Method for clinicals - What is it I'm missing?

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I'm great at test-taking, I had all A's my first couple of semester, I'm looking at getting a B in Med-Surg (I'm doing a lot better than most in this class, we have a very rigorous professor who loves to phrase things in much more complicated terms than you'll see in any NCLEX review book - there's a very high percentage of our class failing his tests). So I'm doing pretty OK so far in theory, but I'm pretty uncomfortable with my performance in clinicals.

I am in the second round of clinicals (well, fourth, sort of - each semester was split into two semesters, since we are part-time students), so presumably I should have some sort of established routine for clinical days. But I don't think I'm doing well at all. I write down everything from the chart, the diagnosis, the labs, the meds, the orders, the diagnostic tests, everything. I write up the pathophysiology for the diagnosis, the implications of any abnormal lab values, etc. I think that whole process takes me a lot longer than it should, and yet I'm still somehow not able to mentally put together the big picture of what's wrong with my patient and what's being done about it (yesterday I had a patient with pancreatic cancer, ascites, swollen legs, and oh, there was cirrhosis of the liver as well, I just didn't realize how it related to the ascites and swollen legs because we haven't covered cirrhosis yet and I wrote up the pathophysiology of pancreatic cancer, not cirrhosis. Sorry excuse, I know. I still don't know what was being done for her exactly - she was on pain meds, pancreatic enzymes, some antinausea stuff and something for GERD, but other than that... :confused:)

When I get in for the clinical day, I get report, but I'm not sure what to ask for, I just write down whatever they tell me. I then go in to assess my patient, offer help with breakfast, hygiene, and anything else they might need. I can keep myself busy with hygiene help, chatting with the patient, and such, but I'm not really sure what I should be doing when. I just feel clueless, and at the same time, I feel that I shouldn't be clueless, but I'm not sure what's the piece that I'm missing.

I'm sorry this is so rambling... I'm just not sure what it is that I'm missing, or I'm sure I could've written a more focused question... but then, if I knew what I was missing, I guess I wouldn't have to ask, would I?

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Specializes in LTC.

I hear you! It's frustrating to not feel as proficient as you think you should be. I am struggling with that right now in my clinicals. Sometimes I feel like the slowest one of my group! You sound like you're doing fine, I bet you're being harder on yourself than you need to be! People keep telling me that it just takes time...it will come with experience.

I spoke with my clinical instructor about my feelings and she too told me that it will just take time. Have you talked to your clinical instructor about how you're feeling? Maybe she can talk you through a typical clinical day and go over what's expected of you and when.

We were given this little chart to look at any time we are feeling like we don't know what we should be doing. I'm not sure if it would be helpful to you at all, but it has helped me stay on track at least.

"What are you doing/What should you be doing?"

0700-0800- Have I done my vitals? Does my patient need help with breakfast or need to be fed? Have I checked my MAR and meds?

0900-1000 - Are you ready for your meds? Looking at meds for the rest of the day?

1100-1200 - It is mid-day now. Noon vitals? Have I done my glucose checks? Its my assessment completed and charted? Any new orders on my patient?

1230-1300 - Do I have 2 PM meds? Have I charted my patients breakfast and lunch intake?

1300-1400- Thinking about I/O's? Have I done my IV counts? Did I review my flow sheet for completeness?

1430-1500 - Ready to give report?

1500 - Heading to post conference.

Anyways, sorry I don't have more input - I just know how you're feeling as I'm going through it myself. I'd be interested to hear what others have to say on the matter. Good luck to you, I hope we both get this worked out! :)

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Hi Guys!

I am by NO means an expert, but I am just 2.5 months from graduating with my BSN and about to start my preceptorship. I KNOW WHAT YOU ARE FEELING! I love the chart you posted BandAid. That is fantastic and I think I will use it during preceptorship! The instructors are correct, this does come with time and experience. Part of the reason you are there is to get familiar with what nurses do and to offer extra TLC to patients. You are learning the ropes. Always communicate with your clinical instructor. If they know you are striving to do more, grow more, learn more - well, that is in your favor! Also, offer to help your nurse with everything you can. Are you doing EMR? Pull out your books and research even more than you did during your patient prep. Ask tons of questions. Check to make sure the med doses are safe. Check to see if they can interact with eachother, etc. Sometimes it is really hard to find something to do. It is hard to get into the swing of things. Give yourself a break and keep the communication lines WIDE OPEN with your instructors, faculty and nurses. You sound very concientious and I am sure you are doing fantastic!!!!

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Thanks, you two.

I'm going to try and see if I can adapt that timetable to my clinical day, BandAid. My clinical day is a bit shorter though, only from 0700-1300, and we leave the patient to go to lunch and then post-conference at about 1100-1130, so it's even less time with the patient. But I'm sure I can find a way to break it down effectively. I'm a little afraid to ask my professor to break it down, because she did have it broken down for us the first day she was with us, but we were out of clinicals for almost a month (holiday weekend, then two weeks on campus instead of in the hospital) and I don't remember much of it and didn't have much opportunity to get into the swing of things with it.

Betsy - Thank you for the words of support. What is EMR? I don't think we're doing that yet, if I don't know what it stands for. :p I'll have to try harder to keep the line of communication open with my professors, I've got a ridiculous fear of looking stupid.

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It feels so good to hear about other people feeling a little bit lost. My main problem is that once I'm there, at clinicals, my mind gets very overwhelmed and overstimulated. I don't think clearly and have definitely made at stupid mistake or two (nothing that would harm my pt, thank God). How can I overcome this? Im a straight A student in class but once we get to the hospital my brain turns to mush. I talked to one instructor and she viewed at as a weakness and seemed to take advantage of that fact rather than appreciate my candor.

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EMR = Electronic Medical Records....the patients' charts are on the computer rather than paper. :)

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Shannontoo....some instructors are like that....so, befriend the nurses and learn from them! Know you are NOT alone and your instructor probably felt the same way once upon a time. Keep your care plan with you, talk with your patient, talk with your nurse, just keep putting one foot in front of the other! You can do this! Lots of people less intelligent than you have graduated from nursing school and passed the NCLEX. Just keep going. Read a bit when you get home (about your patient's pathophysiology or meds or anything) and then REST!!! Let's all agree not to be too hard on ourselves, okay? All together now: "We are students!"

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Oh! The hospital has those, in addition to the paper charts. We have to get a nurse or somebody to print out anything that hasn't been added to the chart yet, which can be a bit difficult at times. As students, we don't have access to any of the electronic records unless somebody breaks the rules (I'm assuming it's against the rules) and allows a student to look through the MAR or labwork, for example, under their username.

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Wow this is fascinating to read. I presume you are all American? I will start my bn next year. I love reading about this and imagining me in a few months. I'm Aussie by the way. Good luck to you all and yes don't be too hard on yourselves.

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