I am a first semester ADN student and just started my clinicals in the hospital a few weeks ago. There is one major problem though... my clinical instructor is less than desirable. We essentially walk around until he/she can find us a patient to take care of (sometimes this takes 30-45 minutes) and then we aren't given instruction as to what to do with our patient or what the goals for the day are (beyond "AM care and vitals").
How important is it first semester to have a good clinical experience and what should I be taking away from these first few weeks? This is only one out of two rotations for first semester (the next is in long term care) but I am very nervous that I will continue to have this instructor. He/she is not only unorganized, but can be nasty to the students sometimes and micromanaging (to the point where they almost made someone cry over an accu-chek because the student put the test strips on the edge of the table instead of the middle.... this was the students first time doing one.)
I'm not here to just rant about this professor, I really just want to know if it is possible to have a better clinical experience than I am having. I am not sure what we are supposed to be doing on any given day and that is extremely frustrating to me. Should I speak to my mentor or would this come of "tattle-tale"ish?
As far as assessments, ALWAYS do them. Even for patients discharging. Looking from a nurses perspective, a full assessment before discharge is silly. But you are not a nurse. You are a student nurse. Your assessment is for your own learning. Heck, you'd be surprised. You at find something that was missed and worth looking at by the patients nurse. Most of the time, first semester is all about learning assessments, basic care, and med admin safety. Your instructor will be evaluating your competency is those things. But as far as going to the administrator above your clinical instructor, NOT a good idea while they are atill your instructor. You don't need a target painted on your back if they somehow figure out it was you. But def give all the feedback you want on their lack of communication and direction after you get your passing grade.
Also, I find it hard to believe there is NOTHING you can do for the time you are there. I'm not saying you are being lazy or trying to find a way out, just that maybe you aren't looking in the right places. If you truly can't find an assessment or vitals to do, the just follow a nurse around. Watch how they do discharge education and how they talk to patients, how they chart. They may have little tricks that can help you later in practice. GL. You just need to make it through one cruddy instructor and will hopefully get a better one next time.
Also, I find it hard to believe there is NOTHING you can do for the time you are there. I'm not saying you are being lazy or trying to find a way out, just that maybe you aren't looking in the right places. If you truly can't find an assessment or vitals to do, the just follow a nurse around. Watch how they do discharge education and how they talk to patients, how they chart. They may have little tricks that can help you later in practice. GL. You just need to make it through one cruddy instructor and will hopefully get a better one next time.
I am afraid I will end up with the same one since assignment is based on living location *sigh*. And I do vitals and help others with ADL's, I'm not saying there is NOTHING to do ever, I am just looking for instruction on what to do from there and not getting it. It is week three, I should be doing more than vitals, and when I ask a question I expect to at least have an answer attempted. I really did not know if it was appropriate to do an assessment on the patient, and I wasn't going to do something I wasn't sure about. Now I know.
Thank you for your input. I really hope you don't think I'm stupid for not trying to do the head to toe assessment, I am just very misdirected and unsure of what to do and don't want to mess up and be told I shouldn't have done something. I would rather just ask. It's easy to look back and go "duh, that's what I should have been doing" but as a new student I don't want to step over boundaries that I'm not sure I should be crossing. I did do my general assessment by the way, just not head to toe.
We were also told "we are not following nurses yet", so that was not an option.
Just a thought: if you're supposed to do an assessment and you come to your instructor saying "do I have to do this assessment?", she may have taken it the wrong way and thought you were trying to get out of doing assessments. I know that wasn't your intent, but it might explain why she was short with you & said to just do vitals. Again, just a thought.
I think it's great for you to practice assessments on someone who is soon to be d/c! They are stable. You are there to learn how to perfect assessments. If they don't need help with ADLs and are willing to chat, ask them about their hospital stay. Even if it's already in the notes, ask them what events brought them to the hospital, what happened during their stay, etc. Look through their chart and learn about the tests they had done (what they had done and why/expected vs unexpected findings for that particular test) etc. If you have time to kill and are allowed to use the computers, research/refresh yourself on the disease/surgery/whatever your pt has or had done. Compare it to what you see in your pt and their hospital course. There is so much you can learn, even on stable "boring" patients :)
question: is this your fundamentals clinical experience or med-surg one? sorry if you answered that already.
I ask this question because my fundamentals rotation was very similar. We did vitals, a.m care and there was a LOT of downtime.
One thing that can be super helpful and that I would highly suggest (make sure you are allowed to do this first) is to spend time looking at the patient's chart. As you progress through nursing school, in other rotations you will be responsible for a lOT of things- knowing your patient's reason for admission, medical history, recent diagnostic procedures, their progression SINCE admission, and their medications. Even if you are not responsible for these things in this rotation, if you have downtime and are allowed on the computer/in your patient's paper chart I highly suggest going through these and doing your best to follow the train of thought. It can be a highly beneficial experience.
Doing this taught me a lot. For example, I saw an order that a patient had for a Q6 blood sugar. There was no history of the patient being diabetic, so I was not understanding why this order was in place. I continued looking things up in the chart and realized that the patient was on a Q6 BGM because they were on solu-medrol. Things like that...you make connections as you understand things.
Other suggestions that I have: make a list of questions! Be observant and look around, make notes of questions that you didn't understand and try to look them up at home on google/in your books/asking students in above classes/other nurses. For example, even before we did anything with cardiac rhythms, I would look at the EKG monitors just to see what they were keeping track of. A lot of it, I would say more than 90 percent of it didn't make sense...but I did notice a thing in the corner that kept track of the number of PVC's. When it did come time for my cardiac rhythms lecture and I learned why, it was yet another lightbulb that went off.
