How can I maximize my learning experience at clinical?

OCNRN63, RN · Oct 17, 2010

Ask if there are any bedside procedures you can watch (ie bone marrow biopsy? Paracentesis? or even just an IV placement?) Most doctors and nurses don't mind if students watch
Hi, ChristineN, I was wondering how often student nurses pass out. I am so worried about this b/c my instructor said it happens alot. What should I do so I don't. I would be so humiliated and freaked out!! TIA
Make sure you eat breakfast. I didn't before I saw my first bone marrow and my first thoracentesis. Big mistake.

DizzyLizzyNurse · Oct 17, 2010

Ask if there are any bedside procedures you can watch (ie bone marrow biopsy? Paracentesis? or even just an IV placement?) Most doctors and nurses don't mind if students watch
Hi, ChristineN, I was wondering how often student nurses pass out. I am so worried about this b/c my instructor said it happens alot. What should I do so I don't. I would be so humiliated and freaked out!! TIA
I just had a wonderful doctor allow me to observe him placing an NG tube and he was teaching about a lot of stuff while he did it. Some people are natural teachers so hopefully you will meet some.
The only time I've heard of people passing out was during C-sections in OB. They have all kinds of rules just in case because it does happen. (Stand with your back against the wall, eat breakfast before, etc.) Don't be embarrassed if it does happen. It happens, no biggie.
And whoever said don't talk to the patients - it depends on the patient. A lot are bored and lonely and scared at the hospital and it's nice to get the 1:1 that the student nurses provide because the RNs aren't able. A few weeks ago the lady who got the NG tube has been in and out of hospitals many times and she was teaching me about her NG. She loved teaching the student haha. All my classmates came in to visit her because she enjoyed the students so much. Only a couple of times have I had people who didn't want to talk, usually because they didn't feel well.

RNHeatherLA · Oct 18, 2010

nrice28, I was also nervous about fainting during clinicals. I have a life history of getting dizzy and almost passing out- happens maybe every year or two. My first day of clinical a respiratory tech asked if I wanted to suction a trached patient. He did it a couple times then I did. The pt. looked very uncomfortable, red, and was gagging (that's normal during suctioning) but after doing it I felt like I was gonna pass out. I think I had had like 2 hours of sleep the night before and was hot from wearing isolation gown and gloves. I just told the RT I had to leave the room and go sit down, then I was fine after 5-10 minutes. I did get woozy a few other times throughout school, like watching dialysis, watching a skin graft in the OR, watching a central line insertion, and once I actually passed out just talking to a guy about his AAA (ascending aortic aneurysm) surgery! THAT was embarrassing.

The most important thing to remember is to SIT DOWN if you start feeling light-headed at all! Yes, eat a good breakfast, try to get enough sleep the night before, and stay well hydrated too, those will help prevent getting woozy, but if it hits you, if you don't sit down you will pass out and hit the floor. I was afraid this would affect my nursing career, but over time you just get desensitized to stuff that used to shock your system and it doesn't happen anymore.

As far as maximizing your learning experience, I agree with everyone else- get on the right foot with your nurse each day and let them know exactly what you are allowed to do and how far along in school you are. Let them know if you need to give meds, do an assessment, chart, etc., and also when you will be taking lunch, and leaving for the day so they will know what you will be doing during the day. And make sure you do what you say you will do! I also learned so much from doing things with my nurse's OTHER patients, not just the one I was following. Ask the nurse if you can help out with her other patients too (if you have time!) I've definitely had my share of nurses that I felt were trying to shake me off the whole day, haha. So I hope my advice helps! :)

Over time you will be less nervous around patients and nurses and will get more comfortable the more you learn in school too.

sistasoul · Oct 18, 2010

I am a nurse and I talk to my patients. Of course I talk to them about pertinent things but I also get to know a lilttle bit about them as a person. I usually never have the time to just chat but I make the time depending on the patient. If I can give them even 5 minutes of myself it shows the patient that you care about them and they are just not part of your job. I find patients appreciate this and it builds rapport.

Little old ladies and gents are sometimes lonely and love to talk. If the patient is stable and you have a couple minutes to talk they appreciate it.

In clinical it is hit or miss with the RN you are teamed up with. It is not personal when they don't want t o deal with you it is just that they are in a time crunch. I love to have students with me. Ask the nurse if you can tag along with her. You will get to see how the nurse interacts with the patients and a 2nd pair of hands is always useful (depending on what the student is allowed to do). I remember all too well the feeling of being in the way as a student. It is terrible.

