Clinical Observation: How to make the most of it?

cnmbfa · Jul 7, 2010

Can you keep them as close physically together as possible? Instead of have 1 or 2 on each of 6 units, why not put 3 in PP, 3 in nursery, 2 in L&D? Then rotate over the next 2 days on those 3 units. Then do the same thing on the other 3 units on the other 3 days. That way you can be physically present. Talk to the nurses and ask for their ideas and their help. They may be glad to help you if they do not perceive you as dumping on them.

On day one, we are all on Mom/Baby. I pair them up and give each of the students in the pair a Mom/Baby couple. While the others review charts or do a scavenger hunt, I go with the two of them and demo a NB assessment; then I demo a Mom assessment, then send them jointly to do the other Mom and Baby assessement. If Ok with the Mom, I bring a third student (from the 4th pair) to watch. Next Mom/Baby assessment, I bring the other SN from the 4th pair to watch, so they are then not delayed in doing their assessment. (Get it?) When you bring the 2 who were in L&D back on day 2, pair them each with a stronger peer.

If they see the Moms and the NBs as separate, give the students BOTH the Mom and HER baby as an assignment. They will learn more and see the connections between Mom's prenatal and intrapartum course and the NB's health.

No one in my clinical grous passes meds the first day. It's just too much for everyone. Be sure to convey clearly to the students AND the staff who will do what, what your expectations are for the SNs, and explain their skill levels to the staff. Develop something in writing and hand it to the staff, not just the manager or CNS. Communication is key.

By the next day, most can be somewhat independent, but I only plan on doing meds with half of them. If the RN will agree to pass meds with them, fine, but make sure you have a clear understansding with the nurses. Otherwise, we pass on passing meds. Other leaning experiences matter more; I am sure they will get pleny of chances to pass meds at some point, and probably already have this skill mastered. Don't pass up chances to do a NB assessment, or to learn about jaundice or hypoglycemia or preeclampsia, or what to do about a Mom who cannot urinate and is bleeding. Those will not come along again. Same in Peds.

Partner them the first day on Peds. Go with them to start with patient one, then send them off together to start on the second paitent. It helps their nerves, and allows you to teach two of them at a time, and lessens you running around.

Patients alomost never balk at having two students. The feel doted on, and find the students charming. Works well for everyone.

It does noone any good for you to spread yourself too thin. If they have to miss something, well that's the way it is. L&D may be easiest on you, because students there are often only allowed to observe, and the RNs may want to take them under there wing themselves. That allows you to spend most of your time in Mom/Baby.

VickyRN, MSN, DNP, RN · Jul 7, 2010

Excellent advice, cnmbfa!

mambonurse · Jul 7, 2010

Thanks for the reply!

I'm working on creating some handouts at the moment. Have a few days before our first clinical. Grouping will be impossible as the hospital only allows 1 student in each area. :crying2:

I gotta get creative!

Thank you again!

lance.d · Jul 15, 2010

Pairing students together would cut your "group" in half. You could have some say as to who is paired with who...strong w/ weaker, experienced with less experienced...etc. They could prepare seperately, then compare their care plans and prep & learn from each other. Having another student sharing their clinical experience will boost the learning curve, allow you to spend more time, and increase their participation...

Good Luck!

Trauma Columnist · Jul 15, 2010

When I did the LPN to ADN program, in OB all we did was observe anyway. Since we were already LPNs we were used to passing meds so for us, it was getting the assessment down. That's what we emphasized.

I did this program in Indianapolis and at the hospitals we were at, there were so many students that it wasn't until years later, I even saw a delivery!

However, and I know this isn't the way it was suposed to be, it did work. I passed boards on my first try and have since moved up the nursing food chain.

I would emphasize the assessment skills needed in OB because they do differ from med/surg or even peds.

txnrse1 · Aug 7, 2010

I take 2nd semester RN students to the hospital, usually 10 to 12 per semester. I keep 5 on the floor, and farm out the others to specialty areas and the local school district. They are being precepted in those other areas, they work under a nurse in that area and can perform nursing functions, as long as they have successfully been checked off and I feel comfortable with them. (this is an agreement our college has with the hospital). I've also set up contracts with doctors offices (cardiologist, allergist) and a birthing center run by a nurse practitioner. These places must have an RN who is willing to preceptor my students. Talk with your hospital education director and see if this would be feasible.

Sunflower3 · Aug 8, 2010

Mambonurse,

Contact your Nursing Education dept. If you have a coordinator for student affairs, they may have learning modules that corresponds with a particular clinical nursing focus. If these are not available, you can create them by utilizing your particular organization's unit-specific policies, listing objectives for the observation, provide a list of corresponding web sites/professional organizations, and include 2-3 questions to stimulate critical thinking, pertaining to their observation.

Hope this helps,

Sunflower3