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.
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.
Come prepared and ready to work.
Your hygiene and appearance means everything to your patients.
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.
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.
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.
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.
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.
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.
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.
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.
Specializes in mental health, aged care/disability care.
I like the post!
As a student about to go on clinical placement, it's interesting to know what instructors are looking for.
Being in a different country though I'm confused about something - do your students have 12 weeks of classes or twelve weeks of clinical placement? And what sort of nurse is that?
In Australia we have 2 basic levels - an enrolled nurse and a registered nurse. The enrolled nurse completes 14 months class training and nine weeks in clinical placement. The registered nurse completes three years class training and I think it's 16 weeks clinical placement. They can both do further training after completing the original lot.
Seriously? Eight to twelve hours on a single care plan is just too much. There is no particular merit in time lost to mindless busy work.
There are excellent resources available that allow a fabulous care plan to be put together in much less time. This, in turn, allows time to actually think critically about the information. Yes, putting the care plan together does get the juices flowing, but looking up each factoid and handwriting them simply wastes your precious time. It is just as effective to read a completely pre-prepared care plan document for each NANDA and choose & adapt each part to fit your particular patient's needs. The process is still an exercise in critical thinking. I particularly like an Evolve resource, the online care plan constructor that comes with "Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care", by Ackley & Ladwig, from Elsevier.
For medication information, the Drugs section of Epocrates Online in an exceptional resource. The basic application is free, the medication information is broken out into categories making it a simple task to pull the information for your care plan, and the Diseases section is excellent as well...concise, complete, and also broken out into sections.
Being a well-rested nursing student/nurse is a good thing, and is not to be under estimated. Do a little research on sleep deprivation if you don't believe me.
Liked the letter, and I laughed at this part (not in a bad way). ?
There will come a day when all the patients are tattooed and have the tell-tale pinprick scars of youthful piercings. Just you wait and see....
There's no doubt. You're right. There WILL BE tattoos on the aged patients of the future. There's also no doubt they too will have their own socially acceptable and unacceptable opinions. But, the question is will there be young nurses scaring and provoking those (tattooed, but old and frail) patients? Or will there be humble young people willing to lay down their pride and their rights of expression for 8-12 hours and care for those that have lost much of the control in their lives?
I could be wrong. Marty correct me if I am, but what the instructors like him are saying to us is "It's about the patient." We can express our individuality in a hundred ways when we're off duty. I'm from the hippie generation, I understand and speak rebel very well. But when I chose to become a nurse, I gave up some of my rights in the interests of frail and injured strangers.
Think of your favorite old person in the whole world. Do you want anyone scaring or provoking them just so they can express themselves? No, you wouldn't do that. I'm sure you're going to make a great nurse and you'll do the right thing. Whatever that is.
Seriously? Eight to twelve hours on a single care plan is just too much. There is no particular merit in time lost to mindless busy work.
There are excellent resources available that allow a fabulous care plan to be put together in much less time. This, in turn, allows time to actually think critically about the information. Yes, putting the care plan together does get the juices flowing, but looking up each factoid and handwriting them simply wastes your precious time. It is just as effective to read a completely pre-prepared care plan document for each NANDA and choose & adapt each part to fit your particular patient's needs. The process is still an exercise in critical thinking. I particularly like an Evolve resource, the online care plan constructor that comes with “Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care”, by Ackley & Ladwig, from Elsevier.
For medication information, the Drugs section of Epocrates Online in an exceptional resource. The basic application is free, the medication information is broken out into categories making it a simple task to pull the information for your care plan, and the Diseases section is excellent as well...concise, complete, and also broken out into sections.
Being a well-rested nursing student/nurse is a good thing, and is not to be under estimated. Do a little research on sleep deprivation if you don't believe me.
I like the thinking here as long as it doesn't result in cookie cutter treatment, bad assessment skills, and thoughtless evaluation. I'll try it and see how it helps my thinking. Thank you. I used Excel in business for the same reasons. I'd rather work with the data than be fussing with the method all the time.
Congratulations on some good creative thinking. But let's all beware of going to sleep with our eyes open!
