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Dear Nursing Student

Updated | Published

Specializes in ER, Critical Care, Paramedicine. Has 18 years experience.

How can I succeed in Clinicals?

I am your soon-to-be instructor. Here are my golden rules to my students. Take what you like. Discard the rest. But understand why each is important. Apply them and perhaps you will make the most of our 12 short weeks together.

Dear Nursing Student

Dear clinical student,

I am your soon-to-be instructor. Know that I love this profession and have dedicated my life to it and to my patients. I consider this profession to be a calling. I did not come to this profession for money, for prestige, or for the title. I came to it for the love of caring for people at their worse. Along the way I discovered that I love to teach the next generation this love as well, while at the same time instilling in you all the importance of taking this seriously, understanding that people live or die by your decision.

Nursing today is about much more than turning a patient and washing them (although I seriously doubt it was ever about only this, despite what the movies would have you think). Nursing is about understanding the medical and nursing diagnosis, medication recognition and administration, symptom management, pathophysiology, procedures, and most importantly how the nursing process fits into all of this. Is it a daunting task for us to teach all of this to you in 12 weeks, yet somehow we are expected too.

I ask for your help in all of this. Some things are basic. Show up on time. Come in uniform. Make sure it is washed and pressed. Look your best. Remove your piercings and cover your tattoo's. Wash your hands before and after entering a patient's room. Imagine your grandmother in the hospital and the nurse comes in with a nose ring or a tattoo. Or doesn't wash their hands. Or is unclean. Would you want that person caring for your family? Furthermore, come awake, with passion and motivation to learn. I, like you, have a personal life. However, once we come through those doors to the unit, all of that has to be put aside and we must give all we have to caring for our patients. If we don't, who will?

Furthermore, we challenge you mentally not to show you how much we know, but to stress how much you need to know. It is not enough to report a vital sign. You must be able to tell me the normal ranges, which ones are abnormal, and most importantly why. If you cannot, what good does that do your patient? It is not enough to know that a lab value is abnormal. If you cannot tell me why your post-op patient has a low hemoglobin, what good does that do your patient?

It is certainly not enough to tell me the patient has a history of diabetes. You must tell me why it is so vitally important to understand the pathophysiology of hyperglycemia (high blood sugar) and how it affects the healing process, how it affects the ability of the body to fight infection, and the most accurate way to treat it. If you cannot, your patient will suffer.

To prepare for clinical is not easy. I emphasize that it takes a long time to write a care plan, and that you think it may not be as important as studying for that exam coming up. I understand that each instructor grades your papers differently, and that it feels unfair that you must change and conform to what each instructor wants. However, what you don't understand is that nursing is an ever-changing profession. Each patient is unique, and your ability to care for them needs to change for each patient you see. Some will love you, some will loathe you. It is not personal; they are patients who need different things, much like we are as your instructors. You ability to adapt to out of control situations and dangerous scenarios will define you and your career, not your ability to complain about the amount of work you have.

Golden Rules For Students

Take what you like. Discard the rest. But understand why each is important. Apply them and perhaps you will make the most of our 12 short weeks together.

  1. Come prepared and ready to work.
  2. Your hygiene and appearance means everything to your patients.
  3. If you haven't spent 8 hours on your care plan it is likely incomplete. Coordinate the care plan. Link the pathophysiology, labs, and nursing diagnosis. Show us you understand how they are all related. If you don't know, say it. but give an educated guess that shows us you are trying. I give just as much value to trying as I do to getting it correct.
  4. If you know your patient has a foley catheter, nasogastric tube, chest tube, etc... look up and prepare for how to care for those. Print out the care from the book. Include it on your care plan. make an effort. Saying I don't know to an instructor tells us you didn't care enough to look it up.
  5. Know the 5 rights of medication administration in and out. Be ready to tell them to me during med pass. know your medications. Write down the important information and be ready to discuss it at the pyxis, in the room, in the nursing station.
  6. It is never personal. remember that your patients are there to get better, not provide you with an opportunity to learn. That is a gift that can quickly be taken away by your attitude.
  7. Watch what you say in the hallway and the volume of your voice. sound carries. your patient does not care about your lunch, your day, how mean your instructor is.
  8. If your instructor provides constructive criticism to you, do not take it personal. listen to what they are saying and improve. show them you can internalize criticism and get better.
  9. Love your profession. if you are in it for anything except caring for patients, leave now. If you are in it for the money, leave even faster.
  10. Love nursing. every day. take every opportunity to improve your practice and the profession. This is your shot to make a difference in a world where for many it is difficult to even go to work each day. don't sell yourself short, you are about to enter the most rewarding profession there is.
  11. Smile, the hardest part was getting in.

