First clinical coming up! Some advice, please?

akulahawkRN, ADN, RN, EMT-P · Mar 17, 2014

I remember what it was like to be in your shoes. I am about to graduate in a couple of months and I can remember very clearly how it was when I was going to meet my first patient as a nursing student just a couple of years ago. It really is a bit nerve-racking when you don't know what to expect, and this was no different. I suspect that in about a week, before you go to your first clinical day, you will be oriented to the unit and their practices, as well as introduced to your scope of practice, if you haven't already been introduced to that. You will probably have a day of prep before you actually get to see the patient. Think of that day as a day of information gathering before you have to do something with it the following day. It's your day to be a detective!

On the day of clinical, you might possibly meet up with your instructor before you go to the floor. You will then likely get report from the nurse that you will be working with. Chances are highly likely that you will not be passing medications this early, so don't worry too much about that yet. You will probably end up getting a set of vital signs of your own, you'll need the practice, and you will probably start doing your own assessment, if they want you to do that as well. After you are done with that, you will probably write down the results and go over charting with your instructor at some point during the day so that you have an accurate depiction of what you found. Then they'll probably want you to do some ADL's or basic patient care stuff with the patient, such as giving a bed bath, feeding, or something similar. Trust me on this, you'll take forever to do these things because you'll be really slow at it, and that's OK. You're not going to be an expert at doing patient assessment. I'm certainly not an expert at it now, and I'm almost done with school. I'm a heck of a lot faster than I was a few semesters ago though! Don't worry about speeding up because as you get used to assessing patients, you'll naturally get faster at it. In a few semesters, you'll be amazed that you're able to effectively deal with a few patients, get a bunch of stuff done, and still have time (a little bit of it) for thinking ahead about what you're going to do next with your patients.

While you're in school, try to get as many different experiences as you can. Because you're a student, you'll probably be allowed the freedom to do many different things that you otherwise won't be able to do after you graduate. You won't get to say, "hey, my patient is going for this... can I go with the patient to watch?" I got to see some stents placed a couple weeks ago just because I had the opportunity and I was able to just go do it. I'm not saying you should do something and beg for forgiveness later, but should an opportunity pop up, be ready to contact your instructor quickly and see if you can do it.

Anyway, the point is, should you be nervous? Yes! I'd be worried if you weren't. Should you be so scared that freeze up and not be able to do anything? No. They won't just hand you the keys to the car (your RN license) without quite a bit of training.

As to what to bring? Well, make sure you're in uniform. Bring a penlight, stethoscope, some pens & pencils, a notepad, a clipboard if allowed, your prep sheets, and a willingness to learn. Dive right in and volunteer to do things. You're going to do them anyway at some point, so take initiative and get stuff done! That includes also asking your clinical instructor(s) about what they'd like you to bring that first day too. Chances are good that they have a very good idea about what you should have with you on your first day.

You're in for a very interesting ride from here on out! You can learn something from every patient you care for. Every one of them can teach you about some aspect of nursing. Just being able to establish a rapport with a patient can be something you learn from. Sometimes you won't be able to establish that rapport not matter what you do, and that's something you can learn from too.

Enjoy this time!

Here.I.Stand, BSN, RN · Mar 18, 2014

Hugs!! The first clinical is a little scary b/c it's so new, but also an exciting step in this journey.

Listen to report w/ your nurse if you can. If you'll step onto the floor after report is over already, ask the nurse for a quick one. Also find out what times the pt has appointments if any--diagnostics, PT/OT/ST etc. That way you can 1) observe and learn, and 2) plan your day (pt's bed bath, etc.) around them.

Introduce yourself to your pt. Recheck any abnormal VS from the a.m., or recheck a BP and apical pulse either way if he's going to be getting BP/rate control meds. If he has pictures or cards in his room, I like to ask about them. It's a great way to break the ice and establish rapport! Ask your pt what you or the nurse can do to help him feel more comfortable--does he have pain or nausea, does he need to change positions, get freshened up, lotion on dry skin? Do your head-to-toe assessment. During the bed bath is the right time to inspect skin. Give his meds w/ your instructor, if you are passing meds yet.

If you don't go the night before to read his chart (we did that when I was in school), do this sometime in the a.m. Get familiar w/ his history, course of present illness, meds, interdisciplinary notes.

Start thinking about your nursing dx and care planning. What independent interventions could benefit the pt? Non-pharmacological pain management (in addition to meds, not in place of them), dietary preferences, mucus membrane protection (dry hospital air, supplemental O2, NPO status, med side effects)? Would they benefit from chaplaincy support? Are they getting rest--if not, how can you help provide for an uninterrupted rest period during your shift?

Offer to help fellow students w/ their bed baths and transfers; if you need help, ask. Observe other disciplines such as PT/OT, case management work w/ your pt; ask questions when they are finished. Help pick up their room during down time; staff is very busy, and sometimes trays linger longer than they should, clutter accumulates on the tray tables. Ask your instructor if there are any good learning opportunities happening outside your pt's room. Always be on the lookout for learning opportunities!

