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.

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.

So is this all done in a summative essay at the end of it all, or are there standardized forms on which you check boxes and fill in lines?

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Specializes in LDRP.
So is this all done in a summative essay at the end of it all, or are there standardized forms on which you check boxes and fill in lines?

At my previous school, we have these long green sheets called "client care plans" where we recorded all our info. its folded into thirds and the front lists the clients initials, medical dx, chart #, admission date, and organizational plan of care, the second page is for entering data from assessments and the pts chart according to the functional health patterns (health perception, nutritional-metabolic, elimination, activity-excersise, sleep-rest, cognitive-perceptual, self perception, role-relationship, sexual-reproductive, coping-stress, value-belief). The third page we list any lab/diagnostic test results, summary of medical/surgical history, and the pathophisiology of their major medical dx. On the back we list the physicians orders, and med orders (med, dosage, route, time, classification), as well as the nursing dx with client goals and the nursing interventions and client responses.

We also write a nursing note for every pt in our weekly clinical journals.

I restarting with first semester at a new school in Jan. I am curious as to how similar it will be.

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Specializes in Critical Care; Cardiac; Professional Development.

We also have a worksheet we fill in along with narrative chart notes, which is basically a blank sheet of paper. Everything done is recorded on these pages - the worksheet is pretty much for the head to toe assessment and nursing diagnoses associated with the findings. The charting is what nursing interventions are implemented and then following up through the day on patient responses to those interventions. These things are then utilized to create a formal care plan, which is turned in at the end of the week. It is kind of like having to write a major paper every week to be honest, at least until you get the hang of it. For me, care plans have gotten easier as I have gotten more experienced in writing them.

I found the idea of "nursing diagnosis" and "nursing interventions" to be pretty confusing when I was a brand new nursing student. It is possible that is throwing you off a bit as well. We don't make medical diagnoses, but we do make nursing diagnoses based on what the patient's medical problem is, and then implement our own forms of "intervention", which is evidence (published nursing research) based to statistically be known to improve the quality of patient life or the speed of patient healing etc. These are more holistic in nature (ie: ways to encourage peristalsis after surgery, ways to clear the lungs to prevent pneumonia, ways to prevent blood clot formation etc) than the physician's medical diagnosis and treatments, which are more scientific/pharmacologic in nature (diagnostic tests, medications, surgeries, etc). In order to be able to do this, one has to be current on effective, evidenced based nursing interventions and the disease process itself as well as all the risks and benefits of what treatment they are getting medically (drugs, surgery, wound care, etc), how the hospital setting affects the patient, the patient's personal history both medically and socially etc. Thus all the intensive paperwork and homework.

I have marveled a bit myself how few nursing students I saw during time I have spent at the hospital. When we students are there the hospital feels like it is crawling with us. But we are only there one or two days a week and aren't on every floor so maybe that explains it. It could also be that we just aren't as conspicuous as we feel.

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Specializes in Emergency/Cath Lab.

I think the farther you progress into the program the more you understand the use and rationale behind the madness that RN2BDFW has described. I was the same way when I heard you had to do all this stuff and was like, how is any of this necessary? You quickly realize it gets you thinking about everything and taking into consideration the things that you need to be doing/are doing. It is stuff you eventually do all in your head when you are on the floor working, but you have to build that knowledge and background first.

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I found the idea of "nursing diagnosis" and "nursing interventions" to be pretty confusing when I was a brand new nursing student. It is possible that is throwing you off a bit as well. We don't make medical diagnoses, but we do make nursing diagnoses based on what the patient's medical problem is, and then implement our own forms of "intervention", which is evidence (published nursing research) based to statistically be known to improve the quality of patient life or the speed of patient healing etc. These are more holistic in nature (ie: ways to encourage peristalsis after surgery, ways to clear the lungs to prevent pneumonia, ways to prevent blood clot formation etc) than the physician's medical diagnosis and treatments, which are more scientific/pharmacologic in nature (diagnostic tests, medications, surgeries, etc).

Apparently, I screwed the quote up.

Your reply explained a lot so thanks. I appreciate that. Question: Wouldn't it make sense for these interventions to be backed by hard science?

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Backed up by science...yes. We call that Evidence-Based Practice.

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Specializes in Critical Care; Cardiac; Professional Development.

Yes...that is the research I referred to in my post :) There is a lot of research going on these days on nursing interventions and their effectiveness. You will access a lot of it during your nursing school days, for writing papers, researching interventions and proving rationales.

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Specializes in student; help!.
holy crap

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

And this is right about where Daytonite would blow a gasket.

If you haven't already, check out the care plan sticky thread because it certainly pertains to clinicals. It is logical and educational. Don't you need to know WHY you're doing something? How else will you learn that unless you participate in the care of patients? And honestly, would you want a student just swanning in and and covering your care without having gone through your chart and knowing the whats and whys of your situation? I sure wouldn't. So, you get homework. Remember homework? You do it to show the teacher that you understand the material. If I don't have assignments like this, I will seriously question the quality of my education. That doesn't mean I'll enjoy it, but I understand why they require it, and its purpose in my education.

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Specializes in Cardiac.
The diagnosis is already there and treatments are physician ordered. Am I wrong?

Sure the MEDICAL diagnosis is already in the chart, but as nurses we make our own diagnosis and then plan interventions based on OUR assessment. Some of the nursing interventions involves the medical stuff, but sometimes not. We have our own evidence-based practice as our foundation. The further alon in nursing school you get you will understand what I am talking about. Also, unlike doctors and med-students, we stick around and help the patients, not just perform drive-by medicine...

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And this is right about where Daytonite would blow a gasket.

If you haven't already, check out the care plan sticky thread because it certainly pertains to clinicals. It is logical and educational. Don't you need to know WHY you're doing something? How else will you learn that unless you participate in the care of patients? And honestly, would you want a student just swanning in and and covering your care without having gone through your chart and knowing the whats and whys of your situation? I sure wouldn't. So, you get homework. Remember homework? You do it to show the teacher that you understand the material. If I don't have assignments like this, I will seriously question the quality of my education. That doesn't mean I'll enjoy it, but I understand why they require it, and its purpose in my education.

I think you can read and understand something without first filling out a form. Thanks for the input though.

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drive-by medicine...

another reason why EM seems like the best nursing work environment...shorter contacts. :p

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another reason why EM seems like the best nursing work environment...shorter contacts. :p

I think that is what might confuse you. Unlike med students and EMT's you don't just help a patient, then move onto another patient. I use to think nursing was like that. When you're a nurse, you are that patient's nurse for the entire day. You are the only nurse that is responsible for that patient all day (for your 12hr shift). Think about something like Labor and Delivery. After the baby is born, they are moved to the maternity ward aka postpartum floor. They spend 2-3 days there recovering. They are your patients for those 2-3 days and only you for that shift. If there is couplet care you will be fully responsible for the care of their child as well for your shift (whether the baby is in the room or the nursery). You will be the only nurse to care for them, the only nurse to give meds to them ect.

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