Clinical Preps Rant

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I need to get this off my chest. It is just a rant. I know how important and how relevant everything is in the grand scheme of things, but sometimes I wonder why?! Thank you. Anyone else feel the same?

I understand the importance and purpose of those clinical preps. We arrive the day before to gather information on our patient's, but we can't be there before 5 PM since assignments are not posted before then. Spend at least 2 hours copying the information so that I can rush home and enter it all in to the prep worksheet. Since we must individualize the reason for every individual lab result (i.e. every single result that appears under the umbrella of CBC, urinalysis, LFTs, etc.), diagnostic test, and medication or risk upsetting the professor if we skip some of the results (oh and if the patient has multiple comorbidities, which may apply for the reasoning, we have to select only 1 or be told that we don't know what we are doing and are guessing at the reason for this test). If we don't finish because at 2 AM you decided that it was better to get 3 hours of sleep and be safe for your patient the next morning, the professor lets you know that what you have done is not good enough, you should have finished no matter what. SERIOUSLY?!

Whatever happened to patient safety, if you are too tired to pay attention in clinical, aren't you a danger to everyone?

What about the times when you spend a lot of time looking up procedures so that you don't make a fool out of yourself. All that practicing, learning, watching instructors demonstrate the skills in lab during your first semesters? Then one day you are finally able to perform the procedure and you know those steps like you know the inside of your eyelids. You are doing it exactly as you were told since "The current research supports this being done this way for XYZ reasons."

Then the nurse and your instructor are both horrified at how you are doing the procedure and you are told to review the steps in the book. Did I really do it wrong? (I looked it up again and I followed the steps to the letter. To make sure my book wasn't mistake, a quick online search and a very recent youtube video modeling the steps confirmed that I did know what I was doing. The professor and nurse seem to be out of practice with this one procedure.) Out of annoyance and anger, I e-mailed a copy of the page clearly outlining the steps to the professor and have yet to hear back...next clinical will be interesting since I am now going to be stuck sitting with the professor going over the prep and asked question after question after question. Should I fail to be able to answer one of those questions or have one of my own, I will be asked to look it up.

Sorry about this, but I really need to express this.

THANKS FOR TELLING ME THAT IT IS OK TO ASK QUESTIONS WHEN YOU RESPOND TO MY QUESTION WITH ANOTHER QUESTION OR TELL ME TO LOOK IT UP SINCE YOUR TELLING ME THE ANSWER WILL NOT DO ME ANY GOOD. Also thanks so much for telling me that I pay your salary as a clinical professor and it is your job to answer my questions and assist me when necessary when you are hardly ever to be found and have a way of deflecting questions. In case you haven't noticed, the nurse you are very good friends with, and you continually pair me up with doesn't want students and told me the first week that I shouldn't bother her and to stop asking her questions. When I tell you this, and that she is one octave short of shouting at me for taking too long for taking meds out of this monstrous alien looking machine (i.e. one that I have never had the opportunity of using and am NOT accustomed to using) because I do not want to make a mistake and am not familiar with 'tower meds', why do you fail to believe me and act shocked and respond with, "That doesn't sound like her at all." I love being stuck between walls, rocks, and hard places, really I do.

Back to the clinical preps. At some point, I feel like they are busy work. It really has nothing to do with getting to know our patients, knowing what to expect how to prepare. I think that there has to be a better way. I understand that we are supposed to be getting used to looking at this information and knowing exactly what it is for and how to respond to abnormal values. I know that we need more practice with care plans and assessments. But there seriously has to be a better way because getting no sleep trying to finish it to your high standards is not working. I have to read and learn everything I need to know about these labs on my own; with time and repetition I know I will eventually remember them. We are not given any formal lessons on this in classes, this is a self-study deal and seeing certain labs for the first time hours before I am supposed meet this client is not a good way for me to learn about it, especially since most people (myself included) need sleep in order to process and remember large amounts of information, especially new information.

I really needed to say this out loud somehow. I know that this is supposed to be a learning curve and that is why we are students, and how hard it is for nurses to be burdened with a student when they already have a heavy load, and that clinical professors are supposed to be there for us. But it makes me feel better expressing this.

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LOL, do you go to my old school?

I'm sorry, I shouldn't have LOL'ed, but it just sounds like something I heard everyday, even from myself!

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You just totally tripped me out. Seriously, do we go to the same school? I am dying laughing because you just wrote the story on how my life is going to play out this Friday and Saturday. At least your post will remind me to laugh to keep from crying.

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After reading several other threads, I am seriously starting to think that all nursing school experiences are the same but I really needed to say this out loud. Don't worry about laughing. I know that in a few years once this is all over I will laugh at it too.

I do sometimes wonder why clinical professors do not ask nurses and patient's ahead of time if they would mind having a student. I also sometimes wonder where colleges find these clinical professors and if at some point they become burnt out and should seriously consider taking a semester or two off; or retire from the clinical professor aspect altogether...highly unlikely due to the shortage of nursing instructors.

What I have learned is that should the day ever come and I am given student nurses, I know how NOT to behave. I sometimes wonder if I would consider being a clinical professor someday, because thus far, I've had a few really horrible (and I really wish I were exaggerating on this word, but they were were downright maleficent and sought out every opportunity to put people down, even after following their instructions exactly as stated) clinical professors, a so-so clinical professor, and two really great clinical professors. I swear they let all this power and control get to them and forget that we have never encountered certain things in our entire lives. Thus is the gripe of 98% of nursing students.

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Specializes in Adult Internal Medicine.

You need to provide rationale on why each individual value is ordered? Or just a rationale of why a value is abnormal? At this pint your aren't ordering tests so I find it strange that you need to be providing rationales for it.

