What do you want from your clinical?

[DayDreamin ER CRNP]

I just accepted a clinical teaching position in a BSN program and will be teaching Med Surg II clinical students. My background is ED / trauma but I do have some med surg experience. I am not exactly sure where my clinical will be held but I am about 99% sure it will not be in the ED. I will, however, be able to send 1-2 students down to the ED or to other areas every now and then. I have contacts in SICU, MICU, CVICU, neuro, cath lab and in a trauma step-down unit in my facility so hopefully will be placed in my own hospital.

What I want to know from you students is what you feel like you need and want from your instructor during a clinical. I'm not looking for the "be nice" kind of advice but I want to know what you feel like you are not getting or would like more of during the clinical. Do you want more small-group class-type instruction, more pharm instruction? More opportunities to DO procedures? If so, what?

When I was in school I don't think our clinical instructor gave us much opportunity to do more than give some bed baths, change patients and pass meds. There is value in those things but I want my students to get MORE out of clinicals. I do not want to be the floor's tech all day.

I know that I want my students to start to learn to chart. I also want them to know how to SBAR and give a good report on the patient. What else do you want to do and learn in your clinical?

meredith

[NurseGirl525, ASN, RN]

We did our med surg I clinical in a nursing home facility. It was our first clinical rotation. I loved the facility I was in and loved my instructor. The first couple of weeks were awkward as we did not know what we were doing and didn't know anyone. Now we are kind of in a routine and getting stuff down. The absolutely only thing I wish was we got to do more with meds and procedures. Granted, only one person in the facility was on a cath and no one had trachs so we couldn't do much there. But I do feel like as we have gotten into a groove we aren't doing much more than showering and toileting people. We don't necessarily have to pass meds first semester but to at least follow the nurse and get a good understanding of the process. I am hoping next semester in the hospital we get to do more procedures and more nursing stuff. I get that we need to be proficient at the basics but I feel that sometimes that is absolutely all we did. I would have liked to seen charting and how all of that is done but we weren't allowed to touch the computers. I got to do 1 IM injections and 1 insulin injection. I don't feel like that was enough. But my instructors were extremely supportive and answered all questions and didn't hover over us. I loved getting to know the residents and they loved us also. One resident told me that they all have appreciated us and what we have done for them and that made me feel good. I did feel like I made a difference especially with a couple of them. I also got good feedback from my instructors which is good. I like to hear what I did right as well as what I did wrong so I can correct that. I hope this helps.

[NICU Guy, BSN, RN]

This is Med/Surg II so they already have experience on a Med/Surg floor learning the basics. I would focus on the patient's chart and patient communication. I would review the patient's chart and take some notes as the pertinent info on the patient, then have the student give you a change of shift report on their patient. That will help them focus on what is important to tell the next shift. You can also go over the pertinent labs for the patient and any high or low lab values. It is also important to get them to start looking at lab trends. "If these labs continue to get higher, what is the possible result and what changes can you look for to indicate that the patient's condition is deteriorating?" There is far more to nursing than doing IVs, Foleys, and dressing changes.

They need to start seeing the patient as a person and not as a body in a bed to practice their skills on. Have them spend time talking to their patient about their medical history and their life. I have heard some incredible stories about patients' lives that I would have never known if I didn't take time to listen to them.

[DayDreamin ER CRNP]

just a little bump....

m

[NurseKellyKMo]

It's really difficult to predict what experience your students will get in each clinical day. Pts can improve, decline, and plateau. Something our nursing school did that I thought was awesome was assigning a student to be a charge nurse for the day. That student had to get to clinical at the same time as the instructor, take report on all the floors, and assign pts to their classmates. Then during the day they were responsible for gathering assessment data from their classmates, and performing their own quick assessment. It is a wonderful way to give students the ability to experience being a charge nurse and showcase their leadership skills.

[missmollie, ADN, BSN, RN]

After a student has checked off on a procedure, and you have seen them do it, please allow them to do the procedures with their nurse. Ensure they understand that they must absolutely be with their nurse and that they cannot do it on their own. However, as a student, it is incredibly difficult to find the instructor when there is a simple nursing task to be done (Putting in a catheter, taking out a catheter, doing an enema, changing a dressing, and so on).

[dah doh, BSN, RN]

I haven't been a nursing student in very long time so my answer could be a bit skewed from precepting new grads & students as well as recalling the better nursing instructors I had & that I've seen with students now. Sorry in advance if it's not exactly what you are looking for!

The best instructors I've seen were there for their students! They come around to do procedures & give meds, etc. They come around to get updates (sbar report) & quiz them on patho, meds, & plan of care (in a gentle way). The student is stressed a bit & is usually relieved when it's over. The student probably doesn't appreciate it at the time, but those students usually become some of the better nurses! The instructor also tries to place the student with nurses they know like or at least don't mind teaching students...you know what I mean!

Personally I let the students do whatever they feel comfortable doing; i.e. Meds, procedures, watching bedside procedures, vitals, assessments, charting, etc. Education is usually on the spot with whatever is happening at the moment. Students who are invested in the education process will get more out of it rather than those that aren't interested in doing mundane things as well as meds & procedures. Yes, instructors like me because they know their students are being taught that shift so that's one less student to worry about that day. The instructor will generally do a post conference & have the students discuss their patients & interesting things the students did that day.

Good Luck!