Good clinical experiences vs. Bad clinical experiences

FDW630 · Dec 4, 2013

Last semester was an amazing clinical experience. Our instructor was very intense, but she pulled us all over the hospital finding things for us to do or watch. We didn't stop moving the entire day. Neither did she! She graded our notes and paperwork super hard, and we learned a lot from her. She wasn't the sweetest and kindest person to interact with sometimes. but she cared about us learning and doing well and moving on. She taught us disease processes that we weren't even learning in our class, and expected us to know more than what we learned in our classroom, including lab values. it translated to having an advantage this term. This semester, our instructor was in the middle of her second masters degree. She spent the entire in the break room studying her notes. I gave an injection and passed some meds all semester. That's it. We spent our days trying in vain to find things to do besides answer call lights. We never saw our nurses notes until the last day, which she spent just grading them all. She's not looked at them all semester.

krisiepoo · Dec 4, 2013

Quite honestly, every clinical experience can be a good one if YOU have the right attitude.

It is not the nurses job to cater to you... YOU introduce yourself, YOU follow them, YOU tell them what you can do, YOU follow up on what you said you were going to do

If the nurses are less than enthusiastic about you, then YOU do what you can to learn what YOU can. yeah it sucks, but my learning is my responsibility. I'm assigned my patients, I'll ensure I provide the best care for them while learning what I can. Get to know the NA's and the other nurses. Answer call lights for patients other than yours. the more YOU do, the more YOU learn

One semester I had the instructor from hell so I stayed busy, I charted in the room, I chatted with my patients, I answered call lights and I did my work on time. She didn't have a chance to single me out because I was never in her crosshairs, except when giving meds and I had done my homework on the meds, why my patient was receiving what, knowing the 5 rights, etc. Sure, I wasn't perfect, but I wasn't standing around waiting to be criticized.

It is kind of frustrating to me to hear about so many students who hate clinicals or who have a bad time because nursing is such an independent career, we should be learning that independence as students and not relying on others to tell us what to do all the time.

Clinicals were by far my favorite part of nursing school (just finished my last one on Monday) because it was when I got to 'be' a nurse

elkpark · Dec 4, 2013

IMO (as a former student and as an occasional clinical instructor), a "good" clinical experience is one in which you learn a lot, not necessarily one that is fun or easy. An engaged, tough instructor with high standards helps (in my own school experience, some of the instructors and experiences I learned the most from were the ones I liked the least at the time), but, as krisiepoo just noted, a lot of it has to do with the student. The student can make any experience or setting a worthwhile learning experience (or not). Like so many things in life :), you'll find that you get about as much out of your clinical experiences as you put into them.

Best wishes for your journey!

zeus&lincoln · Dec 4, 2013

Personally I don't think clinicals did a stellar job of making me into a nurse. Hear me out... Functioning in a student role (and not being at the clinical site for the whole shift until practicum of course), made me feel like an audience member instead of the main event (nurse)... Sure I did everything I could for my patients (1-2max), but it IS NOT the same as being a "real RN." I do agree that clinicals are what you make it, which is why I answered everyone's call lights, asked if I could do and see procedures on whatever patients and kept myself busy assessing any patient I could get my stethoscope on, restocking, looking through the patient's chart, and going on rounds. However, it is completely different as a nurse. I think that is why there is such a steep learning curve when you graduate NS and start orientation or on-the-job training. The best clinical instructors I've had encouraged independent practice/accountability, assigned relevant assignments and gave us individual and timely feedback.

classicdame, MSN, EdD · Dec 4, 2013

looking back, I think I would have had better experiences if I had spoken up and asked for nurses to drag me along whenever something interesting was going on. I relied too much on being told what to do. Once I took the initiative my experiences broadened.

krisiepoo · Dec 4, 2013

Personally I don't think clinicals did a stellar job of making me into a nurse. Hear me out... Functioning in a student role (and not being at the clinical site for the whole shift until practicum of course), made me feel like an audience member instead of the main event (nurse)... Sure I did everything I could for my patients (1-2max), but it IS NOT the same as being a "real RN." I do agree that clinicals are what you make it, which is why I answered everyone's call lights, asked if I could do and see procedures on whatever patients and kept myself busy assessing any patient I could get my stethoscope on, restocking, looking through the patient's chart, and going on rounds. However, it is completely different as a nurse. I think that is why there is such a steep learning curve when you graduate NS and start orientation or on-the-job training. The best clinical instructors I've had encouraged independent practice/accountability, assigned relevant assignments and gave us individual and timely feedback.

I agree, you don't learn what you need to be a 'real nurse' however you have the power to make them a good or bad experience

SopranoKris, MSN, RN, NP · Dec 4, 2013

I feel like I've had both a good & bad clinical experience this semester. What I mean is that I've had fabulous weeks and I've had rotten weeks. It all depends on the nurses I'm assigned to work with each shift. My 1st week in the hospital, I had a fabulous, wonderful nurse who really took the time to be welcoming and wanted to teach me. She asked me to explain all the meds to her, she brought me in to watch procedures on other patients that I wasn't assigned to just so I could get the experience of seeing new things. If I could work with her every week, I'd be the happiest nursing student in the world. I wish ALL the nurses on the unit were like her!

