My first Clinical class and how to best prepare for it

CrunchyMama, ASN, RN · May 6, 2010

I'm about halfway through the 2 year program so I can only give so much advice. But from what I've noticed on our tests is that out of 4 answers, there's 3 good ones but you have to pick the BEST. It's hard and I've spent numerous minutes arguing with professors on why certains questions I got wrong should be right, lol. You just have to know what is MORE important. It is tough but start reading ahead of time and taking the practice tests. Good luck to you!

Lawrence F · May 6, 2010

Are you referring to the NCLEX review exams? It sounds like your doing the right thing since your halfway done. I hear from people that have taken their first clinical (NURSING 111) that theres an unbelievable amount of reading and the teachers don't really do a good job at preparing you, where I go. It seems like you have to do monst of it yourself. I'm not saying that it's good or bad because I have yet to take a clinical course, but I would think that some sort of instruction would be warranted. My friends say that there's not much handholding which if true, is very understandable. I have no problem with working hard to obtain a goal; I just don't want to be overwhelmed. It seems that as I've gotten older it takes me longer to remember the material for better or worse.

Thanks for your help.

Lawrence

llg, PhD, RN · May 6, 2010

This response will probably stir up some controversy, but here goes ...

"Critical thinking" is a current buzzword that educators are using to refer to a person's ability to think clearly and problem-solve. It's the ability to go beyond the mere memorization of facts to the ability to apply information to real-life situations that may not always be clear-cut. It includes "common sense."

Some people can memorize facts well enough to anwer test questions that require the recall of those facts just fine ... but they have little ability to actually use that same information to solve a real-life problem. They lack "critical thinking" skills.

Yes, those skills can be learned to some extent. But it requires a lot of practice with problem-solving -- not just the reading of a book. Some people find it helpful to practice problem-solving by doing practice tests questions. Some people don't find that helpful. I wouldn't get all worked up worrying about it unless you find you have a problem with the application questions on exams.

CrunchyMama, ASN, RN · May 6, 2010

Are you referring to the NCLEX review exams? It sounds like your doing the right thing since your halfway done. I hear from people that have taken their first clinical (NURSING 111) that theres an unbelievable amount of reading and the teachers don't really do a good job at preparing you, where I go. It seems like you have to do monst of it yourself. I'm not saying that it's good or bad because I have yet to take a clinical course, but I would think that some sort of instruction would be warranted. My friends say that there's not much handholding which if true, is very understandable. I have no problem with working hard to obtain a goal; I just don't want to be overwhelmed. It seems that as I've gotten older it takes me longer to remember the material for better or worse.
Thanks for your help.
Lawrence

I was referring to the tests I've taken in class. I'm in the process of buying an NCLEX review book, something I wish I would've bought before I started the program...but I've been getting As so far...don't ask me how, lol. So not having one hasn't effected me so far. But from what I hear, it's definitely helpful and the sooner you get started on nursing style questions the better IMO. Every school is different and at mine a lot of it is teach yourself but luckily there's a lot of good resources to help such as books, little handbooks, CDs, etc. Plus there's tutoring which I haven't had to utilize. It is a lot of work but worth it and it doesn't last forever, lol.

dudette10, MSN, RN · May 6, 2010

This response will probably stir up some controversy, but here goes ...
"Critical thinking" is a current buzzword that educators are using to refer to a person's ability to think clearly and problem-solve. It's the ability to go beyond the mere memorization of facts to the ability to apply information to real-life situations that may not always be clear-cut. It includes "common sense."
Some people can memorize facts well enough to anwer test questions that require the recall of those facts just fine ... but they have little ability to actually use that same information to solve a real-life problem. They lack "critical thinking" skills.

That's exactly what I think critical thinking is. Why in the world would your definition "stir up some controversy"?

