Can I ask a few dumb questions?

JROregon, ASN, BSN, RN · Jul 11, 2011

Abbreviations - you will build up your repertoire slowly but surely. I'm thankful I had a background in seeing medical notes because it can feel like learning a different language. Just ask what the abbreviations mean or have some sort of reference guide with you.

My college required a CNA prior to applying to the nursing program so I had a background in taking BPs and other vitals. Auscultating is a skill you will learn and some of that will come slowly. It is very difficult to hear a murmer but if you get word that a patient has a murmer, go and listen to it with the patient's permission. After hearing the normal heart rates of your classmates, you will know when you are hearing an irregular heartbeat. You won't have to know what kind of irregular beat you are hearing unless you work with heart patients. I remember asking a medical resident what kind of heart beat we were hearing and he said "I have no idea, I'm not a cardiologist". Find audio clips to hear different sounds.

First term in clinicals, we did vital signs and anything we had been "signed off on" in lab with an instructor viewing anything invasive until she felt comfortable with our skill level. There were no experienced nurses interested in letting us follow them around. Second term (we are on a quarter system), the nurses were a little more interested in us since we could give drugs and had a better understanding of their job but it was only special nurses that would let us hang with them for a shift. Best thing to do is to practice your assessment skills, do lots of listening to hearts and guts and listen to your patients. You will be able to spend extensive time with your patient(s) so getting background info, giving a lot of TLC and learning about how patients are coping with a chronic disease process can be extremely helpful to you and your patient.

We learned Foley's pretty early on but darned if I've had a chance to do one. Once we learned to give injections, we could give shots of all kinds. Insulin and fragmin are very popular injections as are vaccinations for flu and pneumonia. At the end of the first year, we learned about IVs but won't be able to touch IVs until the 2nd year starts in September. Even then, we won't be able to start and IV, draw blood until we take a class near the end of nursing school and won't get on the job practice until we get a job. That's because the facility where we do our clinicals has highly trained IV-infusion nurses in one of their facilities. So in September, we'll be able to hang bags, change IV tubing, do piggybacks, use an infusion pump.

If someone hands you a needle and tells you to go at it, you'll be way out of your scope of practice. Heck, even a stick for blood glucose measurement had to be watched by successive clinical instructors until each instructor was comfortable and they are all different.

Just make this a great learning experience for yourself. Look and ask for opportunities. Watch any procedures you can. Be open to anything that is within your level of training and enjoy the patients. They will likely be the highlight of your days.

BacktotheBeach, ADN, BSN, RN · Jul 11, 2011

At my school, and I think many others, first quarter and subsequent ones, we have a lab where you learn the skills, like blood pressure, head to toe assessment, taking vital signs, inserting catheters, using a feeding tube etc. You have to check off with the instructor and after you are checked off you can do those things in clinical. I came in with no medical knowledge or experience and did just fine learning these new skills.

My first quarter was a lot of nurse aide type skills, but we did head to toe assessments and everything as we learned it. We passed meds by about the 2nd week. We were in a long term care center that first quarter. My program puts about 8 students with 1 clinical instructor and you are under their supervision.

For the abbreviations, you could get a head start learning some of those, and having an idea of medical calculations would help, too. In fact, I think some of the abbreviations were in my med math book. These are things you will learn first quarter.

Feel free to ask questions!

Twinmom06, ASN, APN · Jul 11, 2011

giving insulin shots and finger sticks actually could (and I know its not) be in my scope of practice - I'm an insulin dependent diabetic (but I'm on a pump)...

thanks for your words of wisdom...I should be getting my clinical calculations book on Tuesday via Amazon - I start a 2 week med course on 8/1

Bob_N_VA · Jul 11, 2011

Don't worry, they will teach you what you need to know. 1st clinicals are focused on getting used to dealing w/ pts, vitals and bed baths and the like, you may get to practice foleys, ng tubes and the like on dummies, but actual people comes later. We started passing meds in the second term with the pharm class. Each following term becomes a bit more heavy duty, but you can keep up. You have to work hard, but the programs are designed to move you along with your classmates. In my program, the only time you go one on one is preceptorship and that is the last semester before graduation.

Reebles · Jul 11, 2011

My experience has been a little different than the posters above. Our first semester we started clinicals 5 weeks in and were able to pass meds, check blood sugars, give injections (including insulin and Enoxaparin). We were in a SNF and although we could do IVS and Foleys, no one got an opportunity to. Of course we did the basics too, bed/bath, wound care, turning patients....

Second semester I actually got to do multiple IVs, did a Foley, I even got to try getting ABGs on a patient in the ED (very exciting). I was also able to DC a PICC line. One of my fellow students got to do an NG tube. If you get the opportunity to try something, do it! You will always have an RN or your clinical instructor by your side.

queenjulie, RN · Jul 11, 2011

My school is like @Reebles--we are required to be CNAs before you can start, so the first semester of clinicals, we do vitals multiple times a day, listen to heart and lung sounds, do blood sugar tests, pass meds, give injections, and check IVs for patency. We could also put in Foleys and NG tubes, although I don't think anyone actually got the chance to. We all put in IVs and Foleys in the second semester, assisted in births, and spent time in an ER and doing home health visits. By the end of the second semester, we were doing full patient care--everything their nurse would do--except for give narcotics.

