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

CT Pixie, BSN, RN · Feb 16, 2015

I think its great that you are asking.

During my schooling our CI (clinical instructor) would tell us what we could do independently, could do with supervision or with the ok before doing it, and what we could NOT do with supervision or not.

Before doing anything with the patient in terms of ambulating, toileting, feeding etc, never do it without getting report on the patient. So many patients think they can walk but in reality are too weak. Having patient on the floor because you decided to walk them without asking is not going to win friends :) So ask before doing.

I love having students on the floor. I can normally tell who's open to learning (even things they can't do yet..I think even just watching and having the abiltiy to ask questions etc really helps when its your turn to do). I normally ask the CI what his/her students can and cannot due independently, with supervision of the CI or me, and what they cannot due under any circumstances.

From there I'll grab my student (our students are assigned to patients not the nurse..so they take care of certain patients.) and say "I'm going into room XXX. I know your aren't assigned to that room but if you'd like, you can go with me and you can pull the IV, do dressing change, flush an IV..what have you. Often times the patient they are assigned to don't have things that need to be done (flushes, etc) so I try to give the student as much as I can to watch/observe or do even if its with another patient of mine.

I've had really great students who come up to me and say 'if there's anything you need/want me to do, please let me know' and 'do you mind if I watch you do XYZ'. I love that. Even if they can't do it under my supervision they WANT to watch and learn as I do it. I had one sweet girl who I loved having and smiled when I saw her. She was the best student I had seen. She took inititive, saw something that needed to be done and asked if she could do it either with me (b/c she needed supervision) or without me (was ok'd by her CI to do alone). She made my day so much smoother. I went to nights and only see her in passing as I'm leaving and she's coming in.

so, if i were your nurse...i'd want you to ask to do and see as much as you can. Clinical experiences are limited so get as much out of it as you can. Even if you are not allowed to do it, you CAN learn just by watching someone else and asking questions. Best of luck to you.

tsm007 · 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.

Why would asking first not show initiative? What doesn't show initiative is standing around waiting for the nurse to ask you. Just make sure what you are asking to do is something you're allowed to do.

Fruit Sucker · Feb 16, 2015

Be careful trying to do too much without permission- this was an issue with some of our students. Don't ambulate patients without permission- we had someone take a fall that way and almost lost the clinical site. Don't give patients any food/drink that hasn't been approved.

What I suggest: Stock your nurse's WOW (workstation) with flushes, syringes and needles, alcohol pads, apple sauce, sleeves for crushing pills, and so on.

Let your nurse know "I'm available for assignments if you have any for me." Depending on their personality, they may give you assignments for bathing/changing patients and that sort of thing, or they may take a liking to you and let you shadow them with all their patients and tell you cool things you can learn.

I like your attitude. Taking initiative is how I got to do extra stuff during clinicals, and I think it's a great idea. If you have time, and opportunity, if you see a respiratory therapist around ask them "excuse me, if you have a few minutes I'd love to ask you some questions." I got three different RT's to tell me about mechanical ventilation this way and aced my exam. As you go along in your program, you'll find you can do this with your patient's doctors, too- I've never found a doctor who wasn't interested in taking a few minutes to teach an earnest student nurse something about a patient.

Also, make sure you take the time to find out where everything is in the supply rooms. When the opportunity comes up where you get to watch a cool procedure and they send you to run grab something, you'll need to know where it is without fumbling around. Make sure you know what things are called. My last semester (yes, LAST semester) I had a patient's PIV blow out and I asked another student to grab me a 22g angiocath and she had no idea what an angiocath is.

studentnurse711 · Feb 16, 2015

Thank you everyone SO much for your advice!! I want to improve myself before my next clinical shift this upcoming Thursday.

KelRN215, BSN, RN · Feb 18, 2015

You should look at your patient's orders/care plan when you arrive at clinical. If you see that he is ordered for q 4hr vitals, say to the nurse when you speak with her about the patient "I would like to do all of his vitals." Then she can tell the CNA not to do them and you certainly don't need to ask before each time, you know the patient needs VS q 4hr. When I worked in the hospital, I always asked the students what they were planning to do at the beginning of the day- VS and basic care were standard but I needed to know if they were planning on doing meds or feeds (if the kid was tube fed) with their instructor. You can also ask that if anyone has anything interesting going on with a patient that they let you know.

caliotter3 · Feb 18, 2015

Get clarification from your clinical instructor so you don't overstep any boundaries and get yourself into trouble by trying to be helpful. I am surprised that the instructor did not make her expectations clear on the first day.