To the OP, llg's response is right on. Many of your test questions will ask you to take your fact-based knowledge and apply it to scenarios given in the question. It's what nurses do, actually. They look at a patient, and from the information they gathered, they figure out what is wrong with the patient and what they can do about it within the scope of practice and who they need to collaborate with based on the roles of other healthcare team members.

Lawrence F · May 6, 2010

Thanks for replying. I suppose that I will purchase an NCLEX review guide/exam book. It's just scary to me because from certain people I've heard that it (the classes) can be be a bear to take and get through. I have spoken to one person who must be extremely intelligent because she is taking up 2 Nursing Clinical classes plus the full complement of pre-requisites as well. I'm sure that it's all in who you ask but since I don't consider myself an outstanding student (When I was in my 20's the information would just absorb like a sponge.) Now that I'm considerably older, I'm looking for every trick in the book to outwit (not cheat) but outsmart the nursing clinical classes if that's at all possible. We shall find out in a few months since finals are over next week for me; but I am taking up a remedial math course in the summer so that I can take up clinical calculations in the fall. It's been probably about 40 years for me since I've seen that kind of math (I took up clinical calculations this semester and when I asked my young teenage kids for their help they said that "they forgot" when it came to fractions and all. I thought it would do me good to take up the math review class. Heck, I'm 51 but feel that I can keep pace with everyone including my own kids.:) Now I just have to convince myself that all I need to do is appy myself and dedicate the nessary time and resources and it shouldn't be a problem. Hopefully, I'll turn out to be right.

Thank you,

Lawrence

Armygirl7 · May 7, 2010

Hey Lawrence-

Keep an open mind - and do the best you can! You'll develop your own rhythm once you get into clinicals.

Two books I used that were great for prepping and testing myself on fundamentals were

"Test Success"

and

"Fundamentals Success" both by Nugent and Vitale

I loved those books.

Ask for help when you need it, find your allies in the program and the instructors who explain things the way that you understand and ask for and accept help if you need it!

I found keeping up with or slightly ahead of the lecture readings helped me. When I fell behind I inevitably did worse on those exams.

Critical thinking starts with common sense - like what's the first intervention when you come upon your patient short of breath lying flat in the bed? You sit them up!!!! And it progresses from there as you incorporate more and more complex clinical data and assessment skills and knowledge of interventions.

As far as remembering what to do in clinicals my first clinical instructor just drilled into us "Head to Toe" and "ABCs" (airway, breathing circulation). Take care of the patient's immediate need first. Wash your hands. And never ever ever ever skip any of the steps (5 rights and 3 checks) in Med. administration!

Nursing school is fascinating because not only do you learn these amazing skills but you learn so much about yourself.

Best of luck!

AG

Lawrence F · May 7, 2010

Hi AG,

I want to thank you for your comments. I actually went ahead and purchased a couple of test preparation books but I need to check to see if they're the same authors. I'm certainly going into this with open eyes and I believe better prepared than a couple of my friends who have preceded me. I know of this young woman who was taking NUR 111 this semester. She was also in my A&P II class and my clinical calculations class. All of a sudden it was as if she had been hijacked because she first disappeared from the Clinical Calculations class. I left shortly after she did but only because the material was like reading/doing a completely new language. Then she left my A&P class and I haven't seen from her or hear from her although I hope she is at least passing that class! I will definitely continue to learn and seek out allies and people that don't mind helping out. I also want to join and get together some type of study groups because I heard those are very constructive as well. Let's put it this way. Anything that is legal and can be done, I'm willing to do; and if that means burying myself in the library for hours at a time, so be it. The program will be over and done with it before I realize it so I intend on keeping up with the pace!

Thanks,

Lawrence

Intern67 · May 7, 2010

Hello,

Have you been accepted into the RN program? If so, good for you for trying to be prepared. A word of warning: Self directed study in nursing textbooks is often nonproductive. Same goes for test taking skills study when you don't have any practice or experience in NCLEX style testing. It's not a bad thing to do, but you may not get much bang for your buck.