Nurse Practitioner

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89 Comment(s)

RhodyGirl, RN

Specializes in Med/Surg.

Holy COW! If I spent 8 hours doing a careplan, I'd never get any sleep. Then you'd have a cranky, unsafe nursing student.

I agree with much that is in your post, and I understand where you're coming from.

I take nursing school seriously, get good grades, and work wonderfully with patients.....but I do need my sleep! And 8 hours on careplans alone is pretty unrealistic. :eek:

marty6001, EdD, EMT-P, APRN

Specializes in ER, Critical Care, Paramedicine. Has 18 years experience.

The care plan format we use includes a pathophysiology section. 8 hours includes all of the research from the chart, the online reports, labs, xrays, etc. The research of the patho and diangosis of the patient. Writing the care plan including the nursing diagnosis (2), and the weekly journal. :)

RhodyGirl, RN

Specializes in Med/Surg.

marty6001 said:
The care plan format we use includes a pathophysiology section. 8 hours includes all of the research from the chart, the online reports, labs, xrays, etc. The research of the patho and diangosis of the patient. Writing the care plan including the nursing diagnosis (2), and the weekly journal. 🙂

Thanks for clarifying this. Do your students take two clinicals per semester? That's how my program is, and I'm just thinking that doing all of the above twice per week would be awfully exhausting. We often don't get our patient assignments until after 5 pm, and then still have to drive home, scarf down something to eat, do a Care Plan/prep, and then get up at 5 AM.

marty6001, EdD, EMT-P, APRN

Specializes in ER, Critical Care, Paramedicine. Has 18 years experience.

Its one care plan per week for the entire semester... The 8 hours of course lessens over time as students learn how to navigate the literature, and I give them a week to write them and email them. So they have from the minute they get their assignment of Tuesday until the following Tuesday at 3pm.. But yes, its expected each week to have this information... I think too many folks underappreciate the care plan, if used correctly they are invaluable.

313RN, BSN, RN

Specializes in Neuro ICU.

I was pretty good with most of the post, but am concerned a little with the following.

marty6001 said:

8. if your instructor yells at you, do not take it personal. listen to what they are saying and improve. show them you can internalize criticism and get better.

I hope that "Yelling" is a figure of speech.

One of the things I've noticed is that nursing schools turn out nurses. What they fail to do (and to be fair it would add a year or more to school otherwise) and more importantly what hospitals often fail to do is develop leaders. As a profession we need to remedy this.

Instructors are first and foremost leaders, and leaders who yell aren't usually good leaders.

A good leader develops, coaches and motivates. Most people are willing to be lead, but unwilling to be driven. Leaders don't criticize, they identify areas where improvement can be made, offer suggestions and plans of action and sets simple, measurable, and achievable goals for the future. The leader reassures the (employee, nurse, student) of their faith in that person and their inate goodness, humanity and their ability to improve and overcome whatever issues that've been identified.

They don't berate, belittle, intimidate or threaten. Ever.

In my experience, a good leader talks about a time when he or she faced a simialr problem, how his or her leader dealt with them, and assures their (employee, nurse, student) that if the leader could learn and grow from the expereience then they're absolutely certain the (employee, nurse, student) can too. They build up, they praise and most importantly, they lead.

I really hope you're a leader too.

marty6001, EdD, EMT-P, APRN

Specializes in ER, Critical Care, Paramedicine. Has 18 years experience.

Wow, I didn't expect to take such a beating here.. LOL.. All I was trying to do was to tell students that they are not alone, that most of us out there teaching them were in their shoes as well, and that all we're trying to do is give them 10 years worth of education in 12 weeks in most cases.. I suppose I should have typed "if you are given constructive criticism, don't take it personally"... I'm really taken aback that the first 2 folks to comment have found fault. Sorry about that...

Edit: I fixed it as I really meant to say constructive criticism.. As all my students hopefully would say, I am passionate about this profession, probably to a fault. My wife and I both have given a good portion of our adult lives to advancing the profession where we can, and really love what we do!! Thanks for opening my eyes to that one, I re-read it and shuddered!! LOL

JaneyW

Specializes in Perinatal, Education. Has 9 years experience.

