Give me a day in the life at clinicals!

crunchymomx3 · May 16, 2008

Oh hun, you have NO idea. LOL

Typical day for me would be:

Have pre-conference with my instructor and classmates.

Get onto the floor and get report from the RN.

Go see my patient and do a full assessment (done for all the patients you have).

If I had one or two patients I'd do full care which included vitals, patient care, blood glucoes monitoring, etc. More than 2 and I'd delegate.

Get meds ready and pass them.

Address any issues, do patient teaching, etc. There will almost always be something to do. The patient needs to be changed, something needs to be done, etc

Usually at some point the instructor would come around and pull us aside one by one and "quiz" us on what was going on with our patients.

Grab dinner. Woot!

Back onto the floor, go check on patients and reassess.

Evening meds. Evening care. Evening vitals.

Notes.

Now that is mostly the typical stuff. Toss is a admit or discharge, something is going awry with your patient, etc and it can toss you for a curve if you don't have a good flow down.

Oh, and as for patients having "accidents", I am assuming you mean being incontinent. It depends on what the workload was. If I had 1 or 2 patients, I did it myself. In fact, in our entire first year it was required that we did total patient care, and didn't get to delegate much at all. In my senior year we didn't have to, but honestly if I had the time I did it myself.

shoegalRN, RN · May 16, 2008

I agree with the poster above me.

You really have no idea! LOL!

And yes, you will be busy the entire time, unless, you patient is to go off the floor for a procedure, you will go with them.

Typical day for me includes:

Get report from RN on my patient (we didnt have pre-conference)

Look over chart after report to see if there are any new orders from the doctor, also look up lab values, and any previous doctor orders from the previous day.

Meet patient and do assessment, this also includes a full set of vitals

Chart

Gather meds for 0800 and 0900 med pass

Wait on instructor before meds can be passed, also will get prepared for "quiz" by instructor on meds, side effects, and adverse reactions, what to look for, and mechanisms of action

Chart

After meds are passed, set patient up for a bath, do a linen change, or assist with ADL's if patient is unable

Chart

If patient is diabetic, do blood sugar prior to breakfast, give insulin if I have to

Check PRN meds just in case pt may be in pain, see when the last time pain med was given and if it's within the designated time frame

Chart

Doctor may come in, may ask some questions and may give some new orders, check chart, unable to find chart, locate unit secretary for chart, check computer for new orders

Look for new meds in tube system from pharmacy

Time for lunch

Need to get noon set of vitals, blood sugars, check chart for new orders

Chart

Get 1300 and 1400 meds ready, wait on instructor for med pass

Chart

Hopefully, patient is stable and won't need to be transferred to ICU for a possible intubation due to respirtory distress

Time for post conference, go over careplans

Go back on floor and pass 1500 meds and get last set of vitals

Chart

Give report off to the RN and let her know you are leaving for the day

Anything could happen in between report and post conference that can throw your whole day off.

You will be busy and the time will just fly by.

elisabeth · May 16, 2008

You also have to remember that you'll be slower at doing everything to begin with. I'm just finishing my second year and have noticed I'm faster than I was first semester, but still much slower than the nurses.

We had to get to the hospital at 5:45 to choose patients and prep (learn the pathophys of their disease process(es), research all the meds, find any sort of lab/test results and understand what they mean...).

Then we at least tried to get report (didn't always work out so well), assessments and vitals, morning meds, morning glucose checks generally followed by insulin, baths...

Also, at a lot of hospitals where we've been, they require you to go into the patients room every hour to check on their pain level, whether they need to go to the bathroom or need anything. The general idea is to keep them off the call light. If they know you'll be back in approximately an hour, they can usually wait.

You'll be surprised how busy you'll actually be. Have fun!

futurecnm · May 16, 2008

I'm wondering...when you go to clinicals for 8 or 10 hours one day a week at the hospital...what is it that you DO all day? There's only so much a student can do I would imagine...You can't be busy the whole time? Do the nurses use you as a sort of "slave"? If your patient has an accident, do they expect the student to clean it? Do you feel like you are in the way a lot of times? What in the world do you do for all that time? Seems like a long day to me.

yes, you are busy the WHOLE time. If you aren't doing direct patient care you are getting information from the charts, filling in your careplan, looking up drugs and diseases etc. But really you are busy with patients much of the day. At first, it is kind of awkward but you get the hang of what is going on. As a new nursing student you would do bed baths, vital signs, helping feed patients, ambulating them, observing the nurse give meds (until you can give them which comes up pretty quick). once you can give meds, that takes quite a while especially if you have more than 1 patient. There is also a ton of documentation that you will do, and you have to make sure it is complete and done on time. You also can clean up the pt room, make bed, change their gown, and yes you do help when the patient is incontinent. Most nursing students are responsible for this (with help from another student if the patient is hard to turn etc). You also have pre and post conference with your instuctor and will be responsible for knowing all your pt information and presenting it. YOu also have to know all your drugs, what they do, side effects, etc etc and your instructor will ask you about them. So, it is a very busy day!!

tachybradyRN · May 16, 2008

You all were allowed to give insulin as students? We're not allowed, because it's termed a high-risk medication. Not that it matters much to me, I know what insulin does and besides, I give enough meds as it is!

shoegalRN, RN · May 16, 2008

You all were allowed to give insulin as students? We're not allowed, because it's termed a high-risk medication. Not that it matters much to me, I know what insulin does and besides, I give enough meds as it is!

