Tips for Making Your Clinical Day Better
The clinical practice environment is the place where classroom theory becomes "real." This is the place where the "rubber meets the road," so to speak, and students begin to build their personal foundation for safe, effective nursing practice and develop essential critical thinking skills. What can nursing instructors do to enhance this very valuable time?
Before you begin, investigate the floor in which you will be having the clinical. It is our responsibility as nurse educators to facilitate our students' education. In other words, we partner together with our students for their learning. It is our responsibility to create the best environment possible for learning. Cultivate an amicable learning environment by meeting with the unit manager and unit educator. Chat informally with some of the nurses just to get a "feel" for the floor. Attend one of their unit meetings or change of shift report sessions, just to give them opportunity to know you better and to be comfortable with you. Discuss the clinical expectations and limitations. Find out which nursing staff would like to work with students. This little bit of "PR" work up front can earn tremendous dividends later. You may want to "shadow" on the unit for 6-8 hours; this will help you become familiar with supplies, policy and procedures, medication delivery systems, IV pumps, charting, and primary care providers.
It is very helpful to bring some "goodies" at the end of the semester to leave on the floor as a gesture of appreciation. All the students in the clinical group should sign a thank-you card to leave on the unit after the semester is finished.
Have clear expectations, even to the point of "stating the obvious." Make a list of things students should be doing to help organize and prioritize their day. Set deadlines and remind them often. This is especially important with first semester students, who often have little prior clinical experience. Include the basics of hand hygiene, communication with staff and patients, safety, and documentation.
This free Internet site has some excellent head-to-toe narrative assessment exercises for student practice: Assessment, Nursing Process, Charting
Require students to research their patient assignments before coming onto the unit. This maximizes precious clinical time and enhances student learning, as well as the quality of their patient care.
Start each semester with very basic assignments. Have objectives for the day and stick to them. Start simple and evolve to more complex assignments as the rotation progresses. At the same time, set the bar high for expectations. People tend to rise to the level of whatever is expected of them. Be consistent and objective, and follow the facility's and school of nursing's protocols and guidelines.
Consult with the charge nurse or staff as to suitable patient assignments for the students. Make sure the total assignment load is realistic (and not overwhelming or unsafe) for the clinical instructor to manage.
It helps immensely to assign a "student charge nurse" or "team leader" role to rotating students each week. This "student charge" will be your right hand person, strategic in keeping the other students on track during the clinical day. This arrangement works well, even with first semester students.
Cultivate open communication. If you encounter a problem with staff on the floor, don't just ignore the problem, but address it at the point of conflict in a professional manner. Go up the chain of command if necessary, until the situation is satisfactorily resolved. Work diligently to maintain positive communication with the nursing staff and the unit manager. That good rapport on a unit is worth its weight in gold, but sometimes takes a lot of work.
Always treat your students with dignity and respect. Strive to be fair and consistent. Intimidation makes for poor learning. We certainly cannot be personal friends with our students or cross professional boundaries by becoming "buddies," but we should encourage them and let them know we are invested in their success. There is a right way and a wrong way to correct a student. When you must correct a student, (if at all possible) never do so in front of the patient, staff, or other students. Correct in a private area, as soon after the incident as possible. Start out with a positive statement, then gently bring correction, then end with another positive comment (the "sandwich" approach).
On the other hand, issues concerning patient safety can never be compromised. These situations require immediate intervention. Also, I do not tolerate an "I do-not care" attitude, sloppiness, laziness, being late for no valid reason, lack of preparation, or treating the staff/ patients rudely. If you do encounter an unsafe, ill-mannered, or unprepared student (which, thankfully, is a rare occurrence), make sure you document the situation thoroughly and objectively on the student's clinical competency form.
It is a good idea to have a "quick" pre-conference before the students go out on the floor, to go over patient assignments. You can also quiz the students as to which of the patients has the top acuity or the best way to prioritize the day.
The post-conference is an invaluable time for the students to debrief, discuss patient concerns, and share insights and knowledge they have gained. You can also question them about patient diagnoses and other pertinent matters: "What does congestive heart failure mean in your own words? How has this affected your patient? Why is Impaired Gas Exchange in the nursing plan of care?" Aim to inspire enthusiasm and critical thinking in your students.
