Help with 3rd semester clinicals

nurseprnRN, BSN, RN · Oct 19, 2013

1) Totally stop with the "terrified." "Terrified" is not going to get you anywhere. You are challenged. The minute "terrified" enters your brain you are to banish it and replace it with "challenged." "Terrified" is a paralytic, but you can meet a challenge.

2) You are learning that you have to have a certain baseline down already (common meds, common labs, basic physical assessment skills, anatomy, physiology, medications, safety). You learned all that in your first semesters, and now is the place you start being held responsible for putting it all together. So a lot of your preparation will be rereading all those basics and making sure you feel solid with them. You still have all those books, right?

3. The nurses on the floor do the same thing-- they come in, get report, and start work. They don't prepare the night before. How do they get oriented to their individual patients? Ask every nurse what works for her, and see what resonates with you. But I will bet that they have some variation on the following:

--They have a basic understanding of what, say, congestive heart failure, or diabetes, or COPD, or pancreatitis, or small bowel obstruction, or whatever is, so they don't need to look that all up as if they've never seen it before.

--Then they do a quick flip through the patients' admitting H&P to get a good idea of what the person looked like at admission.

-- They look at the admitting nursing diagnoses to see if there's anything special that needs attention

--They check the last applicable labs to see if there are any weird ones or meds that need to be PRN for lab results.

--Then they do a quick flip through the meds to see that there's nothing weird, and they start to plan their med pass times.

-- They look for treatments, preps, dressing changes, whatever, and see when they will fit those in.

(My friend Esme has some wonderful "brain sheets" to help you get all this organized.)

All that should (and eventually will) take about 5 minutes per patient once you get organized c Esme's helper brain sheets. Don't worry if you can't do it on your first week, but you should make progress over the rest of the semester. Remember, this is what nurses do and this is what you are in school for. This is time management backed up by solid knowledge.You can learn this.

krisiepoo · Oct 21, 2013

You're a nursing STUDENT which means you have a ton of resources available to you, such as the nurses assigned to these patients, the charge nurse and your instructor. Asking questions does not equal stupidity, it means you are enquiring about what you are unsure of. Ask questions, and TONS of them. State, "I'm unsure how this all comes together for this patient" or something like this. It's OK to say "I don't know but I can find out" to your instructor, the nurses and the patient. You're never going to know ALL the questions. I would be surprised if everything is coming to your classmates as easily as you think it is. Maybe they're just coming off as more confident, maybe they're asking questions to their nurses that you're not hearing. never compare yourself to your classmates, this is about you.

and I agree with GrnTea, get rid of that terrified word because you need to be confident, even if you're not you can surely come off as such.

akulahawkRN, ADN, RN, EMT-P · Oct 21, 2013

Kg2374 said:

Hi, I am in my 3rd semester of a 2year ADN program. I am looking for advice on how, or when all the dots are going to connect. I do very well with theory and have done OK in clinical so far. This semester however we do not have a "prep" day. We go straight to the hospital, pick our patients (2-3), receive hand of report, and begin patient care for the day.
I am terrified that I do not get the time to research meds, labs, etc. before I begin my care. And even more terrified when my CI questions me about my patient and expects me to correlate all of the data. I am feeling very overwhelmed and wonder if I will ever be able to connect those dots? There are other students in my program who seem to have no problems at all. I just don't know what I am missing. Any advice would be helpful!!

Thank you!

I'm also in 3rd Semester of a 4 semester (2 year) ADN program. While we do get to prep on our patients the night before, often we show up in the morning only to find that one or both of our patients died, were moved to another unit in the hospital, or were discharged, leaving us to pick up new patients right then. How do we deal with this challenge? Well, first off, we show up a few minutes early (15-30) and either double check patient info or we select new patients that are at least somewhat similar to ones we prepped on.

We then go sit in on the unit meeting and then get report on our patients and do our assessments and so on. Any meds that I'm unfamiliar with, I'm going to look them up before I have to give them. It really is setting us up for the real world, much as GrnTea has described. Our patient load is 2 patients... but while it's just 2 at a time, it's very possible that by the end of our 2 days on the floor, I've prepped and/or cared for 6 or 7 patients. We're very much starting to see where time management is coming into play... as we're now having more free time than we used to. We also still have days where we're just overwhelmed with 2 patients... and that's a learning process too.

As to when the dots start connecting for you, all I can say is that it's an individual thing. One day, things will just suddenly fall into place and make sense.

Esme12, ASN, BSN, RN · Oct 21, 2013

Esme's brain sheets.......here are a few.

FinalGraduateShiftReport.doc

DAY SHEET 2 doc.doc