I was also paired with nurses who were bitter about having to "deal" with students and were disgruntled with their jobs and took it upon themselves to be very unavailable and unpleasant to work with. One even told me "what's the point of me helping you? You'll just graduate and get hired at lower pay and then take all our hours and we won't get enough shift hours because the newbies are taking them all at lower pay". :eek: All I said was "well, we were all students once. I'm just here to help and learn as much as I can." She just rolled her eyes and walked away. Any time I asked if she needed any assistance or if I could observe her with other patients, she would snap "NO!" and walk away. It was a rough day, but I tried to make the best of it. I even asked other nurses and the techs on the floor if there was anything I could do to help them with their workload. They were appreciative, but it seemed to make her even grumpier. I also had a male nurse who seemed to think one particular wheel-a-roo computer was his own personal computer (there are no assigned computers on the floor). I had to give a patient meds and needed to look up a lab value to see if I could safely give it and there were no available wheel-a-roo PCs except one. I asked at the nurses' station if anyone was using it and they all said "no". So, I logged in and looked up the lab value. He comes walking up while I'm on it and yelled at me for using "his" computer and got mad that he was going to have to log back in (it takes a while to log in when you switch users, it's a cruddy system). I would have gladly used another computer if one was available, but there weren't any. Goodness grief, you would have thought I stole his wallet! :rolleyes:

Luckily, I've had quite a few wonderful nurses who have out-numbered the bad, so overall, my clinical experience has been good I think the grumpy ones have completely forgot what it was like to be a student and are burned out by hospital politics. I hear the grumblings at the nurses' station constantly. Makes me not ever want to apply for a job there!

elkpark · Dec 5, 2013

I feel like I've had both a good & bad clinical experience this semester. What I mean is that I've had fabulous weeks and I've had rotten weeks. It all depends on the nurses I'm assigned to work with each shift. My 1st week in the hospital, I had a fabulous, wonderful nurse who really took the time to be welcoming and wanted to teach me. She asked me to explain all the meds to her, she brought me in to watch procedures on other patients that I wasn't assigned to just so I could get the experience of seeing new things. If I could work with her every week, I'd be the happiest nursing student in the world. I wish ALL the nurses on the unit were like her!
I was also paired with nurses who were bitter about having to "deal" with students and were disgruntled with their jobs and took it upon themselves to be very unavailable and unpleasant to work with. One even told me "what's the point of me helping you? You'll just graduate and get hired at lower pay and then take all our hours and we won't get enough shift hours because the newbies are taking them all at lower pay". All I said was "well, we were all students once. I'm just here to help and learn as much as I can." She just rolled her eyes and walked away. Any time I asked if she needed any assistance or if I could observe her with other patients, she would snap "NO!" and walk away. It was a rough day, but I tried to make the best of it. I even asked other nurses and the techs on the floor if there was anything I could do to help them with their workload. They were appreciative, but it seemed to make her even grumpier. I also had a male nurse who seemed to think one particular wheel-a-roo computer was his own personal computer (there are no assigned computers on the floor). I had to give a patient meds and needed to look up a lab value to see if I could safely give it and there were no available wheel-a-roo PCs except one. I asked at the nurses' station if anyone was using it and they all said "no". So, I logged in and looked up the lab value. He comes walking up while I'm on it and yelled at me for using "his" computer and got mad that he was going to have to log back in (it takes a while to log in when you switch users, it's a cruddy system). I would have gladly used another computer if one was available, but there weren't any. Goodness grief, you would have thought I stole his wallet!
Luckily, I've had quite a few wonderful nurses who have out-numbered the bad, so overall, my clinical experience has been good I think the grumpy ones have completely forgot what it was like to be a student and are burned out by hospital politics. I hear the grumblings at the nurses' station constantly. Makes me not ever want to apply for a job there!

Part of the issue in these kinds of situations is that no one asks these nurses whether they want to have students assigned to them and be responsible for teaching them, they get no extra compensation for doing so, and, regardless of what students believe, they are not making the staff nurse's job easier/lighter, they are making it longer and harder.

I don't know when this shift in how clinicals are done occurred. When I was in school (in a hospital-based diploma school), we were on floors with our clinical instructors and our clinical instructors did all the teaching and supervision. We were assigned to specific clients, not to specific nurses, and the staff nurses had nothing to do with us (other than our reporting off to them what we had done at the end of the day, and updating about anything significant during the day). By fairly early on in the program, we provided nearly all the nursing care to our assigned clients (under our instructors' supervision), so the nurses really did like having us there -- if we were assigned to one of your clients, you didn't really have to do anything with that client all day, and it was considered a treat to have a student assigned to one of more of your assigned clients.

