Clinical Tips

patwil73 · Oct 12, 2007

Hey everyone. I'm sure u get posts like this all the time, but I'm a junior in my bsn program and I'm about to start clinicals this month for the first time. I'm a little nervous and apprehensive. If anyone has a few words of wisdom...or any kind of advice i would greatly appreciate it...thanks!!!!
griff

Hope this helps,

Words of wisdom:

1) You are a student - it is ok to not know something. However, it is not ok to not know something and try to do it anyway. Always ask when unsure.

2) Get in the habit of asking is there anything else I can do for you before heading out of the room. Invariably you will be called back because they forgot they wanted water with their pain meds.

3) When researching your patient (and always research the night before if possible) try and get the big picture about what is going on. You will be amazed at what you remember of the details if you have a clear idea of the big picture.

4) Ask as many questions as you can (of the patient, your preceptor, the assigned RN, the charge nurse, doctors, etc). Corollary - try not to be a pain about it though.

You will need to find a system that works for you - however, what I usually start with is a sheet of paper with pt name, diagnosis, allergies, doctor, age, a 7 point assessment (Neuro, Pulmonary, Cardiovascular, Gastrointestinal, Geniturinary, Integumentary, Safety), then a med list on the side what is given when.

As a student I would include side effects of meds and symptoms of medical history.

Pat

leslymill · Oct 12, 2007

Listen AND observe. I think you can find many different posts on this subject if you look.

nyapa, RN · Oct 12, 2007

Try to relax, not stress yourself out too much. When you do become stressed, just stop for a minute, take a deep breath and then move on.

It is really difficult to concentrate when one is anxious - and on your first prac of course you will be. After your day, take time out for an hour; go for a swim, or a walk. Then go back to your life and study. And eat properly, sleep as best as you can (yeah right! but try) - you'll need your energy.

Don't be too hard on yourself; if you are concerned about anything, then ask.

If you are not doing it as part of your course, keep a daily journal, no names of course. It may only take half an hour out of your day, or less. Record

what happened that mattered to you. This doesn't just have to be procedures, but also how you interact with patients, other staff, etc. Don't write everything that happened.
work out why it mattered; incorporate your emotions
then, look at ways to solve the problem for next time. Or if it was something good - and make sure you record those too, then list the reasons as to why you think it was good.

It teaches you problem solving skills. You can use it as a basis for researching diseases/conditions that you may have come into contact with. And it is great to look back on as you go through your clinical placement. We used one as part of our course, it was an assignment. I had a particularly bad experience with a preceptor. Because I had a record, to the date, and because others had had a similar experience, the uni lecturer was able to follow it up.

ericalynn, BSN, RN · Oct 12, 2007

don't be afraid to ask patients how they can best help themselves, such as "How much work can you do while we are turning you", or "how can I best help you, get to the bathroom, be more comfortable" etc. Sometimes patients have been through the routine before and they know themselves better than we know them. Otherwise, be patient, stay calm, appear confident, ask questions (even the "dumb" ones) and NEVER be afraid to ask for help. Best of luck to you!

classicdame, MSN, EdD · Oct 12, 2007

well, the good news is: every nurse has been thru this and survived. You will too.

oldiebutgoodie, RN · Oct 12, 2007

A few tips on meds:

1. Know the patient's BP before you give blood pressure medication. (not the BP taken 4 hours ago). Your clinical instructor will want to know if you know it.

2. If your patient is a renal patient, find out if he/she is going to get dialysis that day. YOu may want to ask your instructor about holding blood pressure meds (nothing like giving the BP med, patient has dialysis, BP goes in the toilet).

3. If you are giving Coumadin, know why and what the patient's INR is, and if it is therapeutic.

4. If giving Lasix (furosemide), know what the patient's potassium is first.

Regarding your patient:

1. If you get a blood pressure of 50/30, but the patient is sitting up and chatting with you happily, you might want to retake it. Actually, redo any test that has funky results.

2. Don't take a patient's temperature orally if he/she has been sucking ice chips.

3. If your patient has no heartbeat, your stethoscope chest piece may not be turned the right way. (Or the patient is dead.)

