Feeling lost during clinicals

manofcare · Feb 29, 2008

Trust me the days of having nothing to do will NOT last. I'm in my fourth semester and they slam us with pt care. Four pts and all meds, plus ADLs etc. My suggestion is to learn to manage your time and not fib on your paperwork. When you start, you are given one pt and all of the responsibilities with that pt for the clinical day. The health hx and assessment is from head to toe, and all freckles in between. They are trying to teach you to assess. Document and critically think. The further you go, the more narrow you get in your assessment and your true focus in on the specific problems at hand. Not how little Johhny felt about not having saucers to set his tea cup on as a child. They are trying to show you the big picture of looking at the pt, then it gets more focused as you move on. With multiple pts you have little time to spend doing a true head to toe assessment. Your assessment should be from about 3-5 minutes on the first contact in the morning. Chart only what you see. When you first walk into the room, talk to your pt. If they watch you move around the room, and respond to what you are saying, you have a good start on a neuro exam. Do they have an IV? Do they have O2? How much? How are they lying in bed? Relaxed or fetal position? Do they sound wet when they breath? On charts, you'll get better. Most have tabs at the bottom. Labs are usually one. H&P is loaded with good information on their hx and physical. I prefer to look at the most current MAR. But yesterdays is in the chart under MEDS. The cover sheet has information of the pt as far as who is paying the bills. Their primary contact. Dr orders have the most current orders, of coorifice you need someone to decipher the chicken scatching of some Docs. If you look at orders you can find out what tx are going to be done for the day. Wooohooo, start IVs, foleys, in and outs for residuals, drop NG tubes, fecal disempaction. Did I say disempaction? Tall gloves and take off your watch:) You'll get the hang of it. Now let me give you the best advice that I think any nursing student should hear.

Your preceptor works for a living, he or she is not playing nurse. Tell them you will do whatever you can to help them for the clinical day. That you do not mind doing anything you can to help. Then do it. Grab that water pitcher as she walks by and take it to the room. Help with the giant code brown. This is what you get in return.

Respect- and any cool procedure that comes along in your scope of practice. See where I am going with this? A little sweat on your part gets you this cool inside line with the staff. Not only that, do you think your instructors talk with the floor nurses? Duh.

BeenThereDoneThat74, MSN, RN · Feb 29, 2008

I'm in my 2nd semester now. And I've noticed that during clinicals, a lot of times I just find myself feeling...idle. It seems like I never really have enough to actually do. And when I am doing something - such as an assessment/history/exam/etc, I often find myself sliding by...making things up, or guessing, just to get it over with. A lot of times I feel like I'm doing the patient far more harm than good by having to ask them 10 zillion questions. Especially when they are tired and just want to rest, which seems to be most of the time. The only time that I feel that I'm actually being useful is when I'm giving a shot (which I've only done twice so far), measuring output, or doing routine vitals. And it seems like I only spend about 3% or so of clinical time actually doing things like that. Which, so far, I find to be rather odd, because I've always been told that something like 75% of nursing time is spent giving meds - and I'm barely even doing any of that!
I'm also feeling a lost when it comes to finding things in the charts. Usually it seems that my instructor is busy with 50 other things all at once, so I hate to bother him/her by asking something so simple like "Where can I find the medical diagnosis?" Plus, everyone else in my group always seems so confident and chipper, just breezing through the charts like a pro. So I feel too stupid and embarassed to ask a classmate, or one of the floor nurses, for that matter.
I've never had an instructor say that I'm doing anything wrong. I've always gotten good or mostly good feedback from my assessments/care plans/comprehensives/etc. But I honestly don't feel like I'm learning anything.
Anyone else ever feel this way?

Okay, I'll try to give you some insight from my perspective. basically, what I tell my students when they feel the same way (yes, you're not the only one who feels that way).

There seems to be no way around convincing students that clinical does not revolve around giving meds (despite the fact that it seems like that is all nurses do, as you mentioned). Nursing is not all about giving meds!!! A colleaugue if mine recently said this (she used this line for her students). When a patient is asked, "what makes someone a good nurse", is the patient's reply ever "She gives good meds"!!!! As an instructor I look way beyond the med administration portion of the day to assess who is competent.

If your instructor is anything like mine, the bulk of the shift is spent passing meds with the students who are selected that day. Trust me, I can't stand that feeling of the students feeling like i am not paying attention to them if they are not giving meds. It is the nature of the beast. As you progress through the semesters, all of you will get down the process of getting your meds ready, comparing orders to MARs and the actual process, and by the time you are in the 3rd and 4th semester, you will be doing it much more proficiently, and with more than one patient. It will come, but it takes time.

Now, as far as what you are actually doing (which you feel like is nothing)

: You have all the time in the world to assess one patient, so take use time to your advantage. There is no reason you have to make things up, or guess what your findings are. If you have 'nothing else to do' why are you trying to get it over with. If you have a fear of being with the patient, then you should spend as much time as you can with the ones who are willing to cooperate with you. You are NOT doing them any harm, you are learning!! Learn to get yourself organized when you are assessing, whatever approach works for you. A head to toe approach is always a good way. There are so many things you can assess without them even realizing you are doing it. Look at your patients diagnosis, and think about that body system. Think of everything within that system that is assess-able.... don't leave any stone unturned!!

