotation went on, we learned more and more stuff and our workload increased. I have never taken care of more than 2 patients at at a time, and when I did it was voluntary. When I did my preceptorship, I usually had 3 patients + 1 to cover for the LPN, but one day we were short-staffed and we had 7 between my preceptor & I. On that day we sort of tag-teamed everything. I know on some units nurses can get 10+ patients (and in nursing homes it's like you and the entire unit!) but on that floor (which was a cardiac surgery and vascular intensive care unit) the nurse/patient ratio was 1:3-4 because of the nature of these patients - they usually have a lot more going on than your typical med-surg patient. Same with ICU - usually the ratio is 1:2 or sometimes 1:1 depending on how sick the patient is.

But....I digress. You can't be expected to know EVERYTHING right off the bat. Don't worry about it, you will be fine!