I guess my thinking is old fashioned when it comes to piercings, tattoo's etc in that if we are attempting to advance ourselves as a profession, we have to uphold ourselves to the highest level of professionalism to our patients... That being said, we all have the right to be individuals, and to exercise that in anyway we wish. I myself have tattoo's, but when I am in clinical, either working or teaching I wear a shirt that covers them in respect to my patients, my institution, and most importantly my profession...
As to the care plans, I still stick to the belief that as a student, researching the patient, gathering the data, and writing the plan should take 8 hours. Yes, I do add in the researching part. Doing a complete chart and online review, then going home and defining the terms and writing the plan should take a mininum of 8 hours... That's just me, but I will say that I've never received a bad score from a student and I expect this level of work from them all.
I am an EEN (Endorsed Enrolled Nurse) in Australia, and have just undertaken to upgrade to do my Registered Nursing through University. I'm an oldie too .. 48yo. My first placement is nothing short of a nightmare. I'M LUCKY .. I've got an ex-colleague I get to work with, but one of my fellow students is a naive 19yo, who has NO floor experience and doesn't know how do *decode* a taped handover and missed the hourly urine measures. She had a patient load dumped on her as her RN found students to be "a nuisance" and then got screamed at (yes, I heard this woman screaming at the students) for missing the measures.
Necessary? No. No amount of screaming is going to teach this young thing how to decode a taped handover (god bless bedside handovers). Thank the Lord I have an advantage in that way.
Then again, where some see me as a "useful student" cause I have floor experience, others see me as 'painful' because I've got experience and assume I'm a know-it-all (I'm not .. I do realise RN's are significantly more trained than EEN's on so many levels it's frightening).
so .. to my preceptor .. THANK YOU for knowing me, trusting me and teaching me the finer points .. to my fellow students preceptor .. retire or refuse. Making somebody cry on their first day is NOT the way to encourage somebody.
Wow, I have to admit that while in nursing school I would often have 20 page care plans that usually took 12 hours to complete (8 hours the night before my clinicals and 3-4 hours post clinical). Everything had to be in my own words and APA refrenced to a T.
I will also admit that the amount I slept while in nursing school was minimal as I had a heavy work load and much studying to do. The best advice I can give you is to slowly learn to be overworked and exhausted with a smile on your face and a skip in your step until you graduate. It eventually gets better, good luck.
WOW!- you guys have some intense care plans! Ours is (this quarter) 2 nursing diagnoses, one psychosocial and one physiological, with one goal each and 3 interventions each. We have to provide a rationale for the intervention. Our prep sheets are more time consuming than our care plans- those are where we have all the lab values and a progression of hospitalization.
We get to clinical, find our patients and go to work, so all of this is due the next week. Logistically, I'm glad we don't go in the night before to prep, but it does often mean you're presented with something it would have been better to have time to look up ahead of time.
There are excellent resources available that allow a fabulous care plan to be put together in much less time. This, in turn, allows time to actually think critically about the information. Yes, putting the care plan together does get the juices flowing, but looking up each factoid and handwriting them simply wastes your precious time. It is just as effective to read a completely pre-prepared care plan document for each NANDA and choose & adapt each part to fit your particular patient's needs.
Not for me! Tried it. Thanks for some new tools, but cut and past plans don't give me the personal investmentt I need to make the material stick.
Admittedly, I don't want to sprend 8 hrs for every 8 hrs I work on EACH patient I treat in the future! But for now the discovery process is important.
totally_nuts
85 Posts
I like the post!
As a student about to go on clinical placement, it's interesting to know what instructors are looking for.
Being in a different country though I'm confused about something - do your students have 12 weeks of classes or twelve weeks of clinical placement? And what sort of nurse is that?
In Australia we have 2 basic levels - an enrolled nurse and a registered nurse. The enrolled nurse completes 14 months class training and nine weeks in clinical placement. The registered nurse completes three years class training and I think it's 16 weeks clinical placement. They can both do further training after completing the original lot.
Nursing in the USA certainly sounds complicated!
Cheers
Chris