Clinical Placement Tips for Nursing Students

NurseStorm, BSN, RN

First of all, keep in mind that things are changing. When most of us went to nursing school, our clinical instructors were responsible for our learning in clinical placements. Now it seems instructors are dropping off students in some cases leaving floor nurses responsible for teaching. We are not getting paid anything extra for this, and as much as it may seem you are helping, it actually does end up making more work for the floor nurses (Think of having a 7 year old help you bake cookies. They are trying hard, and they are helping but everything is a little slower, you have to supervise everything, and as special as it can be to see their growing confidence, you know you could've made the cookies much faster had you just done it yourself).

This is not meant to degrade students. I actually enjoy teaching! I just want to try to give a bit of a different perspective to students so they can understand how the floor nurses feel. Yes, we remember what it's like to be a student. You guys have not yet had to be a floor nurse with full load of patients and responsibilities though, so while this does not excuse outright rudeness, just keep in mind that sometimes with the stresses of so much responsibility, burnout, short staffing, etc., students are another responsibility thrown on top in some places, and this frustration can sometimes leak out onto the students. Try not to take it personally if it happens.

Tips To Getting the Best Experience

STEP 1 Be humble and appreciative.

This alone makes a huge difference. Cockiness, arrogance or entitlement are an automatic turn off to most nurses. We are not being paid to teach you (unlike your instructor) so things as simple as showing appreciation go a long way!

STEP 2 Don't act like you know everything.

You don't. If someone tells you something or corrects you on something don't answer "I know" (for some reason a lot of students seem to use this as a response even when being corrected on an incorrect behaviour? lol) Say something like thank you, I will do it that way. Or thank you, I will try to do it that way in the future, etc. Or even when being told about things. I remember one shift, I had a coworker (who is known to be pretty blunt) who was working in the special care nursery and she had a student in there with her. She was trying to explain different things we do in the nursery, the protocols, the different assessments, etc. The student would say "I know" to almost everything she said. Finally the nurse said "If you know everything about the nursery, then get the hell out and let someone else learn about it. You're done." - Best way for the nurse to handle it? Not really, no. Understandable she got annoyed? Um, YES! Don't be this person.

STEP 4 Be prepared.

Research your patients, their medications, things you will commonly encounter on your floor. Make sure your instructor shows you the supply rooms, how to use the pumps etc. before she sets you loose onto the floor. Knowing where to fetch supplies for staff is a pretty essential thing you need to know! But more importantly knowing about your patients' diagnosis, treatment, meds etc is VERY IMPORTANT!

STEP 4 Try not to have your whole clinical group gather in one spot frequently if you can help it.

Especially at the desk or the break room. This can be frustrating for staff trying to get to their belongings, or if they are charting at the desk and have 6-8 people standing in a group now talking. In general, try to be respectful and speak quietly when you are at the desk as people are most likely trying to chart.

STEP 5 If at all possible, do your charting on a side computer somewhere, and not one of the main computers.

I don't know if this is possible in all hospitals, but I know it can be very frustrating when all the students take over all the main computers and the RN is either needing to check orders/give meds or even chart themselves and there is nowhere left to sit :no:

STEP 6 NEVER LOG SOMEONE OUT!!!

I left the desk for a second when a patient was calling out for me, quickly locking the screen (didn't save my document as the person seemed to need help quickly). When I came back, a student was sitting at my computer doing something... I asked "umm... did you log me off??" and she goes "yes..?" and I'm like *inside screaming and cursing* "Okay.. well I was in the middle of a huge charting thing I was almost done of and now you've gotten rid of it... Please ask in the future before logging a nurse off a computer.." She was very apologetic and I tried very hard to be nice about it, but inside I was so pissed off. Yes, I probably should've saved it, but patients come first and no student should be logging RNs out of computers! Don't do this! (without asking anyway)

STEP 7 Be helpful.

Offer to fetch supplies, answer call bells, answer the phone (if this is allowed), put charts together, etc. NEVER NEVER say "I already did that skill" or "I'm already checked off on that skill". Doing something once does NOT mean you have mastered it, and I don't care if you've already "checked it off", great way to piss off your nurse who is trying to perhaps give you experience is by saying this.

STEP 8 DO NOT EVER EVER degrade the unit you are on.

I don't care if you hate maternity, you hate med-surg, you would never work in palliative, etc, etc. You are there to learn, and if you start bad-mouthing the unit or the specialty, you will quickly piss everyone off. For example, I once had a student say to me "I don't think I could ever work peds.. it's so boring and slow and nothing good ever happens. Don't know how you guys stand it. I need more going on in my specialty"

Realize that as a student, you have about 1/50th of the responsibility of the nurses. So even if you think it's "boring" realize that 1) you may actually be here on an uncharacteristically slow day, and one day does not equal how a specialty is. 2) You are working with one patient, and now they are improving. Why don't you come tell me how boring it is when the child is on q1hr mask treatements, iv steroids, high flow 02 etc and their family is terrified and looking to you for answers and reassurance. (As well as your other patients of course, which are of such a huge variety that it is never "boring") 3) Realize that even if you don't like the specialty, the people who work on that unit obviously have chosen the unit for a reason, and unless you come upon the few people who hate their job, you are insulting them and being very offensive. You don't have to pretend the unit is your dream job and you've never worked anywhere better, etc etc, but just be respectful and a hard worker.

