Asking for help with clinicals

I teach nursing, including clinical. Here's what I tell my students to prioritize:

1. The previous medical history. We use Epic. I tell them to get the history from the H&P note, because the complete history might not be in the problem list.

2. The current meds list. Make sure you know the indications, class, effects, side effects, teaching, and nursing considerations for the meds. Now, I tell my students to focus on side effects that are common and/or life-threatening, because common things are common, and you need to watch for anything very dangerous. If there is a rare chance of them getting a minor skin rash, I don't expect them to know that. Your instructor may have different expectations.

3. The care team sticky note. This is a feature on Epic on the front page of the chart; our site uses it as a Kardex equivalent. This will tell you the current diagnosis, vitals frequency, any isolation protocols, their code status, how they transfer, any LDAs (lines, drains, airways; this includes dressings), the plan for them, and any special nursing considerations. Again, this may vary for your site, but these are all things you need to know.

4. Double check if there have been any recent labs (within the last 48 hours or so) or any recent imaging studies. If any results are abnormal, make sure you recognize that and understand the implications. (These might also be written on the Kardex/care team sticky note.)

As an instructor, if a student brings me a report about a patient, I want to know that they understand why the patient is admitted, what their code status is, what we are currently doing for the patient, and what their priorities are for nursing care.

Angel Nurse Instructor, thank you so much for this. This is exactly what I was seeking. Having this information really gives me a lot more peace now. I really appreciate you! 

I am a senior BSN student and completed an internship last Summer, so I have some experience from a student perspective.

In my clinicals, I never had the opportunity to look at charts before shift report. So I'd just listen during report and write down anything I understood/whatever I could write down as fast as they were talking. I found this really helpful when I was just starting clinicals, because it really showed me what's important to nurses in each unit (I.e. ICU tells you all the vent settings, L&D tells you dilation/effacement/station, etc). As the shift started, I just would basically jump in and as my nurse was looking through the patient charts, I would follow along with them. If they were looking at labs, so was I. If they wrote something down from the H&P, so did I. This showed me more and more what each unit found important from their charts. Soak in every unit even if you don't think you want it after you graduate. You may think you know what you want but, also, you may fall in love with a unit unexpectedly.

I also was never afraid to ask questions from things I saw in their chart. There was one patient I had who had labs that were way off and I was trying to reconcile what their symptoms were with the lab results. I suggested something it could be to my preceptor and she agreed, but we didn't have doctor orders to treat what I was concerned about. An hour later, we did. This was in my third semester of the program. I was super nervous to even suggest what I thought I was seeing, but I was right. Don't be afraid when looking at the chart to try to ask those hard questions and really critically think through what you know!

I know this might not have fully answered the question, but I get it's overwhelming. It's hard to process it all. Once you get more experience, you'll get it down. I'm graduating in a few weeks and can't believe the same baby nursing student who walked onto a med surg floor for the first time a year and a half ago absolutely terrified is about to be a "real" nurse working with my dream patient population. It does get easier the more times you read charts, the more clinicals you have, the more experience you get. Trust the process! From one nursing student to another, you got this!!