Just a few thing I could think of...

Good luck!

Oldiebutgoodie

Natkat, BSN, MSN, RN · Oct 13, 2007

In my clinical experience we started out with a few simple tasks. We did just three things at first

- do an assessment

- look up the meds

- find the doctor's order for the meds the patient is taking

That's it. Over time we were given more instructions.

The main thing you need to do is do what your instructor tells you to. If your instructor comes on the unit make sure you have everything done that you were told to do. Don't let your instructor find you sitting around. Once you have done the things you were told to do, do things that you can do or have been checked off on - take vitals, change bed linens, do Accu-Cheks, do mouth care.

Ask questions but time them well. If the nurse is doing 50 things at once, wait until things calm down. If it is something you need an answer for immediately and the nurse is busy, ask the charge nurse.

If you see something you feel is unsafe or irresponsible, don't confront the nurse. Tell your clinical instructor and have him/her handle it.

At the end of the day thank the nurse for allowing you to work with her. Thank your patient for letting you take care of them. Be polite. Be professional. Keep your opinions to yourself. Be a sponge and absorb as much as you can.

Best of luck and have fun. You'll be nervous at first and that's okay. We all started out there and survived.

Riseupandnurse · Oct 13, 2007

Congratulations on starting clinicals! I have taught them for over ten years and I can tell you what I want from my students:

1. Be prepared! Know as much about your patient as you can. If you don't know what a medication is, look it up. If that fails, call pharmacy or use the Dr.s' PDR. If a lab or a diagnostic doesn't make sense, ask the instructor. Be curious---good instructors encourage this.

2. Don't expect to be entertained. Staff are busy, and so are instructors. If you find yourself hanging out in the hall with nothing to do, go and read another student's patient's chart or look something up that has something to do with your patient. Ask your nurse if there's anything you can do for them. We would like to be everywhere helping everyone at once, but that's just not possible.

3. Follow the rules!! If you are supposed to be there at 0700, show up at 0700, or at least call if something happens to make you late. Wear what you are supposed to wear, and cite your literature using the format you are told to use.

4. Be pleasant and friendly to everyone. That includes the instructor! If the instructor is trying to teach you something, try to learn without being defensive. That's why you have an instructor, because there are things you will need to learn. This goes double for prioritization. That's the hardest part of nursing.

5. Realize that nobody is perfect, certainly not the staff and the instructors. Don't be contemptuous when one of use makes a mistake or says something that is incorrect. Good instructors will not expect perfection from you either, and are looking to see that you have made every effort to do things correctly and safely. If you make a mistake, we are looking to make sure that you learn from it, and that you regret it.

6. Try to have a little fun with the patients and your fellow students when this is appropriate. Nursing can be enjoyable; this is why you are in the nursing program, right?

nyapa, RN · Oct 13, 2007

I forgot the most important things!

1. Check on your patients as soon as you are allotted them. Then consider your plan. There is nothing worse for the patient or you if you are halfway through your med round and get to a patient who is really ill - or worse

2. Check your charts before the previous shift leave, and before you leave. It takes five seconds to check and see if all medications have been given/signed for. You don't want to double up doses.

leslymill · Oct 13, 2007

3. If your patient has no heartbeat, your stethoscope chest piece may not be turned the right way. (Or the patient is dead.)

:roll

mcknis · Oct 13, 2007

About the above posting, make sure you have your stethoscope with you and any other things that may come in handy (hemostats, scissors, tape, alcohol wipes, pens(black and red), highlighters, penlight, etc.)

-Keep an eye out for interesting stuff (something will happen, just a matter of when)

-Always know your pt and what they should be looking like. If there are ANY changes, tell your instructor, RN, LPN, doc, somebody.

-Remember blood goes round and round, the chest rises and falls EQUALLY, and if there are any changes here...tell SOMEBODY!!!!

JUst hang in there and you will do fine. Like the other posters have said, go in as early as you can the day before if possible to learn as much about your pt as possible to get the whole picture.

Always remember...C=RN! Or, C=Degree!