What are clinicals all about????

murphyle, BSN, RN · Aug 5, 2011

Coming from a second-degree program that's relatively well known for rigor, I found that there wasn't a great deal of difference between school and "the real world" except the lack of written assignments.

From the middle of Med-Surg 1 onward, we were expected to carry the same load as a staff nurse (4-6 on a MS/tele unit, 2-4 on L&D and Peds, 2 in ICU if you were smart enough to earn a preceptorship there), twelve-hour shifts, complete care (the clinical instructors would specifically tell the unit CNAs not to touch our patients - we had to do EVERYTHING ourselves, from meds down to baths and vitals, plus assist on anyone else's patients on request), assignments handed out at 0700 with all the rest of the staff. If you had an ounce of sense, you got to the unit at 0600 and read over all the patient charts so you at least had an idea what you might be facing. Instructors could and did conduct oral spot quizzes throughout the day, and God help you if you didn't know a med or a disease process. "I don't know, but I'll look it up" was acceptable, but you would be expected to give a five-minute oral presentation on anything you didn't know at that day's post-conference (which was added onto the 12-hour floor shift, meaning we didn't usually go home till 2000-2030). We had weekend clinical, holiday clinical, midnight clinical - we basically didn't see our families for a year. Call in sick or show up tardy once and you lost a grade; twice and you failed, no exceptions, no appeal. Oh, and then there was the small matter of classes eight hours a day, two to three days a week...

Frankly, being out in the real world is easier than nursing school ever was! :uhoh3:

xtxrn, ASN, RN · Aug 5, 2011

Coming from a second-degree program that's relatively well known for rigor, I found that there wasn't a great deal of difference between school and "the real world" except the lack of written assignments.
From the middle of Med-Surg 1 onward, we were expected to carry the same load as a staff nurse (4-6 on a MS/tele unit, 2-4 on L&D and Peds, 2 in ICU if you were smart enough to earn a preceptorship there), twelve-hour shifts, complete care (the clinical instructors would specifically tell the unit CNAs not to touch our patients - we had to do EVERYTHING ourselves, from meds down to baths and vitals, plus assist on anyone else's patients on request), assignments handed out at 0700 with all the rest of the staff. If you had an ounce of sense, you got to the unit at 0600 and read over all the patient charts so you at least had an idea what you might be facing. Instructors could and did conduct oral spot quizzes throughout the day, and God help you if you didn't know a med or a disease process. "I don't know, but I'll look it up" was acceptable, but you would be expected to give a five-minute oral presentation on anything you didn't know at that day's post-conference (which was added onto the 12-hour floor shift, meaning we didn't usually go home till 2000-2030). We had weekend clinical, holiday clinical, midnight clinical - we basically didn't see our families for a year. Call in sick or show up tardy once and you lost a grade; twice and you failed, no exceptions, no appeal. Oh, and then there was the small matter of classes eight hours a day, two to three days a week...
Frankly, being out in the real world is easier than nursing school ever was!

:yeah: :yeah: :yeah: :yeah: That sounds like an incredible program :) If more were like that, the sense of being overwhelmed would be decreased after graduating :)

anotherone, BSN, RN · Aug 5, 2011

In clinicals you are just a student. if you don't do it the nurse has to do it. as a nurse it ends with you. As a student you have a few patients . There were so many students on one rotation, the second to last one, I coudl only take 2 at a time. In my jbo as a nurse I take a minimum of 4 at a time. Any less and you would be canceled. We can work short and often do but we can never have extra help! In some programs you can not do things, like IV push meds, that as a nurse you do multiple times a day. I never talked to the drs or other departments as a student. As a nurse the family, drs, and other departments are hunting me down every day........ You don't have an instructor to help or watch over you. You can ask other co -workers but sometimes they aren't willing to help. etc.

