Disappointing final clinical rotation

[WalnutCookies]

I'm in my last quarter of my BSN program. There are four weeks until graduation. During this rotation, we are supposed to be focusing on prioritization, organization, and time management. My university calls it an immersion;” it's supposed to be like an unpaid externship that the university sponsors. Our instructor has also emphasized more than once that this is our last chance to practice psychomotor skills as students. I'm in a group of less than ten students. There were a couple ICU spots, a few progressive care spots, a cath lab spot, an OR spot, and a PACU spot. I got the PACU spot. Here's my problem; this is the slow season here. Lots of retirees come in the winter, but it's 110° out right now. I don't have hardly any patients to work with. Yesterday, I was there for five hours waiting for a patient to get to my unit. I helped my nurses catch up with restocking and cleaning but then there was just a lot of waiting. I got to pick their brains about prioritization of patients, but didn't put much into practice. There were two patients there, for a little over an hour each. I'm not allowed to do femoral sheath pulls, so I just did assessments, blood draws, ECG lead applications, monitoring, etc. After the last patient left, my nurses were sent home for lack of work. How am I supposed to work on prioritization and delegation in a unit like this? I'm really struggling to see how this is going to prepare me to be a nurse. Sure, I am doing some skills, but this is hardly helping with organization or time management at all; the emphasis of this rotation. I'm going to work just as hard as I did for every other rotation, and I'm really trying not to get discouraged. I do have one advantage; I secured a new grad med/surg position in the sister hospital (on the same campus, but it's a separate facility) before this rotation started. The new grad orientation is 12 weeks. I got incredibly lucky to get that position, and I'm very grateful. However, I can't help but feel a little like I was put in this slow unit because I'm the only one in my class that already has a job waiting for me. I really want to practice my time management and organization skills before I start the orientation/new grad program. Everyone else seems to be having these awesome experiences in the ICU, progressive care, etc. I was hoping to progress as a nurse, not sit in a corner doing homework and restocking drawers. Am I expecting too much from my last clinical rotation? Am I putting too much emphasis on it? I know it's up to me to get as much out of my clinical experiences as I want to, but I'm really struggling with it on this rotation.

[xxdiscoxxheaven]

I know this is a bummer! But realize that this is just another clinical...4 weeks as a student won't compare to your first year of nursing. You won't be behind! The 12 weeks of orientation you get at the hospital will be what you really need to get a jump in your learning. After all, you might have quite a bit of time between NCLEX and your start date! Finish up strong and we will see you on the other side!

[anh06005, MSN, APRN, NP]

PACU, OR, and cath lab are different beasts. You can get some cool stuff. Some action. Some coding patients. But considering you aren't dealing as much with 5 different patients with 5 different families with 2-3 pages of med lists each you may not get the full experience you may be looking for. These specialties are needed and awesome in their own rights and draw a lot of experienced nurses.

Even though it's slow and besides throwing marbles down stairwells hoping for a couple of ortho cases (please don't do this) take advantage of having down time as it sounds like you're already doing:

Ask the nurses questions about interesting cases they have had

Get familiar with equipment

Ask them about their past jobs and pros and cons

Ask them about "brain sheets" that help with organizing patient info when you DO have 5 patients on your own

Get VEEEERY familiar with your patients

Practice assessment skills constantly on patients OR the nurses (good way to get your flow down)

Look up meds patients are taking

Also you might bring up your concerns to your clinical instructor and ask for their suggestions. Maybe they can move you somewhere else if they didn't realize how slow it is this time of year. Who knows until you ask.

[windsurfer8, BSN, RN]

You are making a lot of assumptions and focusing on negative and not getting "what everyone else is getting"

There is no perfect clinical. They are not a class. There is no way to control some units busy and some not. You cannot experience everything in even the best clinical. Be appreciative the unit is allowing you to be there and do the best you can with the situation.

[WalnutCookies]

Thanks for the suggestions and encouragement, everyone. Aside from the marbles (haha), I'm pretty much doing all these other things. It's hard to get super familiar with a patient when they're only with me for an hour and coming out of sedation, but I'm trying. I already did talk to my instructor. She's totally aware of what's going on. All of the other student spots were already taken by my classmates. I talked to the nurse manager at the CVICU and she said that she'll see if she can squeeze me in somewhere on her unit next week, but that it my be difficult with the low census right now. I guess I just have to lower my expectations a little and keep pushing for more experiences.

PACU, OR, and cath lab are different beasts. You can get some cool stuff. Some action. Some coding patients. But considering you aren't dealing as much with 5 different patients with 5 different families with 2-3 pages of med lists each you may not get the full experience you may be looking for. These specialties are needed and awesome in their own rights and draw a lot of experienced nurses.

Even though it's slow and besides throwing marbles down stairwells hoping for a couple of ortho cases (please don't do this) take advantage of having down time as it sounds like you're already doing:

Ask the nurses questions about interesting cases they have had

Get familiar with equipment

Ask them about their past jobs and pros and cons

Ask them about "brain sheets" that help with organizing patient info when you DO have 5 patients on your own

Get VEEEERY familiar with your patients

Practice assessment skills constantly on patients OR the nurses (good way to get your flow down)

Look up meds patients are taking

Also you might bring up your concerns to your clinical instructor and ask for their suggestions. Maybe they can move you somewhere else if they didn't realize how slow it is this time of year. Who knows until you ask.

[anh06005, MSN, APRN, NP]

Thanks for the suggestions and encouragement, everyone. Aside from the marbles (haha), I'm pretty much doing all these other things. It's hard to get super familiar with a patient when they're only with me for an hour and coming out of sedation, but I'm trying. I already did talk to my instructor. She's totally aware of what's going on. All of the other student spots were already taken by my classmates. I talked to the nurse manager at the CVICU and she said that she'll see if she can squeeze me in somewhere on her unit next week, but that it my be difficult with the low census right now. I guess I just have to lower my expectations a little and keep pushing for more experiences.

And that's all you can really do! Unfortunately all units have slow times. Chances are it (PACU experience) won't contribute much to your med surg position you have waiting besides assessment and IV skills. At least you have some time to do some NCLEX study!!