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Yes I and my fellow classmates are being asked to provide a personalized rationale for the patient as to why each individual lab is ordered and Nursing considerations for lab values. I am not going to lie, but this takes a very long time to do. It took longer when she said that we shouldn't be using the rationale's found in the book. . . then she mysteriously changed her mind and said using the book was okay. I thought her original request was asinine because we don't know anything about these labs and need the book as a reference guide to help us with this, but she would seriously become upset in her own way if we used what we saw in the lab/diagnostic book. She also became annoyed with me when she saw that I was writing in my explanation a brief description of the lab itself because "You are supposed to know and have this memorized by the time you show up for clinical." Seriously? with little to no sleep, and very little experience, I am supposed to be an overnight expert?

I can't wait for this clinical to be over. I am at the point of dropping and retaking the class next semester, especially if I am paired yet another week with her 'best-buddy nurse'. I do not pay all that tuition to learn how a professional nurse should not act towards colleagues and patients.

I digress, this isn't about that aspect of the clinical. Only the sometimes unrealistic expectations.

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Maybe you are going into too much detail on the labs? Try to look at the "10,000 foot view" first, the really big picture, not much detail, and then prioritize which lab tests are the MOST important or most relevant to the patient's condition ON THAT SHIFT YOU ARE THERE, and which ones might be of less importance. Nursing is all about prioritizing. Maybe that's what they want you to do. I dunno. (shrug) Try thinking it through first, and hit the major items first and maybe even leave some things off. Coming from a technical background, I am a perfectionist and I spent too much time going into too much detail.

You are nurse for the shift, 8 hours. What do you need to know/watch/assess/ monitor for that shift?

The best clinical instructor I had, came to nursing as a career change from a business and finance background. She was a no-BS instructor. I loved her style of instruction, LOL. She actually gave us rules of thumb for why or whynot certain things are done, or not done. She encouraged us to think, and actually consider what is high priority and what was more "back burner" stuff. She also didn't beat us up with busywork. She didn't want students scared and exhausted on clinicals. She wanted them working and learning the clinical skills.

I think some of my nursing instructors were completely oblivious to exactly how much time it took to complete their paperwork demands. And I know for a fact that the teaching team never sat down with each other and compared what each instructor was dumping on students and when.

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The best clinical instructor I had, came to nursing as a career change from a business and finance background. She was a no-BS instructor. I loved her style of instruction, LOL. She actually gave us rules of thumb for why or whynot certain things are done, or not done. She encouraged us to think, and actually consider what is high priority and what was more "back burner" stuff. She also didn't beat us up with busywork. She didn't want students scared and exhausted on clinicals. She wanted them working and learning the clinical skills..

I am making a career change from business to nursing myself! Don't mean to hijack this post, but thanks for the encouraging comment. I sometimes wonder if I am crazy for leaving a business job to go nback to school full-time...

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My clinical groups get our information on our patients when we get to the clinical site. The instructors don't even know what patient's we will be getting. I think that would be a horrible idea and it does not relate to what an actual nurse does. Nurses don't go into work the evening before to figure out how to treat their patient the next day! This is just crazy to me.

We do have all that paperwork to do but it is done after clinical and due before the next clinical day. It helps a lot because I live in a rural area and there have been times when there are only 3 patients on medsurge but 8 students, and our instructor at that time wouldn't let us go to any other areas. These are great times to complete any paperwork that we have.

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You're right, nurses don't come in the night before to research who their patients will be. As a new practicing nurse, I can tell you for certainty that there is good reason why your instructor is making you do all of these things that seem so nonsensical. Nursing school is tough [and seemingly nonsensical] for a reason. My job is cake compared to nursing school and it's also the best reward for all of my hard work and sacrifice during nursing school. Hang tight; you'll get your reward for all of your efforts soon enough :yes:

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This sounds just like my old nursing program. I graduated in May and I do NOT miss clinical prep paperwork! (I just hate the paperwork at my current job... haha). But yeah. I feel like a lot of it was just busywork and a lot of it was that the instructors just didn't understand how much they were all throwing at us at once.

If it wouldn't tick them off, you could try as a class explaining that the paperwork is just too much.

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We had to do the reasons behind why each test was ordered and the nursing considerations also. I spent a weekend going through each and every lab test imaginable listing by CBC, BMP, LFT ect and did a really good rationale as to why those tests are ordered, what considerations were needed and so on. Then when I would have to do my clinical prep work I had most of the hard labor completed, and I just had to personalize it for each patient. We had to do this on 2 patients....bleh it was awful. Do you have to do a medication sheet for each and every medication? We used to, and sometimes these patients on med-surg would have 40 medications. I made a list of all the common medications and made sheets for them and saved them individually in a pdf file listed by drug name. I would add medications as needed when I would come across one that I didnt have stored in the computer. I would do the same thing and personalize it for each patient. This really cut down on my prep time. By the end of nursing school I had hundreds of medication files and lab work definitions/rationales.

I made a binder and I printed out the list of lab tests, the reasons they are typically ordered and also printed out a spread sheet with common medications and brought it to clinic. I also had copies of the skills we were resonsible for that listed step by step preparations. When I had an NG tube to insert, I would simply look over "how to insert an NG tube" an I always felt prepared. These things that I did took a lot of time and effort, but they were such a big help and time saver that I thought I would share with you.

Good luck, its been a while since nursing school but the thought of those 2AM mornings before clinic still give me heartburn.

Also: I forgot to add that I also had a sheet in my brain binder that listed all normal values for lab test, therapeutic drug levels, ABG's, vital signs ect

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