At my school we are. As long as you do the 3 checks, you are fine.

missninaRN · May 16, 2008

Ditto to the above posts. Everything takes so much longer than you think it will.

I'd also like to add:

You will spend a great deal of time trying to find things: the MAR (because the unit secretary has it), the specific type of dressing the doctor ordered that is not routinely stocked on this particular floor, a cup of pudding for your patient who needs their pills crushed (none left in the fridge, none on the floors above and below yours, and it's the weekend with no deliveries until Monday), your instructor/nurse so that you can do an IV push or change the tubing on a central line, the chart (because yet another physician has it and is adding more orders).
Just when you think you are caught up, you will find new orders in the chart. Again. You will not know what the orders say due to terrible penmanship. You will spend time asking anybody and everybody to interpret the cryptic entries in the chart.
You will spend a lot of time calling the pharmacy because the meds for your patients are not in the pyxis. I have never had a patient whose entire med list was in the pyxis.
You will check and re-check the tube system for meds that your patient was supposed to have hours ago.
You will make charting entries in the wrong chart at least once, which is time consuming because you have to go back and re-write everything in the correct chart.
You will find that your patient is prescribed a med that neither the drug book nor the entire nursing staff has ever heard of. Another call to pharmacy.
When the missing meds finally arrive you will head down the hall with the pill cup in hand only to realize that you patient is (a) on the toilet, (b) downstairs for a CT, or © receiving a respiratory treatment. Back to the med room to put the meds in the patient's drawer and wait until the patient is available.
What seems like a simple procedure in the nursing lab seems to take on a life of it's own when done in the real world. Patients move and contaminate your sterile field just when you are about to insert a catheter. You find that you are dealing with the IV pump from he** that keeps alarming "occlusion" even after you, a fellow student, your instructor, and two staff nurses have inspected every inch of tubing.
You will have at least one patient who enjoys keeping you very, very busy.

By the end of my last semester, I finally felt like I was starting to get the hang of it, though I still had shifts where I was swamped. Over time, you will learn the routine on your floor, where things are kept, how things are done there, and start to develop your own system.

obicurn · May 16, 2008

Question:

When you are assigned to a clinical location 1st semester, is that the same location you will be at throughout nursing school or do you get shuffled around all over different places?

shoegalRN, RN · May 16, 2008

Question:
When you are assigned to a clinical location 1st semester, is that the same location you will be at throughout nursing school or do you get shuffled around all over different places?

You will probably be shuffled around to several locations during nursing school.

I've been to 2 different clinical sites already and I've completed my first year of nursing school. Next semester is Peds/OB, and I will go to yet another hopsital that only deals with Peds.

So yeah, it may change from semester to semester, especially if your school is within a healthcare system (example HCA Midwest).

missninaRN · May 16, 2008

I was at 7 different clinical sites over two years. That doesn't count the precepted specialty clinicals, which we attended alone for one day each. That would bring the total number of sites to 16.

catzy5 · May 16, 2008

Oh hun, you have NO idea. LOL
Typical day for me would be:
Have pre-conference with my instructor and classmates.
Get onto the floor and get report from the RN.
Go see my patient and do a full assessment (done for all the patients you have).
If I had one or two patients I'd do full care which included vitals, patient care, blood glucoes monitoring, etc. More than 2 and I'd delegate.
Get meds ready and pass them.
Address any issues, do patient teaching, etc. There will almost always be something to do. The patient needs to be changed, something needs to be done, etc
Usually at some point the instructor would come around and pull us aside one by one and "quiz" us on what was going on with our patients.
Grab dinner. Woot!
Back onto the floor, go check on patients and reassess.
Evening meds. Evening care. Evening vitals.
Notes.
Now that is mostly the typical stuff. Toss is a admit or discharge, something is going awry with your patient, etc and it can toss you for a curve if you don't have a good flow down.
Oh, and as for patients having "accidents", I am assuming you mean being incontinent. It depends on what the workload was. If I had 1 or 2 patients, I did it myself. In fact, in our entire first year it was required that we did total patient care, and didn't get to delegate much at all. In my senior year we didn't have to, but honestly if I had the time I did it myself.

We don't have anyone to deligate too, we have no CNA's at our hospital so yes we do our own patient care, if I find myself with the rare free moment I ask my nurse if they need any help with anything.