How do nurse clinical usually work?

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I think the question asks it all.

You show up at the hospital or whichever setting with your handful of stuff. Then what? Grab charts and go at it? Shadow someone around the whole time? Shadow at first then do on your own? I'm curious.

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Specializes in Critical Care; Cardiac; Professional Development.

It may have variations at every school.

At mine, we were assigned our patient the night before. We had to go to the hospital, look up labs, record what meds the patient is on along with their diagnosis etc. Then prior to clinicals the next day, we prepare a "textbook picture" of this patient's diagnosis and the top nursing interventions pertaining to it. We also make drug cards for each of the patient's medications, then make a care map that incorporates all of the above information to help us understand how each piece of the puzzle interacts with and affects the other pieces.

We MUST have all of this documentation when showing up for clinicals the next morning or we are sent home. In first semester we have one patient for most of the semester, then graduate up to two by the end of the semester. It is my understanding we will start with two in second semester and continue up from there.

Then we get to clinicals, have brief discussion with one another and our instructor about our patients for that day, sit in on shift change, then go in to get the patient's vital signs. We record these things, talk with the patient and then utilize our research to perform interventions that will assist the patient in getting well. We also do tech care such as bed baths, walking the patient, assisting the patient to the bathroom etc. We record I&Os and shadow or assist with passing meds once cleared to do so. Once in a while we get a day that for whatever reason is slow. On those days, we are assigned to shadow a nurse, who then teaches us anything and everything she is doing as she does it. We do dressing changes, injections, pull Foley catheters...help order meals, talk with the patient, teach them exercises, nutrition, about their disease process. We advocate for the patient, talk with the assigned nurse about the patient's condition, ask questions, get answers, take notes. We do head to toe assessments on every single patient we are assigned to and chart everything we do.

That night, we take all the information we have about our assigned patient or patients and create care plans, which must be turned in with all paperwork to our clinical instructor by noon on Friday for a grade, which consists of all of this documentation plus professional behavior and technical skills observed by our instructor during clinicals that week.

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holy crap

What in the real world works like that? None of that seems remotely logical or even educational.

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Specializes in Cardiac.

wow...I must attend the planet's easiest nursing school...

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Specializes in Utilization Management.
holy crap

What in the real world works like that? None of that seems remotely logical or even educational.

Hardly anything about nursing school is logical :clown:

While most programs vary greatly in how clinicals are done, they are similar in that you'll be part of a clinical group. Usually your instructor will assign a patient to you (whether it's on your clinical day or prior is what varies) and you gather information on the patient for what ends up being a TON of paperwork. What semester of nursing you are in is what determines the kinds of skills you'll be allowed to perform in the clinical setting. In my program, as long as we had been taught the skill in lecture/lab we were allowed to perform it during clinicals (with our assigned nurse).

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Specializes in Critical Care; Cardiac; Professional Development.

Actually it is both logical and educational. It teaches us about disease processes, how they affect the body, how pharmacologic intervention affects the disease process as well as the body, how each of these things interaction with one another, facilitating the critical thinking needed to answer those pesky NCLEX style questions on exams. We practice the skills we are working on in lab in real life situations and learn the ins and outs of real hospital life and what is involved in caring for a patient both from the nurse's point of view and that of the tech, who we theoretically will be needing to delegate to once we are RNs. I find clinicals both fun and educational. We learn not only how to do things, but why we do them and what the risks and benefits are.

Our school has a 90% retention of the admitted student body on average and 95% of our students pass the NCLEX within 90 days of graduation. This past semester 100% of the student body graduating had employment offers for RN positions prior to graduation. It seems this rigorous routine pays off.

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Specializes in Cardiovascular, School Nursing.

In my experience with nursing school (I've completed 2 semesters thus far), it is very similar to the above posts. We have a ton of paperwork that needs to be completed about our assigned patient. This paperwork includes detailed care plans, medication sheets, etc. It is tedious, however like RN2BDFW stated, it is designed to educate us on the nursing process, disease processes, medications and such. The hands-on part helps to gain nursing skills (vitals, assessments, bed baths, ambulation, med pass, injections). Our program also has an impressive first-time NCLEX pass rate (100% last year!!), so in my opinion, that is something to be said about the workings of this program.

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Specializes in OB/women's Health, Pharm.

ImThatGuy

No, this is very logical and very necessary.