Being a clinical instructor is a challenging position, but with adequate planning and preparation, will prove to be a very rewarding experience. It is thrilling to watch the students grow and develop over the semester and to witness the "light bulb" moments, when it all starts coming together.Last edit by Joe V on Jan 8, '15
VickyRN has '16' year(s) of experience and specializes in 'Gerontological, cardiac, med-surg, peds'. From 'Under the shadow of His wings...'; Joined Mar '01; Posts: 12,051; Likes: 6,473.Mar 27, '09I'm not in nursing school yet, although I have had my share of working with difficult people and difficult professors. I hope you will reconsider your decision to quit school - I think it is a hasty decision based on the experience you have had with one instructor. Think about the reasons WHY you wanted to pursue nursing. Note that I would not blame you for deciding to quit if you have a myriad of reasons to do so and that this instructor's rudeness is the straw that broke the camel's back. But if this is an isolated reason, I would advise you to hang in there because I am sure this instructor's demeanor ALONE should not determine the direction of your future.
:icon_hug:Mar 27, '09I think all nursing schools are tough! I don't think they do it to actually be hateful (some instructors are worse than others) but to push you to the limit that an actual nurse would be pushed to. Nursing isn't easy or everyone would be doing it. My instructor(s) are very rude at times, but I don't let them get to me. I just listen, nod my head and agree. Power is knowledge, and if you know your stuff then they can't pick on ya too much. As my CI says...in order to be a knowledgable nurse you have to be nosey..loook up every word you don't know..look up every dx you don't know, along with everything else you don't know. I hope you reconsider quitting too. Good luck!!Mar 28, '09I personally have had one instructor that was fantastic.....firm when warranted, encouraging when needed, and made all of us WANT and STRIVE to learn. When you have an instructor who seems to be on more of a "power" play like one I have now (and, i don't understand that), it does make it very difficult to learn. But, having had one that I will ALWAYS ALWAYS remember (she was my first) to the one I currently have (which is nothing like my first one), I realize that everyone is different. I try and take something positive from everything, though, it is difficult at times. I, however, in reading the post from VickiRN, I, as a student, wish that instructors would be more encouraging when something is accomplished correctly or just some positive reinforcements.......they go a long way with us students. I can take the criticism and do. It would just be nice to occasionally hear, "good job" or "nicely done" once in awhile.
Also, in reading the above, I couldn't agree more with the statement about instructors not reprimanding in front of others, staff or other students. Unfortunately, this happens at times, and as a student, there is nothing more demeaning and degrading. In my opinion, is extremely unprofessional. I look up to and respect my instructors more than words can say. I admire their intelligence and try desperately to become a "sponge" daily when in their presence.
I decided to become a nurse after being hospitalized for over 40 + days (8 years ago with a complicated pregnancy). It was the nurses that took care of me.....comforted me.....encouraged me.......It was because of these wonderful people that I decided (years after) to see my dream through. I never gave up on it.
I will graduate later this year. I still remember their names....still have their cards they sent after I came home (reading how they could probably get in trouble for sending me a card (after the fact), but that I had touched them just as they had touched me..... I still think of them often and wish I could let them know just how much they did influence the course of my life!
Thanks for the opportunity to share........Apr 1, '09Thank you for your posting!
I added "clinical instructor" to my workload about 9 months ago, and I am still striving to improve my skills.
You made many valid points which I will incorporate into my practice. I am teaching Fundamentals In Nursing clinically this semester for the first time. (" hospital virgins ") so it will be interesting for me to help them grow.
Keep the good ideas coming!
HazeApr 1, '09Quote from RNJodi2010I am learning over time that I was a complete wimpy pushover as a clinical instructor the first semester I taught! And last semester was eye-opening for me, as to the harm I can cause by being too trusting, too leiniant (SP?) on students. I am much "tougher" this semester, and hopefully, a better educator.I think all nursing schools are tough! I don't think they do it to actually be hateful but to push you to the limit that an actual nurse would be pushed to.
I am a very naiive and trusting person so when someone says they have done something or looked something up, I believe them and do not question them or their work. Until now. I learned the hard way that I was not really helping the students learn that way.
Oh, I'll still be encouraging, but the students had best know their meds and procedures before they come to me!
