Clinicals - What Not to Do?

[meganec17]

Hi all,

I am beginning my sophomore year of Nursing school, and will begin clinicals on a Med Surg unit in a few weeks. I was hoping to get some advice to what to do/what not to do in terms of being helpful, and not an annoyance to my nurse.

If you've worked with students, what did you appreciate them for? What annoyed you, or made you resent them? I'm hoping to "get on the nurses good side", so I can make my learning experience as positive as possible!

Thanks for your help!

[ambr46]

Don't take up the chairs at the nurses' station if you have no reason to be there. If you are assigned to a nurse, don't leave the unit without letting him/her know you'll be leaving. No gum chewing/cracking.

Be helpful. Don't just ask to do the "cool stuff." There's a lot you can learn about your patient from just mundane tasks.

This is excellent advice

[Larry3373]

Introduce yourself to everyone and offer to help.

Be approachable. I know clinicals can be stressful, but try to keep a smile on your face.

If in doubt ask someone, especially if it may cause harm to a patient. Be honest about your limitations.

Some practical advice: always wash your hands and put on gloves upon entering the room (hand sanitizer is fine too unless your hands look dirty, cdiff patients you must use soap and water; don't leave a patient on a bedpan too long; turn bed alarm on for all confused/unsteady patients; siderails up x2 or 3 (not 4) and bed in lowest position before walking out of room; call light and bedside table should be in reach at all times; educate constantly while in the room, even while performing other tasks; listen to the patient, but keep in mind if you have other tasks that need to be done; quickly report high/low blood sugars; glance at your patients labs and any new orders when you get there; if you're not sure if someone can get out of bed, or needs 2 person assist, ask the nurse before attempting to help them up (better they go in the bed than fall on the floor); write down your med pass times and if/when they will be getting insulin; always keep an eye on confused people, they can easily climb out the bed and fall on the floor; everybody gets nonskid socks; sit the head of bed up before giving pills, especially if they are elderly due to aspiration risk; look at when the next pain med is due before going into room (or get this in report); psy close attention to any signs on the door,especially those that may indicate contact/droplet/airborne precautions. if not sure how to donn PPE, ask; always perform your 5(some say 6) rights when giving meds, and make sure you know pertinent vital signs/labs before giving medications (don't give BP med usually for SBP less than 100, a med that affects pulse for pulse less than 60, last vanc trough before giving vancomycin, etc)always wash your hands before leaving a room, or use hand sanitizer.

That's all I can think of right now. Best wishes!

[aeris99]

I'm a senior nursing student. (9 months to go!)

Don't hide. Don't be above doing anything. Be polite to everyone, be respectful, be quiet!

If your group is standing around chatting, walk away, find something to do. If you notice your group doing something they shouldn't be doing, say something to them and then move yourself away

Answer call bells for everyone, not just your assigned patients.

Make friends with the LNA's, they know a ton, like where everything is.

If you have patient specific questions, look it up read the chart. Use the built in references for drug or procedure questions.

I keep a small book of index cards on a ring that I fill with reference info. Things I have looked up more than once go in there. I start a new one each semester and organize it by clinical type (Med-surg, psych, OB)

[FlyingScot, RN]

Don't ever say "but that's not the way they showed us in lab" to a seasoned nurse you got assigned to that day. If you have a question about something there are better ways to ask it. Like "that looks like a neat way to do that. How did you come up with it" which is the same as saying "what's your rationale" without the attitude. Don't roll your eyes. No seriously. Just don't.

[AspiringNurseMW]

This is an awesome time thread!

[tnicnat]

We get students 7 days a week, day and night shifts - the nurses on my floor tell me what not to do in clinicals:

Don't disappear doing other tasks, if the nurse your assigned to didn't ask you to do something, and you want to, lets say fill a patients water pitcher (which is great, believe me), let the nurse know. Especially if your doing it during a med pass - what is the first thing you learn in pharm and med administration - don't leave the meds to do another task.

