First Clinical. Where was yours?

guest042302019, BSN, RN · Mar 27, 2013

My first clinical was on a MED/TELE unit. There was a fair amount of cardiac, renal, pulmonary, and some GI stuff. Primarily, I would see CHF, pneumonia, and renal insufficiency/failure.

The first day of clinical can be a stressful period. There are people all over the place, moving quick, moving slow, in and out of rooms, and a lot of chatter. There are machines, wheelchairs, parades of families, people laughing/crying/yelling/etc.

There's you. Don't worry you shall prevail. I found my first few days to be exciting. I thought of myself as on the frontline of healthcare or like a superhero. Seriously. Aren't we though? Superheros helping people and saving people. It's invigorating.

This is your first clinical and the expectations won't be terribly high. You will not know everything now (or ever). Don't give yourself tooo hard of a time if you don't know the answer. If someone ask's you a question and you blank, whether that be family, patients, or instructors, your best answer is, "I don't know. BUT, I will find the answer for you." Music to the ears. No need to BS if you don't know. People appreciate honesty.

Personally, I greeted nearly everyone. Doctors, patients, nurses, janitors, CNAs, NAs, Respiratory people, Executives, families, etc, etc. There are reasons. Partly, I'm a talkative, friendly guy. As well as, you WILL be memorable. This is good for future job contacts or getting a job. Be polite. Use Mr/Mrs/Sir/Mam until told otherwise.

Also, have a list of things to do with times. Say your clinical is 6 hours and your arrive at 0600. It could go something like this.

0600-0645 Review of Patient chart (computer AND hard copy)

0645-0700 Introduce/Reintroduce/Greet yourself to your RN, CNAs, and patient/family

0700-0900 Assist with Medications/Breakfast/Morning ADLs/Physical Assessment

0900-1130 Assist RN/Volunteer with CNAs/Give more Meds prn

1130-1230 Lunch

1230-1300 Break time for you

1300-1430 Breath, Post-Conference

This is very tentative but you see how this would work. Get used to the schedule at the hospital and plan your day accordingly.

Also, say you have a list of Diagnoses for your patient.

PMH: Right sided Heart Failure, CHF, emphysema, COPD, life-long smoker, pneumonia, CAD, hyperlipidemia, Renal insufficiency, S3 gallop, PVCs

Admitting Diagnosis: CHF exacerbation, SOB

Have a tentative list of pertinent assessments for you to refer to pertaining to the diagnosis.

For instance:

VS

Heart rate, rhythm, quality

Aortic, pulmonic, tricupsid, mitral areas (if you want, you are going to be on a cardiac unit afterall)

Lung Sounds, Bilateral, anterior and posterior

Lung pattern, depth, quality

EKG strip (just the basics, youll get into harder stuff later)

Affect of Current Condition on ADLs and life

Presence of Edema?

LOC, orientation X3

Etc, Etc, Etc

Don't take every book under the sun. Have a book that summarizes nursing care in a clear, concise fashion. You probably won't have time to delve into your textbook. If you have time on your hands and is not break time, check your patient. If patient is good, volunteer yourself to RN and CNAs. There is always something to do. They appreciate the help and it makes you look good. :)

When you review the chart, it is tempting to take every piece of information and write it down. You don't need to necessarily to complete your patient care plans and clinical work. You'll soon see what is needed and not. Ahh, yes! Have a prepared sheet created for you to write information down on about your patient. I'll upload mine so you can get a feel for what you may need. Keep in mind, that the sheet is highly detailed and by the 2nd semester I wasn't using most of it because it was too much. I didn't have time.

Brown nose with your clinical instructor to an extent. These people are the gate to your pass clinicals. The grading system is highly subjective and they are moving around so much that they may not see you do everything. Usually, one person to 6-9 people. So, don't get into arguments with your instructor. They may be seemingly tough drill instructors but again, these people can fail you. Take an interest into their career and ask their advice. They are there for a reason. Stay on their good side and develop a good relationship.

If you are ever in doubt about something, ASK, ASK, ASK!!! Don't EVER assume anything! An assumption can kill someone, you could fail, or both. Ask your clinical instructor or nurse. If you want to make you are doing it the "textbook" way, ask your instructor because they may want a task done a certain way. Sorry for the big and bold, but you see my point?

Most importantly, try to enjoy your experience. Try to find your chi. lol Get into a groove and build relationships with the families, patients, and co-workers. I really, really enjoy hearing stories from older people. I really enjoy savoring the look of people when I know I've helped them. Sit back sometimes and enjoy the moment you are in. Enjoy your clinical. They are over before you know it!!!

-Andrew

P.S. Hope my forms help you out.

My Chart Study Form.doc

VS Chart 2.docx