Clinical Preps Rant

Nursing Students General Students

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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.

Sounds so similar to my school as well. Something that always bothers me is when I work up my labs, meds, care plan, patho ect. the night before and my patient is GONE the next day! My lovely instructor gives us new patients (no problem) BUT we have to finish are 1st care plan and now do a second full care plan. Everyday before clinicals I say a silent prayer that my patient is still there:)

Specializes in cardiac CVRU/ICU/cardiac rehab/case management.

About a week ago someone posted how much they loved nursing school and received rapturous agreement . My response that "nursing school was a nightmare " stood alone a midst all the happy res-ponders. I did wonder when reading all those happy post "Was I a misery in N. School " or "Was I the only one who was so stressed that I looked like a mobile spot? " So it is refreshing to hear that I am not alone in my experience.

Perhaps N.school it more about testing out your ability to handle stress because there can be a lot in the job. My mantra in school was "This is a test in endurance .I am stronger than I think "

Just get through it, that's all. Jump,sure . How high?

I precept students now as a result of my nursing school experience. I try to empower,encourage and dare I say...have a little fun while learning. I will never understand how knocking people can ever be seen as helpful.

Glad you got it out. Forget about it. Laugh. Move on

Specializes in cardiac CVRU/ICU/cardiac rehab/case management.

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 lwith you.

Excellent planning!! Keep it up! and you will go far. Nice job and share

Specializes in ICU.

Hilarious! That is totally my experience too ... I'm prepping for tomorrow too right now. I just hope the patients I chose don't get discharged before I get back in the morning. Now THAT sucks!

Specializes in MS, Tele, CM, Informatics.

You will rise to the challenge. I will say this don't give up. You have a purpose and follow your dream, and yes you work your butt off. But when you hear your name called at graduation you will be jumping for joy. So press on and keep your eyes on the prize. Remember clinicals don't last forever. You are important pick yourself up and run after your dream. I would limit the email to the professor, nursing school is hard enough with having the extra stress. Everyone has different preceptions when reading emails...so you might not want to make yourself a easy target with challenges.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.

Feel better???? Good!

I am sorry you are experiencing this........I have my own opinion why this seems to be a growing disease amongst CI (clinical instructors) I had those same requirements YEARS ago but my CI were more nurturing and we had entire classes devoted to this very subject.

I have however met CI's like this and it is my belief that those who don't have the knowledge to begin with don't have it to share so they cover up with passive aggressive behavior.

The links I gave you should help you in your quest for lab understanding

Lab Test Interpretation

Lab Tests Online: Welcome!

Who knew that my bottled up frustration was felt by so many. And many have had the exact same experience recently and long ago. Good to know that some things never change, errr sort of. I do feel better letting it out because complaining about it to everyone I know wasn't good enough since many have no idea what I am talking about or cannot relate.

Calinurse11, I also spent one weekend writing up whatever I needed to know on the most common labs ordered, and another weekend on a list of common drugs. Thing is, my patients have drugs that weren't on my original list, so I look them up, and add it to my list. Same thing with the labs. So provided that my future patients do not have any new labs that I have never seen, I should be ok with writing the lab part. . .but one may never assume anything.

Esme12, thank you for the links, I think I may start using them instead of trying to use my book since it is an older addition and new labs have been added.

EchoRNC711, I think I may have read some of those "I love nursing school posts" and that's what pushed me to sign up for an official account. Nursing school is a lot of work, clinical instructors can either make your learning experience a good one or a bad one. My Med-Surge clinical professor tells us that this is the semester where we will see the biggest jump in skills, I am still waiting for this "Jump" because the care I am giving now, is similar to what I did in my first semester, only I know a lot more now. I will admit that I will never repeat the same patient care error I made last week ever again. I will hunt down the nurse or my professor and ask them if "what is this hospital's policy on ABC?" instead of taking the initiative to do something as simple as toileting a patient (and there is a lot more to this story, but yes I am seriously going to ask before assisting a patient to perform normal bodily functions). I am still waiting to learn effective nursing communication because this is where I am failing (could it be due to poor role modeling or too many theoretical situations?). So yes, I have had really good clinical experiences and really horrible one's that make me sometimes regret my decision to go to nursing school instead of my original choice (I like interacting with patients, hearing what they have to say, and caring for them).

As for discharged patients, the professor decides on who we get because she asks who will still be there in the morning, who would be good for us to have, I think the professors would have MIs if we ever attempted to select our own patients. Sometimes I wish my patients were discharged moments after having breakfast because that means I won't have to worry about taking too long to take their meds out of the alien drug dispensing machine with green flashing lights.

I cannot remember who suggested looking at the big picture and focusing on the abnormal results. I did ask the clinical professor that question since my very first patient had close to 70 lab values and there was no possible way I could have completed them all the night before because I really did need to get some sleep, BUT I did complete all the drugs. I got "the look" and eventually okayed the deleting of maybe 5 results since they really were irrelevant and were part of a routine check, and she allowed me to skip the interpretation of the EKG results since we hadn't learned that in lecture at that point. How kind, but technically, we hadn't learned much of anything that first week on the unit. Labs and their results are still self-study at this point in the semester.

