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!
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.
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)
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.
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.
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.
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
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?
I am a recent nursing graduate and have not yet had the opportunity to become a preceptor. So why give the advice? Well, let's just say that I have had a lot of (recent) experience as a student nurse and that I have an almost supernatural ability to combine both verbal and non-verbal output with my personal instincts... and voila! Excellent perception! ...ok, maybe it's just years of customer service... but still, it helps to know different personality types and related expectations, because all preceptors will expect something different of you (after all, we nurses are all unique and will not quite fall into cookie cutter form).
1.) Yes, it's true, don't take up space at the nurses' station; if you're doing something very important, ask permission.
As a student, there are times when you feel desperate to acquire the information… whether for care, a form, or your instructor (who will inevitably quiz you sometime within the next hour)... but as a nursing student, you are a second class citizen. There are real people working with real clients, judgments to make, and orders to fulfill... and while you are working with clients, too, it is not your job or license on the line. Be courteous and ask if the nurse hovering two feet away is in need of the computer you are using. Most often, you will be told "no" - but it eases your guilt and, quite possibly, the evil "stink eye" which is meant to imply "hello, you are a guest in MY house."
(2.) Know who wants your questions and who doesn't.
Some nurses love questions and, as a matter of fact, will consider you careless, arrogant, or less competent if you don't ask them anything. Conversely, if you ask a nurse too many questions and you start getting the distinct impression that they are annoyed, you probably need to tone it down a bit and get your answers elsewhere.
And keep in mind that you do have options when you and your preceptor are not meshing well: adjust your behavior, talk it out with your preceptor (professionally, of course, don't argue), or let your clinical instructor know (probably to be safe, let them know anyway).
Conversely, your preceptor may be supportively inquisitive (my personal favorite!) or even go to the extent of quizzing you – which may result in either a wonderfully informative rationale or a look it up, I'll ask you for the answer at the end of the day.†FYI: If the retort is more along the lines of a disgruntled you should already know this,†then refer to the paragraph above.
(4) Recognize a challenge.
My favorite clinical experience with a preceptor actually originated from a bad one. I was supposed to help prep a client for surgery (as indicated by my instructor) and was about to experience many firsts… well, my cosign effectively pushed me out of the way by jumping in and trying to do it all herself – leaving me both anxious to intervene and fearful to impede on an important and time-dependant process. Worse yet, she ignored every question that I asked, randomly disappeared so that I had to desperately (and continuously) seek her out (eek! If I lose her, I'll miss out on observing the surgery!), and set me up to fail when conveniently forgetting to mention the meaning of the lines on the floor (yep, turns out they meant PPE) and , when informing me, omitted one of the PPE requirements (fortunately I saw the additional box of supplies). Low and behold, I arrived in surgery on time and properly protected. My mouth dropped when she bent over backwards to teach me throughout the procedure… Here, stand on this stool to see better… did you know that this is for this and that is for that… touch this… try to do that…†As it turns out, she was an incredibly knowledgeable nurse… who only opened up to those students who proved themselves. Persistence counts!
(5) Be Courteous
If you stick to your nurse like glue, then make sure he / she sees you as a team. Let your cosign know what you would really like to accomplish and skills with which you would like more experience. If you are going into a client's room together, try to divide tasks to make it run smoother. Here's the thing: it is quite likely that your nurse already has an awful lot on his or her plate as it is… if you want to perform or observe a skill for the first time (with proper observation and instruction), it will sometimes go a long way if you help knock out some of the nurse's time demands. There is also a fine line here of which you need to be aware: It is good to be a member of a team and help accomplish tasks together (so that learning opportunities might be better utilized), but you are not a PCA / CNA. RN's are accustomed to delegating and it is not a stretch for them to want to do the harder stuff and (being understaffed) utilize you for basic care needs; your challenge is to remember that you are also there to practice new skills, including leadership and accountability… you are indeed accountable for your own learning.
I have lots more to add, but as you can see, this comment is beginning to look like a novel. Basically, my advice is to be open to adjusting your approach based on the situation you are given. Like many patient assignments, cosign / preceptor assignment is just as variable; you cannot plan out ahead of time one right way to do something… you must take into account everything you observe / perceive and go from there. Preceptors, like patients, are unique!
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?
LOL!
I once saw someone who apparently decided not to wear any underwear at all... When you bend over and there are several inches of crack, one might think that the shirt / pants gap breeze would become obvious. Apparently not. My goodness, I would choose flowered panties over none any day of the week.
Larry3373
281 Posts
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!