Also don't compare it to other places in a degrading way (at such-and-such hospital/unit, they never do that. Such-and-such hospital always makes sure everyone's meals are piping hot and there is never a gross smell like here. Such-and-such hospital LOVES having students and in fact they say we keep the place running. Such-and-such hospital doesn't use this type of IV pump and they said the ___ pump is the best on the market. ETC) This is just annoying. Especially when done frequently. With an air of cockiness. If you say something in a respectful manner or something that is appropriate that is fine but keep in mind these types of statements can be annoying.

Along the lines of the above, if you have previous experience, (LPN, paramedic, etc etc) do not try to lord it over people or use it to show off in any way. This can be very unbecoming. Only bring it up if very relevant and in a non bragging manner. (again another example of what not to do, that I had said to me by an LPN student: "Oh yeah, I was a paramedic. I've put in probably thousands of IVs. Once I got a 14g IV in the hand of 3 year old, no one could believe I got it in," etc blah blah. First of all, sounds like BS, secondly, if you bring something like this up out of almost nowhere it is very braggy and annoying. Don't be a bragger. If someone asks if you have previous experience, talk about it, if they ask if you've done something before and you've done it many times in the past, I'm not saying pretend you didn't. Always be honest, but REMAIN humble. There is a big difference between saying "yes I feel comfortable doing IVs, I've worked as a paramedic for __ years so I have been doing IVs for a number of years" and the above conversation I noted

STEP 9 If someone asks you to do something, do it.

But do not do things that are outside of your scope as a student, or that you are not competent in. Make sure you say "I'm sorry but as a student I'm not allowed to push IV narcotics" or whatever it is. If it is something you are not competent or comfortable with, but are allowed to do, simply explain to the nurse that you have not had much practice with that yet, and if she has time to help you with it you would appreciate it, but if not, it is okay and you will be happy to observe.

STEP 10 Remember, it is about the PATIENTS, NOT the students.

I find sometimes (again with the entitlement) students will get irritated that "their experience" is not the way they want (eg. woman giving birth decides she doesn't want students present. I can see how that would be disappointing, but to say you deserve it and how dare someone not allow you, and "if the other nurses can be there why can't I?" is not appropriate. First of all you are not a nurse yet, so it's not "the other nurses", secondly the nurses are there performing an essential job, so this is different.) Be grateful for all experiences you have, and be accepting of patients desires, or situations where the nurse doesn't have time to slow everything down for you. It's about the patient after all. Observe closely in these situations and if it is slower later you can probably ask some questions! If not, ask your instructor about the experience and situation later.

If it seems quite busy on the unit, having students added can be stressful for the nurse.

You can try to relieve this a bit by saying when you first meet "I am happy to learn anything I can from you, and I understand if it's too busy to explain much! I will simply observe in those cases, and anything you can tell me when time permits I will be grateful to hear"

As I said, I do enjoy students when it's not too crazy busy, and I like to help new grads when they are starting on our unit too. I have obviously also had some bad experiences too though, and this can be very frustrating and a turnoff. Nurses having multiple bad experiences with students can turn them off altogether, so if everyone worked to follow these guidelines it would help not only yourself but everyone else.

Here is an example story:

I once had an instructor place TWO students with me on a one-to-one pediatric patient (this is basically picu for our hospital as its a smaller rural hospital, and no picu unless they reach the level we need to air vac them out, which this child almost was). I felt very very frustrated that I would be closed in this room all day with TWO nursing students and an extremely ill child. This could've went extremely badly, and I was automatically frustrated just by hearing that she was doing this to me without even asking. I actually had a look of shock on my face automatically and said "TWO?? Are you serious?!" I'm sure that didn't seem very welcoming to the students, which I feel bad about in hindsight, as it wasn't their fault, but that is a very stressful thing to thrust upon someone without even asking). However, these 2 students turned out to be very respectful and appropriate and said something along the lines of what I advised you/students in general to say above (we understand you're going to be really busy in here! We are happy to just watch, and if you have time to explain stuff: great! If not we completely understand, the patient comes first!) , which made me feel a bit more relaxed starting out. As I was able to get the patient more stabilized, I then felt more as though I was able to teach and taught them all kinds of stuff about the situation including chest assessments, the benefits of the optiflow, when we use it, retractions, work of breathing, how to interpret blood gases, IV fluids in use, meds in use, ETC, etc. They were very very grateful and thankful to me, and this made me feel good and appreciated, and as though I made a difference. They were attentive and excited to learn, and showed great interest in anything I said. All of this making it more likely that I would do the same thing again. If they were rude, snotty, ungrateful, entitled, etc. I wouldn't have felt the same and it would've been a much different shift for everyone. I probably would've mostly just done my work and tried to ignore them, letting them observe and adding minimal remarks.

So you see, your attitude and behaviour can make a huge difference in "your experience" (also the experience of other students, as they say "one bad apple can spoil the whole bunch").

There will always be nurses having rough days, rough shifts, etc, that may be less than thrilled about having a student (again, instructors are paid for this, staff nurses are not). If you follow these instructions I am pretty confident to say most nurses would agree with me this will help you. It doesn't guarantee every nurse will love you of course, as sometimes no matter what you do, for an overworked understaffed unit, extra responsibility for a nurse will be frustrating and bothersome, but I think for the most part you will have better success if you follow this advice.

(Note, a student asked for nurses to share tips for students in clinical in another post so I wrote most of this up for that post. I then felt it could be useful for other students as well so decided to share here)