Good Providence, but you will be fine. :yes:

Here.I.Stand, BSN, RN · Mar 18, 2014

Oh, I forgot labs! Look up their most recent labs. For any abnormals, look at their previous labs; are the abnormals new, old, trending up or down? Consider why they might be abnormal in light of their disease processes. If you're stuck, talk it out w/ your instructor.

Esme12, ASN, BSN, RN · Mar 18, 2014

Here are some student brain sheets made by another member Daytonite (RIP) to help organize your thoughts

critical thinking flow sheet for nursing students

student clinical report sheet for one patient

and some of mine collected over the years.

mtpmedsurg.doc

1 patient float.doc‎

5 pt. shift.doc‎

finalgraduateshiftreport.doc‎

horshiftsheet.doc‎

report sheet.doc‎

day sheet 2 doc.doc

northmississippi · Mar 22, 2014

You need a good game plan,

As soon as you find out who your pt is and room number,, get up the med list and put it in your database along with lab values...you won't get them all but it will be a state before you go get report at the shift change. Get report, find out the major problem that brought pt to hospital, then go tell your teacher what was in report. You may have time to do a few more meds on your database, but it really time go to meet your pt and tell him who you are and stuff. Do your morning head to toe assessment and put the info on a check off sheet and have one for each pt. You haven't done an assessment until you have checked abs for distention, the back and feet for edema, looked under band aides, and check pedal pulses. Look up youtube videos on assessment. Find at least two things you want to tell your nurse or teacher about the pt, such as pain scale or how a dressing looks. Don't assume the nurse knows they pain scale, etc. IF they have a need then you need to tell about it and do something about it. Now go put all this in your nurses notes. Now it's time to do bath/bed work if needed. Be sure to ask if they need to use bathroom, and if they slept ok, or need anything.

Now its time to get morning meds most likely. Get them going early because if you wait till nine, I guarantee you the teacher will be with another student or the meds will be missing from the cart and you will be late. Get meds out asap. have plenty of blue caps, alcohol wipes, and flushes with you if your doing anything with IV. Be sure you know what type of meds your teacher is letting you give and to what time of day. Get back to nurses notes and database asap. You will probably get an 8am vital signs, that is a good time to introduce your self and let the pt know what meds/tx is coming up. So do that, get your assessment, get your bed/bath and beyond done, get your meds out,,get your nurses notes/database done or at least started,, now its time to get a 12pm vitals then go to lunch...be sure to tell your teacher when you are on and off floor. check your meds and pt thru out the the day. This is the ongoing assessment and it will related to the main problem such as that dressing on their chest, mental change, and recheck feet. check them every two hours and put in your nurses notes that you did this check, and get them whatever they need and report anything to the nurse/teacher. The morning will be the busy time, the after noon will be more about getting your notes/database/care plan done. You will probably do one more med and 4pm vital signs, and if your lucky maybe you can do an dressing change or change a brief. Don't go overboard reading about the pt, once you know the main problem, about all you need to know from the charts are the meds, lab values, and treatments you may give, and whatever question your database has for you that you can look up. Be sure to ask the pt about what the plan is when they leave. Are they staying with family? Do they have someone who can help them? I love using those spiral bound "notes" to do care plans and see what to do to help the pt and what to look out for. The medsurg notes, and lab values notes are a must have. They will tell you what to look out for and how to treat, and the lab values one tells you not only normal values, but why they may be off. Then you will a care plan book or two and a skills book. I like betty ackley's book on care plans, and those green tabers books that have nursing dx and related to statements in the back. Most of all, be safe with your pt, be sterile, and do the ongoing assessment. work fast on the notes/database. If the pt goes home, all the records disappear off the computer and you won't be able to get your lab values and stuff for your database. So pick the pt that is staying and has the most wrong with them to care plans/database on. You need to read this about eight times

because this is exactly how your day will go on a hospital floor.

Nursing hurts, so get your feet and back strong and flexible, practice getting up early, like 445 am. Get a good breakfast like a chicken biscuit, vitamin, oj, and some tea., 12 hours with little sitting time is hard on you. Get some good shoes and maybe have some extra padding in them. I would say that a nurse needs to be in the shape of Jr. high basketball player at a minimum, and practice bending over and touching your toes and squatting down every night. A good game plan for the day is what you need, along with a fit back and feet. I wish someone had told me all this before I started.

And leave your cell phone alone. If you want to see a ****** teacher, let them catch you talking on a cell phone. It is a good idea to have your teachers number in your cell so you can call if your running late or need to catch them after the clinical before they get to their car after the clinical.

northmississippi · Mar 22, 2014

And always wear your gloves when handling your pt, even if they are packing up to go home. Nothing makes your day more than helping your pt pack and getting final vitals only to be walking out the door and someone is hanging a contact precaution sign on the door. With that said, when you are getting your morning lab values, check the wbc close and see if its high, which may mean they are infected with something. good luck, let us know how it went.

SaraMC · Mar 23, 2014

Thank you to all who left me some great advice and tips. I'm going to be reading this thread over and over until Tuesday! Lol