As for e-mailing the procedure to my professor, well people do stupid and irrational things when frustrated/angry. I was a little of both because at that point of the day, to be told that I didn't know what I was doing after having a series of misinterpretations and failed communications snowball down a mountain side and hit me, I was at my wit's end and needed something to prove that I did do (or attempted to do because I was thwarted even at that task) 1 thing right that day.

I feel as though I've gone on for too long, but thank you everyone for the support and sharing with me that you have also had similar experiences and that I am not going insane. Thank you for providing hope that this will end and clinical is not a true reflection of actual nursing work, because I feel like a CNA right now, an incompetent one at that.

I spoke with my advisor today and she provided me with some helpful feedback and tips. I also learned that next semester's Med-Surge (well the section I want to sign up for) is at a different hospital (same affiliation, but different hospital), and the students arrive early in the morning (oh joy) to gather information for the prep. The best news was that this unit is on a dedicated educational unit, meaning the nurses work there specifically to teach student nurses, and care for patients of course. I think that this is a lot more efficient than what we are currently doing. I am praying that next semester is when I will finally learn something other than how not to speak/act/behave/interact as nurse because I am really anxious and excited to learn actual nursing things. I'd really like to follow an experienced nurse around the floor one day and see what s/he does instead of trying to figure it out on my own (I know, I have a professor I can ask, but she does respond to questions and requests with questions and requests of her own).

Specializes in Trauma ICU.

Hahaha oooh I remember those days. My Med Surg instructor was the same way. We would go on the unit the day before our clinicals with our patient assignments, look up lab values, meds, medical history, and anything else pertinent and be expected to have it all recited the next day. And we would be quizzed for at least a half an hour. We also had to think of problems for these patients (at least 3) and what nursing interventions we would use to fix them.

Listen, it really does make you a better nurse. You don't think it will now but there is a purpose to all this leg work because one day you'll be able to pick up on why the chronic drinker who fell with a head bleed requires a head and abdominal CT, why he's in four point restraints because he keeps trying to crawl out of bed and understand why his platelets and coagulopathy are crummy and need to be watched. And additionally why his serum ammonia is through the roof and you're giving him lactulose. ;)

Keep your head up and try and keep your answers short and sweet with the bulk of information you're expected to know. It is alot but sometimes it helps cut down on the time.

I also go to sleep very late the day before clinical working on those sheets. Honestly, I do see the value in them even when my alarm goes off the next day and I'm exhausted. We don't have a separate class or lecture on labs so I feel that the only way I'm learning how to understand them, their normal ranges, and what you'd see in this and that disease is through these clinical sheets (working on one as I type!). Don't get me wrong, I feel like I'm grasping at straws at times but I'm getting an understanding...slowly. We also do pathophys of our pt's dx so I'm learning about different disease processes that way. Again, we don't have a separate pathophys course. Trust me, I've complained about how I feel like I need more classes but my instructor insists these sheets will help me get a real world understanding. We'll see!

Here's a great resource to shortcut some of those wasted moments looking up individual rationales. This book will save your bacon on labs and other diagnostics.

Laboratory and Diagnostic Tests with Nursing Implications, Joyce Lefever Key.

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.

For nursing school I had a folder on a flash drive for each of my nursing classes. All my assignments went into the corresponding class' folder. We had to do an asinine amount of looking medications up. Since MOST of our clinical write ups were similar from term to term in format and requirements - I started a master list of things like - medications. I had a Word document of all the meds I ever had to research/write up for clinical. Copy and paste are a huge friend - instead of looking up 20 meds on a patient you may not get to have as a patient you already have 15 typed up, copy them and look up 5. :) Think smarter, save some steps. Same could easily be done with rationales for labs/nursing considerations. Or - as you get further in school you can reference old write ups of similar patients to copy and paste your own work from ;) NOTE - I am ONLY advocating copying your OWN work, and suggesting you provide appropriate references to all material you get from texts/journals/published works of any kind.

And - unfortunately - there will ALWAYS be people who do not act professionally. Whether you are paying to learn, being paid to learn (orientation), being paid to work, or being paid to teach (precepting/orienting new coworkers). Unfortunately, sometimes you have to learn how to function with people who really get under your skin and annoy you. They will always be around - whether you stay in nursing or have a career elsewhere. It's going to happen. It's not going to be fun. But it is part of life. You'll be better for it - knowing how the world works and how to push through it. Clinicals are like work right now for you. It's awesome if you can be friends with peers or instructors, but if not, then you do what your instructor asks to the best of your ability, ask for clarification, ask good questions, and do the best that you can with the situation. You may have a work situation just like that someday.

Specializes in HH, Peds, Rehab, Clinical.

Our clinical experience was the same way. Our instructor got to the hospital about 45 minutes before us to learn what types of clients were on med/surg, any possible deliveries?, what's scheduled for surgery, etc so that she could assign us appropriately--meaning where we were skill-wise, what we had and hadn't seen/done yet. We arrived with no idea who/what we'd be doing that day and spent the hour before report reading charts, looking up labs, reviewing their meds, procedures, etc.

No way would our school allow us to be on a clinical site, reviewing patient documents without our instructor there with us. What happens if you do all that work on a client and before you arrive the next day they are discharged/transferred/or heaven forbid, pass away?

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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