The best piece of advice I can give is too not be shy when there is an opportunity to do a procedure. I know it is nerve wracking when your instructor is watching you but the more you do things the easier they will get. If there is a foley to be put in jump on it. I never put in a Foley while in school on a real live person. Answer bells if you have nothing else to do (which is rare).

aussiemom · Oct 18, 2010

I agree with what previous posters have said. Now that the shoe is on the other foot and I'm in the RN role instead of student role, I understand more now why the RNs with whom I was paired often didn't have time to talk me through everything they were doing- they may have been swamped and overwhelmed themselves. When I have students with me (which I love!), I do my best to talk through what I'm doing and forewarn them about our busy times on the unit. I do occasionally get very quiet and don't realize it because I'm just trying to focus and get through certain tasks quickly. Once things calm down, I try to debrief my students and bring them back up to speed, as my preceptor did. Here's what you can do to maximize your experience: Know what you can do and definitely take initiative within your scope of practice. Talk to your patients- it's great practice and will increase your comfort level with clinicals. Many patients will jump at the opportunity to speak with a student, but don't take it personally if they do not. Practice your assessments and do not discount the bed bath. This is an opportune time to assess skin. Do not hesitate to ask questions but be mindful of timing. If you are unsure about how to do something, however, do not hesitate to ask, no matter how simple you may think it "should" be. Don't try to "wing it" if it could pose a safety risk. Help your classmates. At this stage you probably have one patient each-? Help everyone else if you are caught up. You'll build a good reputation for yourself and may see other interesting things in the process. Good luck, and enjoy this time to learn. If someone isn't willing to teach you in a given week, wait it out- you'll likely find someone else who clicks with you better. Sometimes, just rely on your own initiative and make your own experience.

nwrn2010 · Oct 18, 2010

All of these posts have some really good advice for getting the most out of your clinicals. I can also remember when I thought some of my nurses in clinical sat behind the desk more than she was giving patient care. Pretty easy for me to say when I only had at the most 3 patients.

You too will quickly learn when you have 6-7 patients, grouping pt care together and delegating are so important because our jobs as nurses (other than overall care and management of the pt) is to assess the labs, xrays/tests, signing off orders, and notify the doctor of any changes. Not to mention constant admissions/discharges. I love doing patient care but most of the basic care is usually delegated because more than likely, another pt is requiring attention.

While you are in clinical, my advice would be to get into everything you can! Discover equipment, touch the different tubings and familiarize yourself to the hospital's way of running things. Always volunteer and make yourself available! I would always get to do more cool stuff because I would be in the hallway or at the nurses station when I felt like something was going on (which is pretty much all of the time). Don't spend your time in the "conference room", get in the action!

I understand that you feel like you are "in the way" but take responsibility for your own learning experiences and create opportunities for yourself. I promise, you will benefit in your first job the more you experience in clinical! :)

Best of luck to you! And remember, these nurses where once students too! Of course, if you feel like you are not learning enough, get your instructor involved! They can pull out equipment and explain procedures! Also, let the instructor know what you would like to do (IVs, foleys, trach care, central line dressings, dressing changes, NG tubes, etc) because it is much different with "real" pts than it is with those dummies! :)

Hope this helps! And the most important thing about clinicals, HAVE FUN!

Spikey9001, BSN, RN · Oct 18, 2010

Thanks! I'm definitely going in with the intent to LEARN this week! I refuse to just stand around like some of the students do when there is nothing to do...

I don't wanna be the student that just looks like around lost when I've done all my work, I wanna do more so that I'm learning for 8 hours instead of 2.

Lennonninja, MSN, APRN, NP · Oct 18, 2010

Definitely see what you can learn from the techs/CNAs. I've learned a lot from them in the last year, and they can really teach you some good tips and tricks about basic patient care. And if you can pitch in and help the techs/CNAs the nurses and your teacher is likely to notice and it'll probably reflect positively. It's been mentioned in every evaluation that I've had that I am willing to help anyone whenever possible and nursing is definitely team work!

Another thing that I've been doing is watching how different nurses organize themselves for the shift. That's really helped me to become more effective.

carluvscats · Oct 18, 2010

Soooooo many good posts so far. I love what Lennonninja said....watch the CNAs/techs and see what you can learn from them; they are invaluable when it comes to patient care and once you become a nurse, you cannot live without them!!!!

Also, I would add..... and I don't think you will.... but don't stand around with a little group of students and talk about non-nursing stuff. It looks really unprofessional and I think people remember the ones who do that.....the job market is hard enough and I can't help but think that the students who do this are just making it harder on themselves should they ever want to actually work there one day.

On our floor, it is soooooooooo helpful when the students help pass out trays. It's a small thing that doesn't take much time, but when you have a zillion things to do, it's really wonderful to have help with that.

Patient education is huge in nursing. You can always get the patient pamphlets and read over them, and that way when your patient is having a procedure or surgery, you will be better equipped to answer questions.

I love good manners :) and you will really stand out if you say "please" and "thank you" if someone takes the time to help you or explain something to you. Probably sounds old-fashioned but I am amazed at those who don't use these niceties. I know, I am lame!

Best of luck to you....and do enjoy your time in clinicals!

