I'm curious to know if other nursing students have had similar clinical experiences to my first one.
I am in my 5th week of my ADN program and our program focuses extensively on Nclex style questions and the theory aspect is very subpar. As far as our skills go we have only been validated on med admin, vitals, and basic wound care.
We arrive at the clinical site and our nurse instructor shows up and verifies our identities and brings us up to the IMC unit. We are each assigned a patient and told to wait outside of our patients door. Prior to this we have not received any other information from the school outside of just the clinical site and date/time. After waiting 10 minutes the instructor swings around the corner and asks what I am doing. I told her I was following instruction and waiting. It turns out the Nurse I was assigned to got report on the other end of the hallway and just went straight to the nurses station. So I missed report. Nice.
I then go ahead and introduce myself to my patient and he was an elderly man admitted for a pressure sore in his sacral area. He was really pleasant and remained asleep the majority of the time I was there. Since we were on the IMC all of the patients were hooked up to monitors so I didn't have to do much to get their vitals. I assisted with his medications and went to check on the other students. Our instructor then grabs me and tells me to give another patient a bath. No problem. Just one thing. I have never been taught how to give a bed bath. I mean it surely wasnt hard but this is my first clinical experience I dont know what I can and cant do. I tell my instructor and she gives me a really confused look and says "They haven't taught you basic patient care?" I understood her frustrations but she clearly wasn't communicating with the school.
She borderline throws me into a room with a patient on contact precautions (nice) and I awkwardly act like I know what I am doing until a tech visits and sees me struggling. She helps me out and I go on about my day. Fast forward 5 minutes and she sends me on a break. So I break with the other students and we talk about our day. The other students were working side by side with the nurses learning everything they are supposed to. My nurse was nowhere to be found at all in our hallway and I was mainly working with the instructor on random assignments all over the floor. After breaking I go back to my patients room and the wound care nurse is finished and is on her way out. My instructor walks by and asks if I got to see anything. I didn't and she basically said I should have come back sooner. Okay.
Two of the other students in my class were assigned to a patient who got rushed to surgery. They were allowed to assist and watch for a couple hours but then came back. Our instructor asked them if she got a chance to perform her head to toe assessment. In my head Im going (wha wha wha whaaaaa?). We havent been taught how to do that. So they of course say no. Our instructor became so furious she grabbed them put them in a conference room and started yelling. These poor girls came out crying and I was just frozen because I knew I was in the exact same boat. So I go back to my patients room to try to basically get a general assessment but when I show up his wife had woken him up to feed and she told me he needed some time so I left. At this point our instructor gives us some papers that have body systems on there. Greaaaaat. This is our assessment form. She tells us to try to get as much patient info as possible. But there is biographical information on there like birthday and religion etc. I ask her if I can see the patients chart. She laughed and said "This is to test YOUR assessment skills, not your nurses." So I go back into my patients room and he is fast asleep and I notice his respirations dropped from 20 all the way down to 5 when I was last in there. I go see the nurse and she rushes in to see what's going on. I am then grabbed by my instructor and assigned to watch a procedure and fast forward 30 more minutes of random assignments I am told to give report on my patient and provide my assessment notes. This lady cut me off on every body system and told me I clearly didn't know what an assessment was. I told her I very much did not because we havent been taught that. She got snippy and said "Well what dooooo yall know?!". We all just kind of looked at each other and she said "Clearly not enough. I don't know how you're expected to pass this clinical if your docucare is submitted the same as your assessment notes here." She then tells us to leave and we all just kind of remain quiet until we get to our cars. It wasn't the smells, or the blood, or the wounds, or any of that which got me. But the embarrassment of being put there without any experience or information and being completely disorganized and rushed literally brought me to tears when I got in my car. So I'm not having any sort of existential crisis about this. I know nursing is hard. But I wanted to know if everyones program throws them to the wolves like that or if it was just us?
Our school is one of the top tier schools in my state for their NCLEX passing rate. It's almost 100 percent.
It is obviously one of those schols that say "you will learn clinical skills when you become a nurse." so, all the students pass NCLEX, but are clueless when they get to their first job and struggle because they don't have the basic clinical skills. That is why your clinical instructor was frustrated.
if school focuses too much on test part just get with friends and watch either youtube or skills videos that probably come with one of your text books and practice on each other
school prob focuses too much on what looks good on paper (high pass rates) vs qualitative hands on skills to make the school itself look good
We have to get validated on everything in order to do it at clinical.... sounds like your school doesn't do that!!! Speak to the dean before they make you look incompetent!
Does your clinical instructor have no connection at all to your nursing program? My clinical instructor is actually one of my teachers, and she absolutely knows 100% what I've been taught and what I haven't. I didn't realize until now that that's something to be grateful for. Some of the other clinical instructors in my program aren't professors, but they know our program well.