But some schools don't require you to be a CNA first, so they spend the whole first semester doing just CNA stuff--baths, vitals, moving patients safely, etc.

Reebles · Jul 11, 2011

My school is like @Reebles--we are required to be CNAs before you can start, so the first semester of clinicals, we do vitals multiple times a day, listen to heart and lung sounds, do blood sugar tests, pass meds, give injections, and check IVs for patency. We could also put in Foleys and NG tubes, although I don't think anyone actually got the chance to. We all put in IVs and Foleys in the second semester, assisted in births, and spent time in an ER and doing home health visits. By the end of the second semester, we were doing full patient care--everything their nurse would do--except for give narcotics.
But some schools don't require you to be a CNA first, so they spend the whole first semester doing just CNA stuff--baths, vitals, moving patients safely, etc.

Just to clarify, my school (SFSU) does not require you to be a CNA, some in the program were, but most of us (including myself) are not.

Music in My Heart · Jul 12, 2011

The short answer to all of your questions is, it depends on your program...

ok - so I see alot of these abbreviations (some which I've been able to figure out on my own) but some I haven't - do they teach you this stuff?

We were not taught any of it explicitly. It was more a matter of looking things up as they came along. We were simply expected to know the terms, symbols, and abbreviations which were germane to the topics at hand.

Is it part of your first nursing course?

Our Fundamentals book included a long list of abbreviations... as did our Med-Surg book.

Are you expected to come in with any kind of experience as to auscultating, manual BP's etc? I've found my heartbeat and my daughter's but I can't tell any difference (as in if the heart beats are out of sync etc..)

Not generally... unless your program requires a CNA course prior to matriculation. The reality is that you'll do very few manual BPs and instead rely on automated equipment to do it for you (which is unfortunate because they sometimes produce erroneous results - generally due to improper cuff placement or sizing)

Your first semester in clinicals - do you pretty much do anything other than watch?

We sure did... Our first day saw us doing ADLs in pairs... the second day was ADLs solo... passing PO meds by the end of the first month... attempting IVs by the end of the first semester (after a number of tries on each other), as well as Foleys and NG tubes... Hanging IV meds by early second semester... IV pushes by the end of second semester... Total patient care (except blood products) by the end of second semester...

do you generally go one on one with a nurse or does an RN have a gaggle of nursing students with her for procedures?

We were one-on-one for everything...

do you do simple stuff like vitals etc??

We did, right out of the gate.

When do you start doing the more extensive stuff (IV's, Foley's, blood draws?)

Late-first, early-second semester... Never did blood draws during school or even on med-surg... do it routinely in the ER.

I'm afraid their going to hand me a needle and tell me to have at it!

Come now... you know that's not going to happen... for liability reasons if nothing else. That said, it does ultimately come down to "going for it," both in school and in practice. Work on projecting self-confidence and competence even when you don't feel it... it helps both you and the patient.

Music in My Heart · Jul 12, 2011

do you generally go one on one with a nurse or does an RN have a gaggle of nursing students with her for procedures?

Let's nip this one in the bud right now. A generic nurse is no more a "her" than is a generic physician a "he."

Plenty of us y-chromo types running around the hospitals.

Twinmom06, ASN, APN · Jul 12, 2011

Let's nip this one in the bud right now. A generic nurse is no more a "her" than is a generic physician a "he."
Plenty of us y-chromo types running around the hospitals.

sorry no offense meant...didn't even realize I typed that (I thought I typed "them")

and I do realize they're not going to hand me a needle and tell me to go for it - it is more of an insecurity of being in a class of people that are already CNA's and LPN's etc and being clueless...

Sand_Dollar, BSN · Jul 12, 2011

My program requires CNA certification as a pre-requisite so everyone had a baseline to begin from. Some of the students already work in Long Term Care, while others (such as myself) have never worked under their certification. As a CNA we learned about restraints, bed making, hygiene, ambulation, Activities of Daily Living (teeth brushing, feeding, toileting) and how to do vitals, etc. A few of these skills are reviewed in my program, and our ability to take vitals is tested, but we don't really have to learn it again.

I am near the end of my first semester and begin my first clinical rotation next week. We will be allowed to do most of what we have learned, dependent on facility rules and situations presented of course. This semester I have learned how to do a full head to toe assessment, which includes palpating the abdomen, auscultating the heart...all that sort of stuff. As well, I will be able to hand out meds, give injections, draw blood, start IV's, hook up IV's and set the pumps, set O2, do airway suction, change wound dressings, chart I/O's as well as specimen collection and manage catheters.

We learned these skills on mannequins (LOTS of hands on) and must pass a proficiency test. Every lab day we also get hands on time in our hifi sim lab which is very cool and has a mannequin that breathes, talks, bleeds, has urine, etc.

For clinicals I have been told we have 2 students per floor. We find a patient and take care of them all day. We are supervised by the nurse along with our Clinical Instructor, who moves around between students. We were told to tell the nurse at the start of shift we want to see/do everything (within our scope of course). But, if given the chance to take a pt to see a cool procedure, go! I have heard the regular nurses sometimes get jealous because they don't get to go watch the fun stuff like we do. lol If the nurses know we are there and willing to learn, they often call us so we can do the procedure, ALWAYS within our scope only.

My CI works at the clinical site normally, so she has told our group what to expect. I will try to come back after I'm all done and let you know how the expectation and reality compared.