Pepper The Cat, BSN, RN · Oct 18, 2010

I"d like to add tell the nurse what you can/can't do. I don't know. Telling me you are first year, second semister, or whatever doesn't help me because every college and university does it differently.

If I give you an opportunity to watch a procedure take it. And go right away if I tell you to! I had a doctor come to take out a g-tube. I asked him if the students could watch, he said sure. So I started rounding them up, tell them to go right away, because he wouldn't wait for them. 2 students dawdled about, then went to the room about 15 minutes later. Yep, they missed the procedure. And then got mad at ME because their friends saw something they didn't!

Also, don't take it personally if I don't jump for joy when you are paired with me. I love students but you do slow me down. And some days, I just don't have a lot of extra time to give you.

Finally,jump in, help out. The best student I had shadowing me introduced herself to the patients after I introduced myself, and told them she was learning and hoped they didn't mind her watching me do things. She was great.

nwrn2010 · Oct 18, 2010

It is great to help out with the basic needs of the pts especially when you do not have anything else going on. However, when I became a senior nursing student, our instructor had to make it clear that we were not there to do the aids job for our patients. We would walk on the floor and they would immediately ask what pts we had because they thought we would be taking over for them. Don't get me wrong, if my pt needed something I did it. It is important to make it clear that you are there not really "shadowing" the nurse, you are the nurse! Tell her what you will be doing under the supervision of your instructor. To get the most out of your clinical rotation, try to make yourself as comfortable as possible and tell yourself that you are the nurse! :)

MissJulie · Oct 18, 2010

I'm REALLY new at this thing called clinicals myself, but I'll share a few things.

Our first day, we only did physical assessments, and my patient was a great one. I went in and he was kicked-back watching TV. He was in pretty decent health, but did have sever liver damage from years of alcohol abuse. I did my assessment, but then also took notice of the IV fluids and while I was in the room, a consult from the local cancer center came in to speak to the patient, so I observed her assessment as well. There wasn't a lot I could gather from the patient, but he did have some MAJOR bowel sounds - gotta love that colace!

On the second day, we did total patient care: physical assessment, bed bath, and change of linens. This time, I got an interesting one... She was 16 hrs post-op from a double hernia repair, incision from sternum to pubic bone, and dilaudid on PCA. I went in, introduced myself, verified her identity, told her what I was going to do, and asked if it was okay. She agreed that it was, and I turned to get some gloves to get started, I turned back around to face the patient, and she had pulled her gown over her head and said "Look what the doctor did for me!" Poor thing had a NG tube, foley cath, IV with NS and fomatadine, and the PCA of dilaudid, obviously, there was a lot to see! I got to observe a cath removal and dressing change. We hadn't done dressings yet, or setting up a sterile field, and the nurse took the opportunity to teach me how to do it. (She had graduated from the same school three years ago.)

On the third day, we did physical assessments and PO meds. This patient, a middle aged woman with pneumonia, knew more about her meds then just about anyone would! She was extremely knowledgable about her health. After we had finished with her, she even gave all of the students (myself and my partner, and bed 1's two students) some bookmarks from her church.

On the fourth day, not a lot to be done. Patient had chronic pancreatitis (I think that's spelled wrong, oh well!) and recieved blood pressure meds... So it was off to the nurses station to ask what else needed to be done. I wound up following the CNA around the floor and assisting in bed baths, toileting, etc. And, since I had finished that, there were some finger sticks and insulins to be done, guess who got those? Yep, me.

I whole heartily believe that shadowing not only your nurse, but any part of the care team that can be shadowed will help you in the long run. There are a few students in our class that when the nurse comes in, they go out. But, I think that we're there for a reason, the whole point of clinicals is to learn. The state gave these nurses a license for a reason, because they know what they are doing! Watch, question, observe, help out!

Talk to your patients! Sometimes they are the best source of knowledge about their disorders, meds, etc. One of my fellow students reminded me that one of the easiest ways to calm you patient is to speak to them. She's had three comatose patients, and yep, she talked to everyone of them! I think she said that she had described the weather to one of them because they had been in a coma for a couple of weeks and the seasons had changed in this time.

Study the chart! If you have access to the chart, study it. At out clinical site, we have access to previous nursing notes, care plans, etc about the patient. We are encouraged to check the MAR to learn common meds, check the labs to learn some basic ranges, etc. My patient with pancreatitis had an ultrasound of her abdomen, it was in the chart, so I pulled it up. Actually the doctor that had ordered it walked past me while I was on the computer and he stoped to explain what the different organs were and how the pancreatitis had been diagnosed. Needless to say, I learned a lot that day.

And, as far as getting sick goes. If you're observing and you feel like you're going to vomit, excuse yourself and get some air; or, take a tip from one of my instructors, smell of an alcohol prep. I did it, it works!

Just remember that clinicals are an extension of school. Use it to learn! :)