Think about this: How in the world can you expect to safely care for someone without having researched their condition, understanding their surgery or diagnostic tests, or reviewing their labs AHEAD of time? This process takes time, so you cannot just show up and look things up then, you have to come prepared to start giving care pronto.

And you cannot count on having learned about it in lecture. First of all, we have so much to cover in class, we cannot go into every condition in detail. And, because we have to care for whatever patients are available, several may have conditions that we will not get to in lecture for several weeks, or until the next quarter.

No nurse should ever give a med without having at least an idea what is is, what it does, what the normal dose is, any major or common side affects, and any special cautions involved in its use. We cannot spend 15 minutes looking up several meds that are all due at 9AM; hence it needs to be done ahead of time, the night before.

I am a faculty member. Reasonable students take seriously that they will spend hours the night before clinical getting ready for the next day, re-reading their books, etc. Goof offs, or the folks who are too dumb or arrogant to realize how little they know, come to clinical unprepared. Whoa! Bad idea. If you are in my clincial group and do this, I will quickly know it, because you will not be able to answer my questions. You will get a warning and risk getting sent home if it happens again. Do it a third time and I will fail you clinically.

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I think the question asks it all.

You show up at the hospital or whichever setting with your handful of stuff. Then what? Grab charts and go at it? Shadow someone around the whole time? Shadow at first then do on your own? I'm curious.

Patient assignments are made the day prior to the clinical experience; students go to the hospital and gather information about the assigned patient late in the day (or evening) prior to clinical. Then the student researches the diagnoses, procedures, medications, etc. for that patient to prepare to give good, safe care the next day.

Students often are assigned to to basic personal care for the first clinical, then care progressses to include po meds, injectibles, IV fluids/medications, and non-pharmaceutical interventions to improve the patient's condition. Typically one begins the day by reviewing the info that was researched, then planning the day with/for the patient, performing a full assessment, personal care, etc. The student may or may not accompany the patient for tests/procedures to be performed off the nursing floor.

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Specializes in OB/women's Health, Pharm.

MammaC95

Good post, nice summary of how clinical works.

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I'm just a little perplexed. I've never really seen nursing students in the hospital or anywhere else that I was aware of.

I know this is a lot different, but when I was in paramedic school we'd walk in, look over charts, go make an assessment or practice whatever other skill we wanted/needed to do, and floated around with the staff nurses or doctors.

I'm really surprised you only get one or two patients. It's kind of perplexing to me is all. I understand that you'll learn about CBCs and interpreting them as such, but I'm confused in what you'll do about it once you've gone through all that paper work. The diagnosis is already there and treatments are physician ordered. Am I wrong?

I'm familiar with medical students and residents and surmised that nursing school worked pretty much the same way. By that I mean, from observation and conversation, walk in, work, report to someone who can actually do the job, and if you come up against something you don't know about then crack a book and read up on it.

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Not all hospitals accept nursing students, so it's very possible that you've not seen any around. Other than a particular uniform or patch, you may not recognize them as being students.

As for the research done on the patient assigned to the student, he or she will look up and write about the patient's diagnoses - pathophysiology of the disorder, common medications/treatments used, possible complications associated with it, etc.

The list of meds used by that patient is listed and a drug reference used to look up the usual dose of the med (or dosage range), possible side/adverse effects, what the drug is used for, the route it's given, etc. The student nurse must know all that info prior to administering the meds and the clinical instructor is likely to quiz the student on this prior to allowing med administration.

The patient's past medical/surgical history is written up, along with social history, med/environmental allergies, etc.

Based on the diagnoses of the patient, the student nurse writes up possible nursing interventions to implement, how those interventions are expected to affect the patient's condition, what will happen if improvements are not as expected, etc.

It is pretty typical to begin with just one patient - and you'd be amazed at how busy one student can be for an entire day with one patient! Total care is given, including those tasks that might usually be done by nurse assistants/aides, or what have you. Bathing, personal care, toileting, linen changes, tending to dietary needs/concerns, measurement and recording of all intake/output, etc. He/she will also perform a full assessment, which takes a while for a new student. Everything is documented, depending on the system of the institution - so a new computer system will be learned as well.

A good clinical instructor will progress the student's responsibility depending on ability and readiness, so at some point there could be students who still have only one patient while others have 2 or more. Just depends.

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