Don't sit and text on your phone in the hall when the nurse and others are helping a patient, i.e. patient comes back on the floor from a procedure and they need lifting help to move the patient back in bed

When the nurse is charting, ask them if there is something you can be doing, or not do - make sure you ask cause each floor do things differently - i.e. lunch trays are being passed, but you need to get insulin for your diabetic patient so they can eat - you want to help pass trays which is great, but your nurse may say no cause after you got the CBG, you need to go get the insulin.

DO ask questions, why are we doing this, why aren't we doing that

MAKE sure you know the information on your patient, that is why you come in a day or two before to get the H&P, meds, clinical notes, etc. Know that your patient is diabetic, they are on a 2gmNA ADA diet, you have to do CBG's Q4 and have strict I&O's. Know they have a history of non compliance of meds and have an altered mental status. WHY? Cause you care, you want to learn, and the patient comes first.

Please don't think anything is below you - bedside nursing is what you are there for, you are not below feeding your patient, cleaning them up after a bowl movement, making sure they are straight in the bed (nothing worse that having a patient legs to the right and their torso to the left) When they eat and you see they are shaking when holding their fork, get a towel and cover their chest - if you don't someone will be changing that patients gown more than 3 times a day and changing linen. Think ahead, if the patient is incontinent, double chux - one straight, one long way and pull up between the legs so that when the patient does go to the bathroom your not changing linen 5x a day - especially if they are on lasix and lactulose.

Hope thats not too much :)

[Jules A, MSN]

These might seem like no brainers but every year I have to address these with at least one student:

1. Be on time-duh! seriously I don't care what great excuse you have do not be late

2. Wear your hair up and if you have the beautiful super long hair so many are sporting today make sure the ponytail is doubled over. Whats the point of a ponytail if there is a 3 foot length of hair hanging into everything or in psych providing an aggressive patient with a perfect handle which which to assault you.

3. No cleavage or super tight uniforms, yes it happens.

4. If you need to use your phone have the courtesy to go in the rest room or somewhere private because while I understand there are times you need to get an important message doing it out in the open is disrespectful.

5. Debriefing is one of my favorite parts of the day but don't come to post conference with a list of terrible nursing and tech actions you witnessed and the attitude that when you officially become Florence Nightingale you will be so much more compassionate. We can definitely learn from good and bad staff however as a student trust me there will be things you think are scandalous that in reality are the way things need to be done to get everything done.

[WKShadowNP, DNP, APRN]

But Jules! My hot-lips Hoolihan brand scrubs run small! I can't help it if my Ds get in the eyeline of my patient while I'm auscultating his lungs! And oops! My thong is showing. So sorry.

[WKShadowNP, DNP, APRN]

Don't take things personally. Your staff member as a guide may not have had a say in being partnered with you. Be eager to help but more eager to learn without being in the way. Help is always appreciated, but not if it takes away from what the nurse needs to do. Keep your ears and eyes open.

Ask questions. If you're one who asks a lot, write a list and then see what gets answered as the day goes by. What doesn't bring to your nurse at the end or you CI at the end.

Days ago written, I realize NOW that there are minor grammar mistakes, which makes me twitch. Sorry, folks. I can't seem to edit it now.

[ambr46]

When I was a nursing student, myself and a fellow student thought we would go above and beyond and fill every water pitcher on the floor. It completely backfired because we screwed up the I&O record for the whole shift and believe me we heard about it. So don't do that í ½í¸Œ

[WKShadowNP, DNP, APRN]

When I was a nursing student, myself and a fellow student thought we would go above and beyond and fill every water pitcher on the floor. It completely backfired because we screwed up the I&O record for the whole shift and believe me we heard about it. So don't do that ������

Or just communicate the desire to do so in order to inform the primary nurse/aid what is going on.

[Jules A, MSN]

But Jules! My hot-lips Hoolihan brand scrubs run small! I can't help it if my Ds get in the eyeline of my patient while I'm auscultating his lungs! And oops! My thong is showing. So sorry.

I forgot to add about the whole pattern panties through white scrubs or thong poking up around their shoulder blades when bending over! LOL, for the love of Pete who with even a speck of insight parades around a psych unit like that?