I liked the post. I also didn't like the "yell", but I am not a yeller. I liked the constructive criticism correction! :) I am a relatively new instructor and I think you have some very good points. I think care plans are part of the way we get student nurses to internalize their plans of care for their patients so that they can be effective care givers. I spend a lot of time tying that all together for my students and for most of them the light goes on after a time or two. Especially if they are actually applying themselves. That is because I get in there and ask them about interventions when they are there caring for their patients and assess if they have rationales when they are providing the care they are. I tell them that if you don't know why you are doing what you are doing then you need to find out before you go any further. You should be able to explain it to me and to the patient. If you have no plan of care you can spend a whole shift spinning your wheels and filling water pitchers and your patients will not improve.:twocents:

Wow! Thanks to all that have contributed.

To our leader.....I love your passion! You weren't beaten up. Don't take the criticism personally, just "internalize it". ;)

One of the things that drew me to nursing was the love for nurses. Big squishy hearts with thick skin! I am 53 and have been a leader most of my life. Adjusting to the varied leadership styles of all the instructors has been a surprising challenge! This exchange has helped a lot! Thank you.

I'm 7 months into my LVN studies and going on the floor next week. I will work the floor where my mother died last February after we all joined and kicked the gates of hell for her for 2 months. Many of the nurses that inspired me will be there. They will teach. I will learn. You can "lead from the bottom".

Only bullies attempt to intimidate me. I don't reward it. I'm an outstanding student ,a hard worker, and a loving person, but I'm not an enjoyable victim.

Thanks again to all of you who invest in all the little knot heads like me.

A New Start

Edited by A New Start
Text was doubled

fromtheseaRN, BSN, RN

Specializes in Emergency/Trauma.

Love it! our first care plan took 12 hours... now that we have the hang of it they are supposed to average about 8 hours, but we haven't had our second one yet. I'm curious to see a care plan that takes less than that. do they not include pathos and lab interpretations?

I wish all nursing instructors expressed that the reason behind the things they say and do is wanting students to be good nurses! :) It's hard to see that sometimes when you're starting clinicals for the first time and don't know a thing about nursing or the challenges it brings. And then there are some teachers that are just on a power trip! :p

avator288

Has 3 years experience.

On 3/15/2010 at 10:31 PM, 313RN said:

I was pretty good with most of the post, but am concerned a little with the following.

I hope that "Yelling" is a figure of speech.

One of the things I've noticed is that nursing schools turn out nurses. What they fail to do (and to be fair it would add a year or more to school otherwise) and more importantly what hospitals often fail to do is develop leaders. As a profession we need to remedy this.

Instructors are first and foremost leaders, and leaders who yell aren't usually good leaders.

A good leader develops, coaches and motivates. Most people are willing to be lead, but unwilling to be driven. Leaders don't criticize, they identify areas where improvement can be made, offer suggestions and plans of action and sets simple, measurable, and achievable goals for the future. The leader reassures the (employee, nurse, student) of their faith in that person and their inate goodness, humanity and their ability to improve and overcome whatever issues that've been identified.

They don't berate, belittle, intimidate or threaten. Ever.

In my experience, a good leader talks about a time when he or she faced a simialr problem, how his or her leader dealt with them, and assures their (employee, nurse, student) that if the leader could learn and grow from the expereience then they're absolutely certain the (employee, nurse, student) can too. They build up, they praise and most importantly, they lead.

I really hope you're a leader too.

I had one nursing instructor who was neither a leader nor someone who controlled her frustration and anxiety very well. I never forgot her and how disgusting she was. Luckily, all of my other clinical instructors were professionals in every sense of the word. Amen to great clinical instructors, you make an already difficult pursuit of a nursing degree, easier and calmer.

whichone'spink, BSN, RN

Has 3 years experience.

8 hours? I guess I beat that. I took 5 hours at the hospital to get all the patient data that I needed, such as H&P, pathophysiology, labs and dx, and medications. And then it took 3 1/2 hours to fill out the purpose of the patient's medications, cluster all abnormals, and finally come up with a nursing diagnosis and 5 interventions. Oh, and I went to the hospital well before everyone else did because I was unsure of whether I had to write down an inhaler drug that my patient was getting. All in all, got 4 hours of sleep. Somehow I didn't fall asleep throughout the day.

marty6001, EdD, EMT-P, APRN

Specializes in ER, Critical Care, Paramedicine. Has 18 years experience.

