what can i do at clinical?

"stay out of the way and help if we're asked"

Many times you won't be be asked, so be proactive and seek out opportunities to practice skills. Sometimes you may get a nurse who will ask if you're allowed to do such-and-such and if that thing comes up, she'll track you down so you can observe/perform/whatever, but not every nurse is going to be that student-friendly.

i remember those days... the clinicals of the 1st semester are frightening and somewhat boring because you just started learning the basics and can't do much. You can use what you've learned so far and try to apply it to your clinical. If the nurse you're shadowing is receptive to students, I would offer to help and def. ask questions. If the skills are within the "fundamentals" range... they will most likely let you help. Most important: be proactive and if your nurse dont like students... ask your instructor to switch you to someone else.

In the meantime, you can read your patient charts and whatever you don't understand, ask the nurse. Also, try to pick up some words (disease, drug names, certain procedures) because it will build your knowledge and help in the long run. What else have you learned so far?

Do not just sit back and wait for the nurse to tell you what to do - half the time the nurse you're working with will forget you're even there (sometimes intentionally). Be proactive - if there aren't any tasks you can complete (a rarity), spend time with your patients. If one of your peers has an interesting patient, observe what they are doing.

Don't worry about feeling useless and in the way - it's part of the fun of nursing school.

Whenever I started a shift with a nurse, I would ask her how she preferred to work with students. I never had one that said "stay out of my way" although a few preferred to supervise me more closely until they figured out that I was competent. Some would really track me down for cool stuff. Sometimes the other nurses on the floor would even bring me in for interesting experiences. I made it clear to everyone I wanted to learn and was not going to make life more difficult. If I had nurses who weren't that hot on letting me take over then I just stuck to them like glue and watched. It was boring to follow someone all day and not do anything, but it didn't happen that way often. Good luck!

Your the lucky one. I'm starting clinicals soon and I will get to give bed baths to old people.

Answer call lights if you are allowed, have your work done, and have nothing to do. I work nights so I don't deal with a lot of students, but what would get under my skin is 4-5 people standing around chit chatting and texting while other people are busting tail.

Be ready to transfer new admits from stretcher to bed. Typically that is where you get a lot of hands-on experience (starting IVs, inserting a F/C, putting on traction, etc). Ask the nurse in charge of that pt if there is anything you can do to help. Typically that is the busiest time for a nurse, so ask, then go get your clinical instructor and say "I have the opportunity to do X but the nurse is busy, will you help me?" The clinical instructor is there to teach you how to put in a Foley, not the nurse.

Also, someone should ask the patient. The majority of pts don't mind having a student nurse do something. I think most people know that nurses have to start somewhere. Personally speaking, I'd let a student nurse do anything within reason with me, but when it comes to my son (3) I don't want someone practicing IVs or blood draws. kwim?

Just my couple of pennies.

There is a lot that you can do at clinical. Remember that you are working under your clincial supervisors license so you need to clarify with him or her what you are and are not allowed to do. I'm going to be really specific because no one was with me. I hope you find it a support.

Here's a basic morning.

You start by getting report. Introduce yourself to the primary nurse. Listen to the previous shifts nurse give your patients primary nurse report. If you missed it, ask the nurse if you can have a brief report. Write down EVERYTHING. Look it up later if you don't understand it. If your nurse is too busy or doesn't want to give report, find the hand off sheet and read it.

Find the PCT or CNA for your patient. Tell him/her that you are there to help and ask them to let you know if there is anything you can do. You will learn as much about direct patient care from your PCT/CNA as you will from the RN or LPN. Find the soiled utility room. Find the area where clean linens and bathing supplies are kept.

You need to get your morning assessment.

Knock before entering. Give them your name. Offer a reason why you are there. Wash your hands.

Do a brief neurological exam. What is your name? Compare to armband. Do you know where you are? Do you know what day it is? Why are you here?

Get Vitals. Ask if they are in pain and if so, rate it. Ask if they have any nausea and when they had their last bowel movement.

Listen to heart and lungs.

Listen to bowel sounds.

Be sure to compare their left and right radial and pedal pulses. Are they regular in rate and rhythm and equal bilaterally? Check capillary refill time.

Note any edema.

Note where/if your patient has IV access. Assess the site. Is there erythema or edema? Not the type and rate of fluid infusing.

Before you leave, lower the bed. Ask them if they need anything. Wash your hands.

It sounds like a lot but you can be doing multiple things at once. You'll get really quick at assessment.

Document your assessment in your nurses notes.

Assist with morning oral care. You may have to ask your CNA/PCT where to get toothbrush and paste.

If your patient needs their finger stick blood sugar (accucheck) done, watch the nurse do it so you can start learning how.

Assist with breakfast if needed. Note what percentage of breakfast was eaten.

About this time, meds will be passed. Watch the nurse and learn his/her method.

Your patient probably needs a bath. Will it be a bed bath or a shower? (and yes, every nurse needs to be comfortable and confident with washing patients. It's a basic nursing skill). If you haven't done one before, assist the CNA/PCT when it's time.

Change linens

Whenever you have extra time, read the patient's chart. What labs, dressing changes, etc... do they need today. Do they have to go off the floor for an ultrasound (or anything else)? Will your instructor, facility, and ultrasound tech let you go with them to observe? Note the medical diagnoses that the patient has. Note what medications they have ordered.

Ask where to find or access the hospital policy/procedures manual. It will tell you exactly how you should do anything.

Ask your clinical instructor to review your morning assessment documentation. How can it be improved for clarity and consistency?

Immobile patients or patients at risk for skin breakdown should be turned every two hours. You need to communicate to the PCT/CNA that you have done it. You may need to have him or her show you the best method.

When you are not working with your patient or patients, see how you can be a help to your fellow students and the floor nurses. Try to observe everything you can. Jump in and do anything you can safely do.

Good luck! Have fun! Learn tons!

Seth

Your the lucky one. I'm starting clinicals soon and I will get to give bed baths to old people.

Welcome to nursing.