Clinical advice?

marienm, RN, CCRN · Feb 12, 2017

I hope it goes well for you! I *hope* your instructor will start the day with a tiny tour for you so you know where stuff is (food/drinks for residents, linens, dining room if that's how things are set up, tub/shower room, etc). No one likes to be lost! Hopefully they will also tell you the normal pattern of the place...I imagine most residents get their vitals checked once or twice a day? Maybe it's vitals, out of bed to wheelchair, go to dining room, go back to room for meds, bath, and nap (for example).

When I started clinical, we were only allowed to do things we'd been taught how to do. So, if you haven't been taught how to get someone out of bed, make sure you consult your instructor before doing it! A *nurse* needs to take a lot of initiative and figure out how to get things done. A *student* needs to be much more careful with what they decide to do on their own. Example: if you don't have anything more emergent to do, you can definitely help your patient get washed up and get some good lotion on their intact skin. However, you should not do their wound care on their leg wound without consulting the wound care orders and your instructor. Another example: You can feed your total-care patient their pureed diet with thickened liquids. You may not, however, decide to try them on thin liquids because 'it seemed like they did okay with the thickened liquids.' You could *mention* this to the nurse/dietician/speech therapist and they may or may not act on it, but that's as far as you would take it.

There might be order-of-operations things regarding medications to watch out for (depending on whether you'll be doing med passes, but even if you aren't doing them yet, you'll get there). Patients who get mealtime insulin need a blood glucose check before the meal (or whatever the policy says). Patients who get blood-pressure meds need their blood pressure and heart rate checked before getting the med-there might be circumstances where you would hold the med, but you would definitely talk this through with your instructor.

I suspect you're starting at a nursing home to get a feel for taking care of people...bathing, toileting, dressing, feeding, etc. It might feel like you're doing 'tech' stuff, not 'nurse' stuff. Not true! Keep your eyes open and *look* at your patients. Notice that one patient has swollen legs, and think about how that relates to their diagnosis. Notice that a different patient has a tremor...when does it occur? How does it affect their life? Can they eat unassisted? If not, how is their nutrition status affected and how is it being addressed?

In a 'normal' day as a nurse, you will not spend the whole day with your one patient. Part of what you are learning is how to attend to their needs (assessment, hygiene, feeding, comfort, meds) as well as your needs (documentation). At first, it may seem difficult to get out of the room...everything will take you a while, and you'll forget something and have to go back in. You'll start to develop patterns that work for you and let you cluster your tasks. If you find yourself with down time, see if another student needs help. Look up the meds your patient is on, even if you're not doing med passes yet. Don't be underfoot, but watch how the staff work together and get through their day...and think critically about it--is it working? Are they able to see every patient when needed, and respond to changes if necessary? Do they seem super-stressed? Do they help each other?

I hope it goes well! Let us know how you feel after the first couple of days!