How to survive clinicals?!

[Gampopa]

OK, in lab and courses we are taught over and over again that procedures MUST be done a particular way. When we get to clinicals, practice is not done that way at all because of speed, lack of knowledge, lazyness whatever. Already, after just a couple weeks in clinical I see myself picking up really bad habits because that's the environment I'm working in. My clinical instructor says "Make a mental note of it and know you wouldn't be doing that in your practice." We'll, isn't clinical supposed to be the place to learn what I'm supposed to be doing? How, after 4 rotations of doing it the "wrong" way am I supposed to recall what is the proper way? How do you deal with this? If you are following your nurse preceptor and see them do things that just aren't the way you'd do them do you question it or not? When you see meds given at meals that are supposed to be given 1 hr before or 2 hrs after meals do you question it? I know there is a vast difference between what we're taught and what actually goes on in practice but how do you determine what's crucial and what's not?

[Altra, BSN, RN]

I think you have to pick your battles. Our instructors have always been very upfront with us about the fact that we will see things in clinical that are not done the way we have been taught. Personally, I wouldn't ever correct a nurse unless I thought something was an immediate threat to patient safety or directly contradicted a policy or standard of care in a REALLY BIG way. I don't see the point otherwise - he/she's the nurse, I'm the student. The ultimate responsibility for the patient lies with him/her. However, having said that, if I ever did get into a situation where I thought the patient's well being was in jeopardy I would certainly know how to open my big mouth and say something. :chuckle

However, there are ways to use your "people skills" - maybe something like, "since med x is best given on an empty stomach and Patient A is eating lunch now, would you like me to come back and give it at (whatever time)?" But even this can be dicey - if meds are being given late because the nurse is having one of those days where everything's going just slightly wrong, he/she probably doesn't need another reminder of that. I think it's a judgement call on your part.

The few times I've been doing something (say changing a dressing) and the nurse I'm with has said "no, do it this way" I've simply said something like, "well, we were taught this way and (small chuckle, shrug my shoulders) if I don't do it that way you KNOW my instructor will be coming in the room right about then, so I'll stick with the way I was taught. But thanks for showing me what works for you."

Hope this helps! :)

[Todd SPN]

I can't speak for all settings a nurse may work in, but I can say there is the right way and then there is the real world of when you start working way. It is something you must experience to understand. Just don't forget the proper way when the state comes to do the yearly inspection. I was thinking it was just my facility, but my classmates I have kept in contact with experience the same thing.

[HyperRNRachel]

I can't speak for all settings a nurse may work in, but I can say there is the right way and then there is the real world of when you start working way. It is something you must experience to understand. Just don't forget the proper way when the state comes to do the yearly inspection. I was thinking it was just my facility, but my classmates I have kept in contact with experience the same thing.

Todd SPN is right. There is always another way. I never question another nurse's skills, I think that may be the single most reason nurses do not like students to follow them around. If anything I compliment them on teaching me a better way of doing things.