And ask your peers!!! I look at my groups and love the way most of them work together. I keep stressing the importance of that, because even when you are an RN, you will not know everything, and will ask your peers for their opinions (looking at an IV site, not hearing the air when checking for placement, and many other things). Do NOT be ashamed, chances are they have questions they would like to run by their peers as well.

And yes, by all means, ask your instructor if you are unsure of something!! She may ask you to wait until meds have been passed, in which case you may need to remind her ( I am guilty of forgetting and 'not hearing' things when i am focused on getting meds done, and need to be reminded :uhoh21:).

Wicked Wahine · Feb 29, 2008

I'm in my second semester too and some days I feel pretty lost too. You really need to get over being too shy to ask fellow students, other RNs and especially your clinical instructor questions. You're there on your dime and your time for your education, learn as much as you can during those clinical days! Also, spend the time on actually performing all of those assessments that you're documenting on. When you're done with that and passing morning meds, you can do skin care and ROM exercises or educating on using the incentive spirometer correctly or whatever. Honestly, in my (albeit limited) experience, most patients actually appreciate all the extra care and if they're really sick, a good bed bath and skin care can really make a big difference. Just make sure that your attitude is that the skills you're performing are for the good of the patient, not that you're worried about bothering them.

Another thing I try to do is to keep an eye out for anything interesting going on and if I find something, I ask if I can observe. Most of the time, it's fine and you can get to see a lot of cool stuff that you might otherwise miss. I like to catch the wound care nurses when they're making their rounds, because that's never dull!

Hang in there!

future L&Dnurse · Feb 29, 2008

I would be surprised if anyone here has not felt that way at least one day of nursing school.

I would spend more time with your patients. Get to know them, ask them those questions, ask them if they'll tell you about their history of whatever illness they've got, since you are still learning. There are an awful lot of lonely people in the hospital, and giving someone an ear to talk to is sometimes the very best treatment you can give. Offer to help nurses. If someone else's patient is discharged, help the techs clean the room. They will appreciate it, and will remember. Make sure every nurse on the floor knows that (insert some nursing skill here) is something you really want to try/practice/see, and if any cool or interesting (or even mundane and routine) procedure needs to be done, you want to do it.

And if all else fails, ask to take on a second (or third, or whatever) patient.

MySimplePlan · Feb 29, 2008

A lot of times I feel like I'm doing the patient far more harm than good by having to ask them 10 zillion questions. Especially when they are tired and just want to rest, which seems to be most of the time. Anyone else ever feel this way?

I have found that most patients are kind, and accomodate you as much as they can. They also are flattered by the attention, and don't really mind all the questions as much as you might think they do.

A little humor goes a long way - remind them that you might be in and out with questions. Find a funny way to say it. Their world has become very small in that bed.....you're a fun distraction from a monotonous day, with all your comments and questions about their favorite subject - themselves.

If they get grumpy with you, well, you'll have to learn to deal with that eventually anyway, so deal with it now. Kindly.

As far as hunting for the charted items, go through the sucker page by page by maddening page. You'll find it eventually. You say you have tons of time....so do it. It's all there....somewhere.

And finally, please don't make stuff up. It's like crack - a very easy habit to develop. You'll get caught eventually, some way, and it won't be pretty. Just don't do it. As nursing students, we are supposed to be firming up our integrity. It's hard sometimes, but if you leave yourself no negotiation on this point, honesty becomes your foundation of everything that you do.

Something that always guides me....imagine that it's your mom or your grandpa in that bed. Let that scenario guide your care.

Good luck. Work hard - you will be fine.

Jedi of Zen · Mar 6, 2008

And finally, please don't make stuff up. It's like crack - a very easy habit to develop. You'll get caught eventually, some way, and it won't be pretty. Just don't do it. As nursing students, we are supposed to be firming up our integrity. It's hard sometimes, but if you leave yourself no negotiation on this point, honesty becomes your foundation of everything that you do.

Yeah. There was a nurse working on my clinical floor last week who happened to be a graduate of my school. She was giving some general advice to a group of us students at one point. And she actually encouraged us to just make things up if we have to when we're doing our daily assessments. I would chalk that up to burnout on her part, but she's only been working for 2 years...

angelchick · Mar 7, 2008

Feeling lost during clinicals... Oh I so hear you! There seems to be a "them" & "us" attitude when it comes to RN's and student nurses, this has been my experience anyway. I often have heard Rn's say "we did it the hard way", etc etc, but a helping hand never went astray!

I know when I have turned up for clinicals, all motivated, willing to help with Anything, and have been ignored, now I know and can hear some RN's saying we are working and busy etc, but when it comes to preceptors, thats different, they are there to mentor the student, to encourage, to guide. I know some of the girls in my class had fabulous preceptors, and had wonderful experiences on their practicums, for me it was a total nightmare, I believe because of the way I was treated by my preceptor. I feel for all you nursing students who experience this, but don't give up!! I have continued and just hope my next experience is better. It's also given me insight, and strength that I didn't have. I know that when I am a RN in a year's time that I will definitely remember what is was like being a student nurse, and endeavour to guide them on their journey.