I thought 8 hours was conservative, but when someone said it was way too long I had to really go back and ask my students about it.. There is so much to learn and so little time to do it in, I can imagine it taking 12 plus hours easy..

Thanks for the comments... It's my first try at writing an article and I hope it was well taken... I took out the "yell" comment as it was a figure of speech... What it says now is what I think is the way it is, criticism is good, but belittling someone is just wrong!! 1100 plus views, I'm still hoping for more comments!!!

Eight hours for a care plan? I wish! I think the least amount of time I've spent on a care plan yet is about 14 hours (I'm in my 2nd semester in an ASN program). In addition to pathophys (on 3 different medical diagnoses, including s/sx, tests, medical tx and nursing tx for each one), lab results (with interpretation), and outcomes & interventions for 3 priority nursing diagnoses, our careplans include a complete rundown of Gordon's functional health patterns (with separate columns for objective and subjective info) for that patient along with any and all nursing diagnoses that may apply (this section alone usually runs about 8-10 pages), a page on discharge planning, complete info on all meds the patient is taking, and a page listing and explaining ALL treatments the patient receives. My careplans usually average about 25 pages (and get A's :D), but one of my classmates did one that was 50 pages long :eek:. Fortunately, we only have to do 2 careplans for the entire clinical and usually have a week to work on each one. I won't go so far as to say that I LIKE careplans, but I do understand why we have to do them -- all of that in-depth info really helps me understand what's going on with my patient, how to prioritize my care and just why I'm doing what I do -- all that 'critical thinking' stuff my instructors love to talk about. :nurse: Nursing school isn't easy, but for the sake of all of our future patients, I'm glad it's not!

oncnursemsn

Specializes in Education and oncology. Has 30 years experience.

Greetings- especially to "A New Start"! Wow!

I am humbled but still asking my students to be respectful. I do have huge expectations of my students- but I have grace. They must complete a care plan (concept map) but ask me for direction- of course. I love teaching and know that when my students are stressed- they don't learn. I try to challenge and not stress my kids. (Er, my adult learners.) Bottom line- they will be responsible and mature.

I do hear what you guys are saying when you talk about having a good care plan. It. shows ME AND my instructor if I'm just guessing. I don't want anyone guessing on me or one of mine.

I Love what one of my instructors says about nursing plans. "You can stop writing them when you don't need them."

Personally, I love research and problem solving. I know! It's weird. Students aren't supposed to like that kind of stuff. But then I like healing and mercy and other corny stuff like that too.

For you instructors out there-- One of you took me into confidence a while back and discussed a job opportunity with me. You said, "I don't know if I'm making a difference doing this. The students give me those blank stares when I lecture. It doesn't seem like they care!" I didn't give you advice because I've quit that for the most part. But I wanted to scream this! Hear me now!

Don't give up on us. We need you. We need you whether we know it, look like it, or act like it.

I've enjoyed watching the other "kids" as we've struggled through your tough assignments. I've watched them grow in their commitment and care. I was your top student. Some of them are passing me now. They look over to see how I'm reacting. They study me and call me a weird old man when I do more than you ask of me. Please don't quit. I remember and still use great lessons taught to me 35 years ago! They will too. There's nothing wrong with them that a little time won't cure.

Thank you. I know you can make a lot more money doing your old specialty. But don't quit on us little knot heads. Please.

A New Start

Lilmimrn

Has 5 years experience.

Thank you for your letter Marty! I am currently a nursing student in my second semester and I thoroughly enjoy coming on this website and reading about different things. As far as care plans go, at my college we research our patients for about an hour or so on Monday evenings. Then we have clinical Tuesdays & Wednesdays. Our reports, which consist of full pt. history including x-rays and and diagnostic testing, full assessment of patient, list of 10 prioritized nursing diagnosis', all meds researched and written, all abnormal labs defined and related to pt., one nursing diagnosis written out in full care plan form and I am sure a few others I am forgetting, are due on Thursday at noon. All of this also includes researching topics that you have not yet encountered and understanding them so that you are prepared at pre-conference at 6:45am on Tuesday morning after you researched 24 meds until 2am! Tell your students 7 days to hand in their reports is a gift ;) Thank all of you for your posts and keep them coming!!!