(sound tough enough?? hehehe)
HazeApr 3, '09((((VickyRN)))) Thank you for your explicit and timely guidance and advice. Wish I had known you when I was a "newby"! This is my almost 10th year teaching and what you listed is right on. We are in the 2nd rotation, and the "deer in the headlights" fear is gone, and my students are more confident and secure in their ability to give good care- I love what I do! I'm printing out your blog for our faculty, particularly the new folk. Love to read when you post on allnurses!Apr 20, '09I found this article very helpful, but the only thing I didn't find very realistic was the suggestion to go to the clinical site on your own before your rotation starts. I am graduating from nursing school in May, and have had many clinicals in many facilities, and almost all of them would view a personal trip from a student as a liability. There is a reason why your first day at clinicals is usually filled with tours, paperwork with policies, and introductions to staff and patients. I'm not sure how other schools are run, but that's the purpose for our first day, and it is a lot more comfortable to be with your preceptor/instructor when you are new to a facility. Are there places in the united states where people can go to floors and talk to staff and not get questioned?Apr 20, '09Some instructors at our CON have students visit the clinical floor AFTER the initial orientation and all papers signed, facility competencies completed, etc. They may require the students to go to the clinical floor the night before (or sometimes a few hours before clinical is to start), to gather information from the chart and to research the patient assignment (meds, labs, etc.).Apr 20, '09Quote from nwl0716perhaps this is true as a student...... the only thing I didn't find very realistic was the suggestion to go to the clinical site on your own before your rotation starts. I am graduating from nursing school in May, and have had many clinicals in many facilities, and almost all of them would view a personal trip from a student as a liability...
but as a clinical instructor who will be bringing students to the hospital on Thursday for their very first clinical experience of their nursing school lifetime, I did it.
I went in and met the floor clinical manager, and several charge nurses...
I went to the staff meeting today and introduced myself to the staff as a whole...
and I'm "shadowing" a staff nurse on Wednesday!
Hopefully, my time spent will help the staff be more accepting and supportive of the students and me...
as well as make ME more comfortable on an unfamiliar unit!
Wish me luck!
HazeApr 21, '09Hope things go well for you, Haze, with your clinical group! Sending positive thoughts your way
I plan to do the same this summer - a few weeks before the fall semester begins, I will visit both of my clinical sites. I will probably spend ~ 6 hrs on each unit. Although I am very familiar with these units (from having students there for several years now), changes occur very rapidly in healthcare, so I must stay on my toes! I will need to acquaint myself with new equipment, policies and procedures, etc. In our host facility, for instance, badges are being changed/ updated, parking requirements have changed (and we will need new stickers), the computer charting system is being updated (again!) with major changes, and last but not least, there is the strong hint of a scanner system being implemented for the medication passes sometime in the near future.Apr 21, '09Quote from vickyrnsending positive thoughts your way ...the computer charting system is being updated (again!) with major changes, and last but not least, there is the strong hint of a scanner system being implemented for the medication passes sometime in the near future.
1. thanks for the encouragement!
2. the emar scanner system works well when used properly. i worked at a hospital that implemented it several years ago... we all hated it... initially! but once we finally got used to it, and felt comfortable with it, i really liked it. the emar scanner system really helped to decrease med errors. (note: if a nurse is a cheater, a "short-cut" person, the scanner system can be overridden in such a way that its advantages can be defeated. sigh.)
3. a question about computer charting to all other instructors... do all the student nurses get access to the facilities' computer charting systems? my students seem very comfortable with computers as it is. one semester my students did have access, and i had to constantly "shoo" them off the computer systems and back into their patients' rooms! when i was given the choice for one clinical to allow them access or not, i declined letting them do computer charting, prefering them doing "paper charting" that i could easily review. i found their bedside charting really needed some help and instruction vs the "point & click" of the computer flowsheets.
your opinions??? your experiences???
thanksJun 11, '09As a current nursing student, I found this information to be very helpful as well as insightful. I am currently in my first semester so I actually haven't started clinicals just yet, but I am so anxious as to what I can expect. Although I have worked in hospitals, nursing homes, and currently dialysis clinics, I feel as though training as a nursing student in clinicals it will be quite different.
Being able to use the experience I have gained thus far in combination with the knowledge and skills I will aquire in nursing school, makes me very excited to begin clinicals...if you can't already tell. Nursing school is stressful, so just being able to pick up some tips here and there from others really kinda takes a tiny bit of the edge off, and keeps the stress at least managable.
Thanks for the advice!
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