As a nursing student, how can I take initiative in clinical?

tsm007 · Feb 16, 2015

Things that I do to show initiative are removing empty trays from rooms and answering call lights. I wouldn't take vitals without asking or get water without asking or ambulate a patient anywhere without asking first. Those are things that require knowledge of the patient's reason for being there and an assessment of their abilities. I would ask nurses if you can help with anything. Ask if you can bring water to any patients or if anyone needs their linen changed out. Those kind of things are time consuming for nurses and I have never seen a nurse turn me down. Also, observe as much as you can. At my last rotation there were students from another school and I swear they stood around at the nurses station half the time. I found it really sad. One was supposed to be shadowing the nurse I was with that day and half the time she wasn't with us. I have no idea where she went. I know it's boring just shadowing, but really follow like glue even if you are doing nothing and bored to tears. People notice. Try to offer to help with the little stuff and even if you aren't doing anything try and soak up what you see the nurses do. You really can learn a lot just from observation. Watch how they do their assessments, what order they do them in, how they ask the questions, etc.

akulahawkRN, ADN, RN, EMT-P · Feb 16, 2015

Early on, you show initiative by discussing things with your nurse or your clinical instructor before doing them. Once you get going, you'll learn lots and you'll see where you can go ahead and do things without upsetting the normal flow of things. Getting too aggressive in getting things done can sometimes result in you doing something that is beyond your allowed scope of practice, so be careful about that.

If your hospital has volunteers, check out what they're allowed to do and do those things if you have time to do it. Those are things that aren't considered "direct patient care" and if you do them, it's not going to cause harm to anyone. Just make sure that you know if your patient is on any water or dietary restrictions and if you need to record I&O.

studentnurse711 · Feb 16, 2015

Great advice , thank you. :) Can I practice my assessments on patients without asking the nurse first? I guess I just don't want to have to ask before everything I do, because then I don't really feel that I am taking initiative. Of course, I need to stay within my small scope of practice.

akulahawkRN, ADN, RN, EMT-P · Feb 16, 2015

For the first few days of actual clinical, I would suggest asking first. It can be as simple as "I'd like to..., is that OK?" Then when it's time to do that with your patients, ask them the same thing after you introduce yourself. Many patients will accommodate your request if they know you're a student because they know they're helping you learn. Some won't, but that's why you ask first.

Eventually you'll settle into a routine and you'll know what to do and when to do it and it'll all be expected that you do them.

Nursing School is a process, let the process work.

Cruz.Cookie, BSN, RN · Feb 16, 2015

Actually, I'm getting in trouble because I didn't take initiative. One of my regrets is that I didn't do it earlier. I always shadowed the nurse and that messed me up towards the end. My advice to you is that it's just your first semester so "observing" is ok since you can't pass meds yet. However , ask your nurse how many times a day does she do vitals, assessments, and linen changes for the patient. You can then take action to record the vital signs. Practice your physical assessments, and assists in ADL's. Believe me the nurses love it!! It shows them that you're willing to learn. Just make sure you report to your nurse about the assessments and vital signs after you do them so they are aware. Make sure to also ask lots of questions too! Knowledge is power!! Like the PP said be careful not to go outside of your scope in clinical. Do the most in clinical.. you get what you put in. :)

Nienna Celebrindal · Feb 16, 2015

Ask to do anything and everything, if the nurse is hanging a med ask to hang the med(providing of course your teacher lets you do that), ask if you can do everything for 1 or 2 of their patients (down the line). If you something is about to need to be done, say hey I see this patient needs xyz in 10 minutes, can I do it? Get familar with the orders. Also tell the nurse what you told us, "I'm not very familiar with the hospital setting yet, so I don't really know how things work." Follow that with something like, "I want to know what I can do, I want to do as many hands on things as possible. These are my goals_____." If you aren't sure what your goals should be talk to your clinical instructor. You should have a few goals for every day you are at clinicals and you should be able to articulate them to the RN when you get there. Even writing them down for the RN isn't a bad idea because the likely won't remember.

pht15 · Feb 16, 2015

I've gone in to the rooms of confused patients on my own initiative when they're doing something they shouldn't (trying to pull out an IV, for instance) and re-directed or given a gentle reminder. Following your assigned patient to PT or other therapy is recommended if it's ok with the PT personnel.

HouTx, BSN, MSN, EdD · Feb 16, 2015

There are soooo many 'non-nursing' tasks that need to be done on a continuous basis - anything that could be done by a CNA. Your nurse would love it if you took care of some of these. It's best to clarify first by establishing some ground rules - "I don't want to bother you each time, so is it OK if I just go ahead and ______ (remove trays, straighten bed linens. refill pitchers, tidy the bedside area, re-stock bedside supplies, etc., etc.) whenever I see that it needs to be done?"

There may be instances when the nurse does not want you to perform a certain task alone - these would be the exceptions.

With this type of attitude, your nurses are going to LOVE you!!!

LoriRNCM, ADN, ASN, RN · Feb 16, 2015

With our early clinicals we were supposed to do CNA tasks.... have to be careful passing ice/water d/t some pts possibly being NPO, but if you are going in and getting report on your pt you will know this ahead of time. We never had to ask to do vitals or assessments, but obviously there is nothing wrong with that at all, your nurse would probably appreciate you asking. I'd let her know right off what your plan is for the day (assessments so you can write your careplan or whatever paperwork, also let her know that you are or are not passing meds that day with your instructor). That way you aren't going up to her every hour for permission to do stuff.

Lev, MSN, RN, NP · Feb 16, 2015

Things that I do to show initiative are removing empty trays from rooms

Everything you've been doing is great, just make sure I&Os have been calculated before the trays are taken out.

Lev, MSN, RN, NP · Feb 16, 2015

I love that you're asking this!

The best thing to do is ask if there is anything you can help with. Ask the CNAs and the RNs. If it's a nurse only task, make sure to check with your clinical instructor if it's ok to for you do that task.

Things that never hurt:

Helping to clean, turn, and bathe patients

Taking vital signs (make sure they don't have an arm restriction)

Rounding on patients

and...documenting the things listed above

Help patients select TV channel

Give extra boxes of tissues/toiletries

Adjusting pillows

Giving directions to family members

Things you can ask RN if ok to do (alone)..

Set up patient's tray for lunch (sometimes they are NPO and still get tray or are on aspiration precautions)

Feeding patient

Ambulating patient

Disconnect patient from IV fluids

Apply texas catheter

Offering water, snacks, or ice chips (sometimes have diet restrictions)

Remove trays/empty foleys/hats - make sure to document I&O and let RN know

Apply cream (sometimes patients have skin conditions that do not benefit from extra moisture)

Things you can ask RN and instructor if ok to do (with assistance)...

Draw blood/insert IVs

Insert foley/NG tube

Wound care

Tube feedings

Give medications (instructor usually lets RN know which patients will have meds passed by student)