Clinical Preps Rant

[rei-chan]

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.

[RN58186]

I remember thinking that my first clinical instructor hated me. I thought she as a really unpleasant well, witch, to deal with. She made may of the same demands on her students and yes, if we had a question we were told to look it up (but she would help us research to make sure we understood what we learned. I would spend hours on care plans, only to have them returned with a comment that I did not cover enough material, that I had missed too much and could I please re-do this and re-submit it. I spent so many evenings in tears, and thinking that next time I will get it right. I had never done that kind of work before and we were not really given any instruction on how to prepare care plans. And yes, we were expected to know why a particular test was ordered, and what the results were indicative of the treatment for them. We were expected to know our meds inside out, and be able to describe the action of that med down to the cellular level. And to top it all off we (the instructor and I) had very different religious beliefs (she had commented in her introduction to our group that she found religious people as generally a group of people she really disliked and tried to avoid; I had earned a theology degree before I became a nurse) so it seemed that instructor student relationship was doomed. I thought my nursing career was over before it started. But, by the time I got to my next med/surg rotation I sure knew my stuff and the nurses were frequently impressed at what I had already learned. Now, grant it I have been blessed with a pretty incredible memory for pathophysiology, drugs, lab values among other things so I do know that part was probably not as difficult for me as for others. Her line that always drove me nuts was that someday I would thank her. Took me a long time to realize she was right. She expected a lot out of me, and because I wanted too do well I tried hard to meet those expectations. I chuckle now 25+ years later when I remember her telling me that when being asked about side effects of a new med that answering with nausea, vomiting and diarrhea was a good cover if you could not remember what they were. (That saved my bacon a few times). And now when I tell a student to look it up because the student will remember better, I know that is true, even thought I hated being told that as a student. But, when I got to my first job, my first head nurse (before they were called managers, and yes, I am that old...) told all the nurses that they could all learn something from me about writing a care plan because I wrote really good, well thought out care plans. And because as my first instructor she made darn sure I knew my stuff, the rest of Nursing School went much more smoothly. And as a new nurse I was not quite as frazzled as those who started with me. And, the religion thing became something that we agreed to disagree on and we are still good friends. I would not be the nurse I am without her teaching.

The moral of my story is that one day we all come to recognize the value to doing all that work. Hope yours comes soon....

[Pranqster]

Heres the deal, the prep sucks and we all had to do it. Its part of your education and you are getting more out of it than you think you are. you are inexperienced at this point and if you showed up at clinicals with no prep or understanding of you patient's disease processes, treatments, meds etc you'd be lost and wouldn't have time to do the research before getting to work- that, more than lack of sleep, would be unsafe. Understandably, at this point in your career you don't know how much you don't know. I'm not trying to be mean, but all the work that you feel is meaningless will pay off when you're on your own.

[mindlor]

Parts of nursing school are just plain SILLY. Fictional/Creative writing should be a prereq. All of my IPAs were fictional conversations that never occured. Teacher loved them because I knew what she wanted. Clinical preps had a framework of reality which was then fictionalized to make them interesting. It is a game, nothing more, that must be played.

Perhaps if nursing schools got their heads out of their tushies and focused more on skills, hospitals would be more amenable to hiring new grads......

Luckily I am a skilled writer of creative fiction :)

[La Cubanita RN]

Well your obviously frustrated and a lot of my fellow cohorts probably feel the same way actually I'm sure they do. It's true prep and care plans take so much time and dedication but I have learned so much by doing them. Not for my exams but to improve my patient care. What I always hear from practicing nurses is that nursing school is boot camp you just have to get through it and there is a rhyme and reason for it all but once you graduate you never have to prep or write a care plan again because you have learned and absorbed proper patient care with all those long and insane hours you have already put in. Good luck in your program and just remember to take a deep breath and watch out with stepping on your instructors toes they play a large part of your nursing school experience. They really are just trying to help you be a better nurse at least at my school they are.