Spend the time looking things up! At the very least, you have your patient's diagnosis. If you are allowed to bring a clinical companion or something look up your patient's diagnosis and see what the nurse's priorities are.
As you progress through nursing school, you will no longer complain of being bored/not knowing what to do at clinical because a time will come when you feel overwhelmed at all you have to do in clinical! So do what you can to learn.....even if it is not structured learning.
Another thing you can do is ask your instructor if you can follow around a specific nurse for the duration of your clinical day. Explain that you want to see how the nurse prioritizes a multitude of patients, etc. Worst your instructor can say is no.
Just a thought: if you're supposed to do an assessment and you come to your instructor saying "do I have to do this assessment?", she may have taken it the wrong way and thought you were trying to get out of doing assessments. I know that wasn't your intent, but it might explain why she was short with you & said to just do vitals. Again, just a thought.
I swear I don't ask things this way. I am generally very polite and think I'm pretty clear in what I'm asking, they truly just divert my questions. It's not just me, as I've explained. I believe I said "is it appropriate to do a head to toe assessment on a patient who is being discharged." Not in a whiny, elementary school way.
I am afraid I will end up with the same one since assignment is based on living location *sigh*. And I do vitals and help others with ADL's, I'm not saying there is NOTHING to do ever, I am just looking for instruction on what to do from there and not getting it. It is week three, I should be doing more than vitals, and when I ask a question I expect to at least have an answer attempted. I really did not know if it was appropriate to do an assessment on the patient, and I wasn't going to do something I wasn't sure about. Now I know.
Thank you for your input. I really hope you don't think I'm stupid for not trying to do the head to toe assessment, I am just very misdirected and unsure of what to do and don't want to mess up and be told I shouldn't have done something. I would rather just ask. It's easy to look back and go "duh, that's what I should have been doing" but as a new student I don't want to step over boundaries that I'm not sure I should be crossing. I did do my general assessment by the way, just not head to toe.
We were also told "we are not following nurses yet", so that was not an option.
Trust me, I dont think your stupid or trying to get out of doing things. It really does sound like your are misguided on what the expectations of you are, which is frustrating. If your didnt care, you wouldnt even have asked for help here. And I am also just a student and get flustered and lost sometimes too. My first clinical instructor was a doozy. Her knowledge was amazing and she helped me with pathos and understanding that aspect of nursing, but as far as clinical guidance, not so much. I was in a LTC tht had a lot of patients, so it was easier to find things to do, and nurses usually had a few "cool" things I could shaddow them on during my shift. But if I asked my instructor what else I should be doing, I wouldnt get good answers. I just kind of had to go with it and do my assessment and vitals, then go around and find things to do to pass time and attempt to learn. And if I was lucky, I actually saw the instructor at some point and was able to do a med pass. Once you get further into your program, this wont be a problem anymore because you will have skills. Once you know more skills, there will be more to practice with your nurses.
As a clinical instructor my self, first semester is usually vitals, ADLs, care plans, and assessments. Don't be too hard on yourself if it is your first week. I would ask your instructor for specific daily tasks if you are having trouble with what do do exactly. Sometimes there is really nothing to do with a patient and if that's the case help out ur fellow students or ask for more direction.
Since you have worked with patients before I can see how you feel like you are ready to get in there and really do something. It's only week 3, so much of my first semester was just about making students comfortable washing and cleaning naked people. For people who have never just walked into a room of a stranger and took their clothes off and washed and looked at every little detail of them - that itself is difficult for some. Then you have some getting past the "pee and poop is yucky" phase. Changing an occupied bed can take some practice if you've never done it - more practice if there are tubes involved.
I know I wanted to be doing something exciting, but we pretty much did the same for the beginning of the first semester.
It gets better and with any luck next time you will get an instructor you feel better about.
Specializes in Complex pedi to LTC/SA & now a manager.
I swear I don't ask things this way. I am generally very polite and think I'm pretty clear in what I'm asking, they truly just divert my questions. It's not just me, as I've explained. I believe I said "is it appropriate to do a head to toe assessment on a patient who is being discharged." Not in a whiny, elementary school way.
My clinical instructor would have taken it as trying to get out of an assignment as if she did not want us to do a full assessment on a patient we would have been told. Even if the patient was being discharged within the hour we were required to do a full assessment and vital signs. Period. ADLs VS & assessments plus observation is what we to do in our first clinical rotations.
My clinical instructor would have taken it as trying to get out of an assignment as if she did not want us to do a full assessment on a patient we would have been told. Even if the patient was being discharged within the hour we were required to do a full assessment and vital signs. Period. ADLs VS & assessments plus observation is what we to do in our first clinical rotations.
If the professor were this clear, absolutely I would have done the assessment. We were not told we were required to do an assessment that day, however. Do you see where I am frustrated? I wouldn't have asked if they told me to do it, and even if I did, the simple answer should have been "yes, still do the assessment" instead of ignoring my question and giving me another set of vitals to do.
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mrsboots87
1,761 Posts
As far as assessments, ALWAYS do them. Even for patients discharging. Looking from a nurses perspective, a full assessment before discharge is silly. But you are not a nurse. You are a student nurse. Your assessment is for your own learning. Heck, you'd be surprised. You at find something that was missed and worth looking at by the patients nurse. Most of the time, first semester is all about learning assessments, basic care, and med admin safety. Your instructor will be evaluating your competency is those things. But as far as going to the administrator above your clinical instructor, NOT a good idea while they are atill your instructor. You don't need a target painted on your back if they somehow figure out it was you. But def give all the feedback you want on their lack of communication and direction after you get your passing grade.