anotherone, BSN, RN · Aug 5, 2011

First thing: congratulations on the new job!
I'm also a newer grad; I have a little over a year on a (crazy) surgical floor. I think most of us can agree that transition to 'working nurse' from 'student nurse' is overwhelming and yes, that clinical did not adequately represent the demands on your time, pressure and work overload of a typically busy floor. Learning skills, coordinating care, grasping the responsibility you now possess, delegating and (trying to) work as a team while fitting into a new environment only make things harder. It's a steep learning curve to tack down in just a few months.
The biggest things for me: I, like many others, had a somewhat shoddy orientation. My preceptor was constantly pulled to do other things (even off the floor!) I was left alone to make decisions while, say, OR holding is on the phone awaiting an answer whether pt can come down without repeat EKG or a doc is trying to clarify orders and is asking input about pt's condition. I was promised additional training in things like wound care and order entry that I never received, (manager actually said "we already pay enough to train you. No additional time, sorry.") I found myself thrown into things with little help and before I knew it, I had a full patient load (6+) and was going off orientation. There were days I was in way over my head while others charted at the station and watched me drown, despite me asking for help. That's hard to take; these are your coworkers and you want to think that you all can/will help each other. Not always. People can bark in your face, insult you, ignore you and even set you up to fail, all while the well-being of your patients hangs in the balance. Poor environments are out there, and worse, they're common.
In clinical, if you had multiple things going on, your teacher was aware and the patient still always had their RN to fall back on to make sure care was done. As the RN yourself, if you don't do it, it will not get done. You have a full team of patients, all relying on you at the same time, with no one to step in when things become overwhelming. There aren't acceptable excuses to miss something - everything needs to be handled or it needs to be escalated to the charge or house sup to step in, (who may or may not help, depending.)
Lastly - I don't want to make this too involved - is that you're expected to *know*, as the RN. As the student, it's okay to not know and try to find out. You aren't making decisions for the patient, after all, and don't hold the ultimate responsibility. As the RN, you will be expected to know, even if you've never heard of that surgery, given that drug or hung that tubing before. The patient needs to be able to look to you for support and knowledgeable care; that's an awesome responsibility, there. Scary, sometimes. Patients won't always be understanding and the happiness of our 'customers' will unfortunately impact the status of your job on a regular basis. Our patient's comments are posted publicly and we are also put on a 'wall of shame' for complaints for all employees to see.
The workload, the environment, your coworkers. Lots. JME of course.
amarilla

Great post and very acurate description of life after school

sistasoul · Aug 5, 2011

In School. 2 patients with assessments, treatments if any and meds. Real world- 5-6 patients- admits, discharges, treatments, medications,dealing with MDs, families, pharmcy, physical therapy, dietary, occupational therapy, radiolgy, IV insertion, and any and all department in the hospital. There is just no comparison at all. Whatever goes wrong it is up to the nurse to fix it or find someone who can. The phone, TV, bed, etc does not work- call the nurse. My meal is not warm enough-call the nurse. It is raining and I want it to be sunny- call the nurse.

I still would rather be a nurse than a student though. No more homework. Sometimest there is a little bit of at home learning but it is minimal.

School does not even come close to the reality of being a nurse.

carolmaccas66, BSN, RN · Aug 5, 2011

STUDENT RN: You have someone to run to and GET help. Your main catch phrase is probably: 'I dont know the answer to that question, but I'll get the RN for you, SHE will know'.

REGISTERED NURSE: YOU are the one everyone runs to FOR help. You are the problem solver of all and every miniscule or massive problem/s for patients, their families and other staff, irregardless of whether they are in a hospital, leaving hospital, in a respite facility, in rehab, whether you meet them being admitted or discharged - if the sun don't shine, it's YOUR PROBLEM. So just FIX IT now with that magic wand you have, and the crystal ball you didn't want anyone to know you had hidden away.

That's been my experience especially in the last few days, oh, and the good Lord help you if you even forget to tick ONE box in a patient's chart, or forget to sign off one medication, or forget to give one medication. Flames will rise up from hell and the Devil, in the form of a Nurse Manager, will be condemning you to a life of misery so that you NEVER FORGET THAT ONE MISTAKE.

Just cover your ar$e all the time, double check everyone's work and your own, check all the med's are done and signed off b4 you go home, run around like a trooper for 8-12 hours or more whilst being COMPLETELY and UTTERLY professional, and you should be fine :)

TaylorDeeLPN · Jun 15, 2012

Thanks For This.