Med-Surg Clinicals

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Specializes in Med-Surg.

I'm a READMIT 4th semester nursing student (ADN) so I've had a year off and before then, honestly my other clinical instructors were a little TOO laid back, didn't make us do much of anything...and now this semester I have the strictest of the strict. Our instructor expects alot of us, which is fine, I feel I will learn more in this clinical than I ever have and that's what I need.

In the meantime, does anybody have any advice on time management or what you were expected to be able to know/do? I know that's a somewhat vague question but let me give you an example.......

Someone had a cardiac pt to do an assessment on...at the end of the day for post conference we have to all tell about our pts. When this person mentions the cardiac pt the instructor asks if she got labs, did she check troponin, ck-mb levels, etc. etc...that if she had a cardiac pt she should have known to do that. I felt bad for the other student bc honestly I myself wouldn't have known to call and check those levels? Or even known who to call...I feel so stupid right now...and when she asks questions on the spot about how to treat a certain pt, even if I would normally know the answer I just freeze up. I guess our instructor intimidates me.

We also have to be able to come up with teaching and interventions for each pt depending on what's wrong with them. This is hard to come up with on the spot and with so little time. I think it all comes down to poor time management on my part. I'm not used to it and we have so much to do that our 10 hour shift just doesn't give enough time to do it....on the other hand it makes the day go by fast lol.

Does anybody have any tips that helped you adapt to such a fast-paced environment? Or just any advice whatsoever I will be willing to take.

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Specializes in LDRP.

do you have computerized charting? if so the labs should be in the computer, ask a nurse or your instructor where to find them. i can give you a little itinerary of what my day was like in med surg if youd like.

7am - get there, have pre-conference and get my patients. get a copy of their SBAR and identify why they are there and what kind of care they are going to need for the day.

715 - go introduce myself to the patient, get vitals and blood sugar if needed, see if they need anything.

730-745 - get on the computer and do some research on the patient. if they have telemetry, print a strip and look at it. check labs and write down any abnormals, look up any meds im not familiar with. look up their condition and see what kinds of things i need to look out for with this type of pt.

815-9- morning med pass. make sure you have important info like labs and vitals to make sure none of the meds are contraindicated/need to be held. help feed breakfast if needed.

9:30-10:45- start outlining some nursing problems, and interventions to work with the patient throughout the day. give baths/or set up with supplies if they are able to do it themselves. get a coffee/snack. :)

11 - vitals, blood sugar, any interventions you can squeeze in. help with lunch if needed.

11:30-12:30 - give lunch meds (usually not a lot), answer bells, do interventions

1230 - EAT LUNCH!

1-230 - check in on patient, check to see if there are any new labs, see if other students need help, answer bells.

230-3 post conference. if you have been checking labs, vitals, doing interventions with the patient all day, you should have plenty to report on. if your hospital has SBAR report sheets, see if you can get a blank one and fill it in about your patient without using the already made one. just go down the sheet while in post conference and you should have all of your bases covered. if they dont have some kind of report sheet, you can make your own or download one off the internet. just search here on AN for Medsurg report sheet/brain sheet. There are plenty.

good luck! time management is one of the hardest things to get the hang of. just think of how lovely it will be when you are trying to fit the care for 6 patients into one day! :bugeyes:

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Specializes in ICU.

A couple of things...

For a cardiac patient, those labs should easily be found in their chart. The instructor expects a student to be looking for those labs, because those are standard cardiac labs.

I don't think time management is the issue. What the instructor is looking for is a deep enough understanding of pathophysiology and nursing interventions related to specific conditions that should make it easy for you to come up with teaching topics off the cuff. For example, if your patient's cardiac issue is associated with a long history of smoking, then you would want to teach smoking cessation. If you know your disease process and you know your patient's history, coming up with interventions and teaching on the fly should be easy.

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Specializes in Critical Care; Recovery.

I'm a new grad and working on a med-surg/Tele unit now for about 6 weeks. It can be very hard to keep up with labs, etc. I would recommend asking the nurse that is primarily responsible for the patient (the employee of the hospital whose patient you are caring for) for any tips throughout the day and to keep you informed (be very appreciative and thankful) of any significant findings or assessments that are important. Try to ask as many questions of the nurse as you can. Labs are usually drawn early in the morning, so attempt to write those labs down that are out of range. If the primary diagnoses is CHF for example, you may want to know what the cardiac enzymes for this patient were if any were drawn today. You will know what labs should be drawn by checking the orders for the previous day. You need to know the labs, because your responsibility as the nurse is to notify the physician (if they are not already making rounds while you are there) of abnormal results that may require an immediate intervention.

I would also say that coming up with interventions will get easier with time. You can draw on almost any aspect of the patient's care, but try to keep it relative to the primary problem the patient is experiencing that day. For example, a cardiac patient is experiencing an acute arrhythmia. An intervention would be to monitor their tele rhythm for changes, and administer antiarrhythmic meds as ordered. You can teach the patient to alert you via the call light for any dizziness or palpitations, and especially if they need to get out of the bed (if not on bed rest). You can teach the patient to take their meds as ordered, maintain a low salt diet (2000 mg or less), smoking cessation (everyone), and perform activities as tolerated (unless there is a doctor's order for bed rest).

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