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!

[SubSippi]

Thank them before you leave. They probably won't notice if you don't, but it always feels good to be appreciated.

[ladedah1, BSN, RN]

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.

(3.) Watch what your nurse is doing.

If, suddenly, you begin to start thinking (A) Where is my preceptor… I can't ever find him / her,” (B) he / she is in a bad mood,” © my nurse seems really impatient with me,” (D) I think he / she is ignoring me,” … or any other response along the following lines… Take note of this. Chances are that your preceptor was forced” to have a student and is not a fan of having a sidekick for the day (or) your preceptor has been put off by something you've said or done (or) your personality (let's face it, not every gets along with everyone… I've had people want to punch me in the face for having an upbeat personality… I prefer to think that I eventually grow on people… like mold… or fungus… lol).

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!

Good Luck!!! :)

[ladedah1, BSN, RN]

Oops, see below

[ladedah1, BSN, RN]

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.

[icuRNmaggie, BSN, RN]

Be early or at least on time, and take notes because you WILL be giving report.

Take your adderal.

Put away that cell phone.

Do watch the monitor.

Never ignore any alarm of any kind.

I want to see a full assessment and a focused assessment every four hours.

Know the pts diagnosis and meds.

Update the care plan.

[WKShadowNP, DNP, APRN]

Be early or at least on time, and take notes because you WILL be giving report.

Take your adderal.

Put away that cell phone.

Do watch the monitor.

Never ignore any alarm of any kind.

I want to see a full assessment and a focused assessment every four hours.

Know the pts diagnosis and meds.

Update the care plan.

Maggie, I was scared in my ICU rotation and was ignorant of what the alarms meant. The nurse was so mad at me and threw her stuff on the desk because she perceived me as ignoring the alarms. I wish someone had told me what to listen for or what they meant. It would have gone a long way.

Thank you for your words, I'm glad they are here for someone to heed.

[Wave Watcher]

Don't have the attitude of...."He/she did it or said it or wore it then so can I". Follow policy, rules and standards of your nursing program....don't follow what other students may or may not do.

Good luck!!

[nurseprnRN, BSN, RN]

Never, never, never stand around in a group at the end of the hall talking.

Never, never, never carry your cell phone while you're on the floor. Leave it home or lock it up in a locker. I mean it. Cut the cord. If you need to look something up, ask your nurse where the manual or the binder or the book is for that in the nurses' station or how to do it on the floor computer; she may even take pity on you and give you the answer. :)

Do not ever let anybody find you sitting in the nursing lounge studying or doing homework. You study at home or in the library. In the hospital, you're there to learn a lot about patient care. You ought to have come prepared, and you can make notes for yourself to look up new stuff when you get home.

When your patient goes on a field trip to xray or GI lab or PT or anywhere, go along and soak up all you can. If your instructor gives you the chance to spend a day or two in a different place, TAKE IT. Fun places where you can learn a lot you can apply anywhere: cardiopulmonary rehab, diabetes clinic, GI lab, PACU, ortho clinic, inpatient psych or geripsych, shadowing the infection control nurse specialist or the wound/ostomy specialist ...

Write a nice thank you note to your preceptor or any nurse that is particularly helpful to you, and say exactly why. Make a copy for the nurse manager so s/he knows who's doing a good job at that. It's also reinforcing so that nurse will be good (or better) for students the next time.

Bring snacks for the whole staff (don't forget night shift!) on your last day.

Smile a lot!

[oldandintheway]

One thing to do: Approach clinical rotations as you would an extended job interview, be attentive and situationally aware. The person walking down the hall may be the DON or hiring manager, your school uniform will make you very visible and your demeanor and actions will be noted. Don't be overly solicitous, but if you are the student that is eager, helpful, and prepared, you will make a good impression. You may be surprised how often staff is asked if there is an outstanding student in each clinical group. Make yourself remarkable and you will be remembered.

[Dogen]

Bring snacks for the whole staff (don't forget night shift!) on your last day.

If any of my future preceptees are out there, feel free to bring snacks as often as you like.

[Jules A, MSN]

One thing to do: Approach clinical rotations as you would an extended job interview, be attentive and situationally aware. The person walking down the hall may be the DON or hiring manager, your school uniform will make you very visible and your demeanor and actions will be noted. Don't be overly solicitous, but if you are the student that is eager, helpful, and prepared, you will make a good impression. You may be surprised how often staff is asked if there is an outstanding student in each clinical group. Make yourself remarkable and you will be remembered.

This! I had a job offer before I even took my NCLEX based on a clinical rotation where I fit in with the team. I ended up working there for years and loved it.

[nursephillyphil, BSN, RN]

make sure you brush your teeth and trim your nails before coming in early so you can ask questions and show you want to be there by helping whenever appropriate or allowed.