When I've taught med-surg (and other) clinicals since then, I've done it the same way. I'm responsible for the students and their education and I don't ask the staff nurses to do any teaching or supervision. I'm clear with the staff nurses at the beginning of the day about what the students are able to do and what skills/procedures they won't be doing on a particular client. (And most of the nursing staff have considered it a pleasure and a treat to have the students present.) I'm not surprised staff nurses are ticked off to be told they have a student assigned and they're supposed to be teaching them. I've been in that position and watched the school's instructor sit on her butt and schmooze with the unit's nurse manager all day in the office (or just not be around, period), while I was supposed to be teaching the students.

It's not that anyone has forgotten what it's like to be a student or are burned out -- it's that they understandably resent being put in this position by the school and their facility, and the student gets caught in the middle. If those nurses wanted to be teaching students, they'd get teaching jobs. IMO, it's not their fault or problem any more than it is the students' fault or problem; I blame the nursing programs that do clinical this way. They're creating problems for everyone. Whatever happened to clinical instructors doing their jobs??

nlynrob · Dec 5, 2013

Part of the issue in these kinds of situations is that no one asks these nurses whether they want to have students assigned to them and be responsible for teaching them they get no extra compensation for doing so, and, regardless of what students believe, they are not making the staff nurse's job easier/lighter, they are making it longer and harder. I don't know when this shift in how clinicals are done occurred. When I was in school (in a hospital-based diploma school), we were on floors with our clinical instructors and our clinical instructors did all the teaching and supervision. We were assigned to specific clients, not to specific nurses, and the staff nurses had nothing to do with us (other than our reporting off to them what we had done at the end of the day, and updating about anything significant during the day). By fairly early on in the program, we provided nearly all the nursing care to our assigned clients (under our instructors' supervision), so the nurses really did like having us there -- if we were assigned to one of your clients, you didn't really have to do anything with that client all day, and it was considered a treat to have a student assigned to one of more of your assigned clients. When I've taught med-surg (and other) clinicals since then, I've done it the same way. I'm responsible for the students and their education and I don't ask the staff nurses to do any teaching or supervision. I'm clear with the staff nurses at the beginning of the day about what the students are able to do and what skills/procedures they won't be doing on a particular client. (And most of the nursing staff have considered it a pleasure and a treat to have the students present.) I'm not surprised staff nurses are ticked off to be told they have a student assigned and they're supposed to be teaching them. I've been in that position and watched the school's instructor sit on her butt and schmooze with the unit's nurse manager all day in the office (or just not be around, period), while I was supposed to be teaching the students. It's not that anyone has forgotten what it's like to be a student or are burned out -- it's that they understandably resent being put in this position by the school and their facility, and the student gets caught in the middle. If those nurses wanted to be teaching students, they'd get teaching jobs. IMO, it's not their fault or problem any more than it is the students' fault or problem; I blame the nursing programs that do clinical this way. They're creating problems for everyone. Whatever happened to clinical instructors doing their jobs??[/quote'] I always wonder about this when I read posts about how awful the assigned nurse is. My program is just how you described. I don't get assigned to a nurse I get assigned to specific patients. If my patients nurse happens to love teaching that's great and I learn invaluable more "real world" information from getting to follow him/her for the day, but for the most part our clinical instructor is responsible for what we're doing and communicates what we will or won't be able do to with the staff nurses. As far as I can tell this makes the floor nurses happier because their shifts go much easier. I think because the program runs this way I've never really had a bad clinical experience. I don't feel out of place or unsure and the nurses are all extremely welcoming, except the occasional person having a bad day. I've done clinical a at three different hospitals so far and the only experience I would say was bad was the tiny community hospital when compared to the two trauma centers I've been at since, but that has nothing to do with the hospital staff or my instructor. I was bored and figured out early on I needed a big place with a more going on.
I guess my point is my clinical instructor is there to teach me, the nurses are there to do their jobs. I don't blame these RNs who are trying to get their work done for being angry that they've had full time educator tacked on to their job title for the day. What are all these instructors doing all day if they aren't instructing?

seconddegreebsn · Dec 5, 2013

What makes for a bad clinical assignment for me? When I get paired with a nurse who feels the need to spend the entire 12 hour day talking about how horrible her job is, how she'd rather be digging ditches, how I should turn around and run for my life and how everything is just awful and will be terrible forever and ever, NURSING IS THE WORST JOB ON EARTH! I know everyone has bad days, but man, I'm obviously here because I'm fully invested in this career. I'm aware things are not all sunshine and rainbows, but they're also not hellfire and brimstone. Some days they should hang an "abandon all hope ye who enter here" sign above the unit.

I've also been paired with nurses who are just, to put it really frankly, neglect their patients in very upsetting ways. We're talking people sitting in their own BM for the entirety of their shift, pressure ulcers soaking of fecal material and the patient clearly in pain and discomfort. I clean them up, try to do what I can but I feel so bad for those patients--what happens when students aren't around? Do they ever get changed? The new pressure ulcers I see a week later are hinting that no, they probably don't.