The best way for you to prepare for clinical is to work a job as a CNA alongside nurses. The more demanding the floor, the better. Learn as much as you can in that environment and you will be well on your way to clinical success. Your instructor will be far more impressed by your ability to introduce yourself to your patient, do your assessments, perform ADLs and get them to breakfast at a reasonable time than if you can describe all the Korotkoff sounds.

"Critical Thinking" is a challenging subject to wrap your mind around. It has many facets and is how nurses approach problem solving. The concept is very difficult to deliver in one sentence and requires a combination of reading, lecture, discussion, and application to "get". You will study it and will understand it better and better as you go along. Or you won't. Critical thinking is something you never just acheive but is a lifelong process.

You will find that you understand critical thinking more and more as you apply nursing knowledge. However, some of my classmates never get this. Here are some examples:

A few of my classmates:

- Still believe that vaccines cause autism.

- Believe that airplane contrails are probably government controlled poisoning experiments.

- Don't understand the significance of positive/negative charge or intracellular/extracellular location when it comes to ions.

- Believe that websites that claim miraculous cancer cure rates are "Just as valid" sources as the Med-Surg text.

- Have no idea why peer review and scholarly sources are valuable when you can just "google everything".

- Have no understanding of how fluid shifts between compartments in the body or why the tonicity of IV fluids is crucial. (They try to memorize instead of understand.)

- Have no idea that serum pH is a measure of acidity and not just "a number that goes up or down."

- Cannot decide whether to give or hold a med based on data from the patient and the Drug Book.

- Cannot tell why needle sizes, gauges, and injection sites are selected. (Again, they memorize instead of understand.)

In each of the points above, various aspects of critical thinking are sorely lacking. After a year of nursing school, you will have a much better idea of what this means.

Good luck

Lawrence F · May 7, 2010

Thank you very much. I think your answer perhaps grounded me in reality. Yes I have been admitted into the nursing program which is what makes this even more exciting, but I can completely relating to not getting a great ROI with the NCLEX exams and doing them in a vacuum. Definitely made sense. Believe it or not, I have through my wife a sister in law who went to a very fine 4 year NYC based institution who believes that vaccinations causes grave illness and so has selectively given her children immunization shots. You give me a lot to think about and I'm grateful to you for that. The one thing that I am definitely going to be doing is reading the textbook over the summer from cover to cover. I hear that in NUR 111, you walk in and they tell you to have 8-12 chapters read by the following week. So at least I'll feel a little bit better knowing that I have done whatever I could do to prepare myself as best I can. Becoming a CNA sounds like an excellent idea except the hospitals that are near me are more likely to replace anyone who isn't a nurse than to get someone in to assist them. I can probably ask and look in the city to find something but again, you've given me something else to think about; I appreciate it.

Take care and again, thank you.

Lawrence

Isitpossible, LPN, LVN · May 7, 2010

hi lawrence! i too am an older student and began my BSN program in Sept..i felt just like you anxious and worried because id heard so many negative things! dont find the information "hard", its just simply soo much of it..someone mentioned getting the fundamentals success book, i would second that 100%..that book was a godsend..when you take practice questions and get them wrong, concentrate on reviewing the rationales, they provide so much clarity. my school also does not engage in "hand-holding"..i just finished maternity class, and my teacher simply literally read the powerpoints slides to us...so there will be much self-study and self-learning...i studied by reviewing the powerpoints and then reading my book..i have a good friend and we both write up all the notes, and quiz each other before tests...it really helped us alot...also my school uses the evolve system, and i take all those practice test and case studies...so whatever resources your school has take full advantage.. and someone else also mentioned "memorizing" vs "learning"..i hate memorizing..if i learn the material there is NO NEED to memorize! i have a 3.5 gpa now...im very proud of that considering working full time, have a family and not so young anymore ..many people on this board are exactly in our shoes, and they do it...dont get too afraid...your doing the right thing..get PREPARED! good luck and let us know how you do..