Also, we've been doing head-to-toe assessment since the first couple of weeks--our program is based around it. We have a high NCLEX number, too--it doesn't have to be one or the other. Definitely look at videos to make up for what's lacking in your program. My school doesn't make many of our own videos, but there are plenty of schools that do! And they're all free on Youtube...
While not your fault, it is rather concerning a head to toe assessment was not one of the skills you were made to check off on in the very first few weeks of nursing school. How are you supposed to assess if it is proper to administer meds or do anything with a patient without doing a head to toe first?
Clearly your clinical instructor was frustrated and I can see why, granted he/she shouldn't have directed it at you guys. But, had I been her, I would've been frustrated. This clinical for you guys was not fun but a lot of it is because your school failed to prepare you ahead of time for some basics. I'm sure they are eventually planning to teach it, it's just a disservice this was not one of the first things you learned going into clinical.
As for what you should do, talk to your school instructor and possibly ask if he/she can communicate with clinical instructor your clinical expectations. I wouldn't go into that conversation bashing your clinical instructor but communicate there was perhaps some frustration on both sides, keep it light.
I am not that surprised that your clinical instructor doesn't communicate well with the school. That seems like a common issue for nursing schools across the board. They are adjunct faculty and sometimes they don't receive the best information, and sometimes they disagree with what the school wants them to do with the students. It's frustrating, but unfortunately common. Also, some clinical instructors can be really moody for whatever reason. Some of them are amazing and nurturing, and some of them use military-like tactic to try to get students to fall in line. Again, frustrating but unfortunately not uncommon.
One thing that you need to know is that you should never be learning directly from the floor nurse and following them around. That is the instructor's job. They take over the care of the patient with you. The floor nurse, while likely capable of teaching, is not being paid to teach students. Any instructor that asks students to follow the floor nurse is acting inappropriately. They are the ones that have been hired for a teaching position, not the floor nurse. Sometimes the floor nurse may offer to teach you something, but that is just gravy.
Lastly, I literally can not believe your school "checked you off" on med pass when you haven't learned the 6 rights. That is... I just don't even know. What exactly did they check you off on? That pretty much is what med pass is all about. And yeah, completely abnormal to not learn head to toe assessment before med pass. You need to assess your patient before you pass meds.
Our school is one of the top tier schools in my state for their NCLEX passing rate. It's almost 100 percent. However our program focuses primarily on critical thinking tests and problem solving questions rather than practical skills. Head to toe assessments are our last validations after NG tubes. I think it is ridiculous.
Your school's curriculum sounds fine. That's probably not the problem. But your clinical instructor should know what the curriculum is and be prepared to plan and supervise your clinical experience in light of that curriculum.
We practiced head to toe assessments in the lab on a mannequin and then did it our very first day of clinical. Sounds like your school has a serious disconnect between class and clinical. The right hand doesn't know what the left hand is doing. How are you guys giving meds if you don't know about the 5+1 "rights?" That's crazy. I would make sure you tell the class professors how pissed off the clinical teacher was-- what she said and how she said it.
We also have a clinical binder for the whole semester with each day broken down. So I always look ahead to make sure I know what is going on before I show up. You don't have anything like that? If you don't---- ask your clinical instructor what you are doing next week.
Lastly, it's not your fault, but your group made a bad first impression on her-- so don't make her mad any more if you can help it!
@neonn965 For our Med Admin validation we essentially just demonstrated that we were able to properly draw up and administer different types of injections.
@maggieellis Our clinical instructor at this hospital has never been on campus to do anything directly with the students. We have another instructor at a different facility who assisted with our labs and validations but I have yet to have a clinical with her yet. She anticipated us to be mostly self functioning like she was in her program.
Our school is one of the top tier schools in my state for their NCLEX passing rate. It's almost 100 percent. However our program focuses primarily on critical thinking tests and problem solving questions rather than practical skills. Head to toe assessments are our last validations after NG tubes. I think it is ridiculous.
NCLEX pass rates near 100%. These numbers are based on the students that actually graduate from the program. If they fail the clinical they will either have to repeat it or get dropped from the program. I wonder how many students enroll with this school and make it to graduation. Average with many good schools is about 50% from start to finish.
I'm hoping this isn't everyone's experience for beginning clinicals. As for the bed bath thing, I remember a time when we had a week of clinicals in a nursing home to learn how to take care of total care patients before moving on to assessment skills, meds, etc. maybe it's time to go back to basics first.
NICU Guy, BSN, RN
4,161 Posts
It is obviously one of those schols that say "you will learn clinical skills when you become a nurse." so, all the students pass NCLEX, but are clueless when they get to their first job and struggle because they don't have the basic clinical skills. That is why your clinical instructor was frustrated.