Need Advice for Clinicals

**NICU Guy, BSN, RN** · Oct 20, 2019

2 hours ago, Mattf526 said:
I do not really feel confident in a lot of my skills, as I’ve never had patient experience before, but I do not want to come off as being a completely incompetent student.

If this is your very first clinical, then you do not have any skills. That is why you are in nursing school, to develop those skills. Most clinicals are usually 10 students and one clinical instructor. You may be assigned to a nurse, but you will be shadowing the nurse not taking part of her assignment. Depending on the school/hospital policies, students may or may not be able to perform procedures (IVs, foley catheters, giving meds, etc) without their instructor present.

"Preceptor" term is used during a Capstone placement in your final semester. It is 1:1 with a nurse. You perform all procedures under the supervision of the nurse. By the end of your Capstone (if your school has that as part of your schooling) you should be able to handle a majority of the nurse's assignment. It is your final preparation for being a nurse after graduation.

Oldmahubbard · Oct 21, 2019

OK, 10 students to one clinical instructor.

And a student would never have a "preceptor" where I come from.

Form what I hear, students are taking almost the entire assignment, so the RN can sit behind the desk, feet up, doing his or her nails?

So how is every student always supervised by an RN?

The number don't add up.

Once again, I have to call male cow fecal matter on what people write on this forum, about how they did almost everything a licensed nurse would do as a student, including the full caseload.

I do not believe it.

For the OP, your first clinical experience is normally assisting patients with hygiene, and learning to assess the human body.

I am sure specific learning goals have been identified in your course outline

**NICU Guy, BSN, RN** · Oct 22, 2019

17 hours ago, Oldmahubbard said:
OK, 10 students to one clinical instructor.

At the school I went to it was a 10:1 ratio for clinical. Students shadowed a nurse and per hospital policy, were only allowed to do skills under the direct supervision of their instructor.

17 hours ago, Oldmahubbard said:
Form what I hear, students are taking almost the entire assignment, so the RN can sit behind the desk, feet up, doing his or her nails?

I can't imagine a hospital and a school allowing this to happen during normal clinicals (not Capstone) where the instructor from the school is responsible for the ten students. Both the hospital and the school would be liable if something were to happen to a patient and the nurse would lose their license.

17 hours ago, Oldmahubbard said:
So how is every student always supervised by an RN?
The number don't add up.

This is during a Capstone placement during the final semester. Each student listed 3 specialties and 3 hospitals that they wanted to do their Capstone at. The school attempts to arrange the student's top choice of specialty and hospital. I chose the Level IV NICU at the Children's Hospital. One classmate chose ER at the Level I Trauma Center. Others chose specialties that they were interested in. You were assigned a nurse and chose days that worked for your class schedule and aligned with the nurse's work schedule. I was with her for 12 twelve hour shifts. On the last shift I was doing full care of the patients under her general supervision which included an infant on a ventilator and another on High Flow nasal cannula (starting IVs and meds were under direct supervision).

17 hours ago, Oldmahubbard said:
Once again, I have to call male cow fecal matter on what people write on this forum, about how they did almost everything a licensed nurse would do as a student, including the full caseload.

Isn't that the goal of nursing school to prepare you to perform as a nurse upon graduation? If a school does not have a Capstone placement, then yes, the student would not have the opportunity to have one on one teaching that a Capstone provides. These were not 1-2 hr clinicals with 9 other students on the floor. These were 12 hr shifts with me being the only student on the floor with a nurse that was fully responsible for my actions. My unit routinely has Capstone students, so my School (3 hrs away) is not the only school in the country that has them. Every one of them is handling the full workload of the nurse by their last day which they are expected to be able to handle if they want a job after graduation.

**NICU Guy, BSN, RN** · Oct 22, 2019

17 hours ago, Oldmahubbard said:
Once again, I have to call male cow fecal matter on what people write on this forum

I also don't appreciate you challenging my integrity on this site. I have been on this site for 6 yrs, from student to nurse. I am a very active contributor on this site and my journey from a student up until now is well documented. My post was 100% accurate to my nursing school experience. To have you call it "male cow fecal matter" is an insult.

Kyla RN, BSN · Oct 23, 2019

On 10/20/2019 at 12:58 AM, Mattf526 said:
Hey there! This is my first time on the forums, and I’m just looking for advice, helpful tips, and maybe even just some reassurance with the whole clinical experience. I start my first clinical on a tele unit this week and I’m really nervous about slowing down my preceptor and/or being a hassle for them. I do not really feel confident in a lot of my skills, as I’ve never had patient experience before, but I do not want to come off as being a completely incompetent student. So, what’s your best advice for still getting the help and learning experience that I need, but without completely dragging down my preceptor? Thanks!

If it's your first clinical, you will most likely shadow, practice some simple skills (i.e. vitals, hygiene), practice writing care plans. This is your opportunity to absorb as much information as possible in a fast-paced complex unit- so take advantage of it! Get the most out of your education! I can appreciate your sensitivity to not wanting to "slow down" the nurse you're paired with- that's how I felt as a student nurse as well. While there can be some truth to feeling slowed down while having to student, all nurses have been students in the past. Everyone has been in your shoes at one point- it's how we've all ended up where we are now. They should know this. If you get a nurse that's engaging and encourages your learning- awesome. If you get a prickly nurse who inhibits your learning experience- get what you can from the experience, there are other ways you can learn on the unit as well:

-if you meet the charge nurse, as them to let you know if there's any interesting skills being done that day on the unit that you can shadow. I.e. wound vac change, NG tube insertion, ostomy bag change.

-engage with the CNAs, they can be full of knowledge regarding day-to-day skills i.e. hygiene, ambulation or transfer with equipment, (and sometimes, they're looking for an extra pair of hands!)

allnurses Guide · Nov 12, 2019

The best way to not slow down your nurse is to stay close, keep up, don't hover when he/she is charting and perform all the skills you are able to on all the patients he/she is assigned. In first semester, that means giving bed baths, toileting, vital signs, walking the patients who are able and doing other tasks. In first semester you will be entirely focused on these very basic nursing skills along with a head to toe assessment on one of those patients.

Good luck!

Professor X, MSN, RN · Nov 12, 2019

1. know exactly what you are supposed to be doing. Ask your clinical instructor if you don't understand the learning goal of the day. (Is this a day we just shadow? do we write up a care plan for one patient? or two? Is this the day I give meds? Should I be doing full patient care on one patient or should I be practicing focused assessments on several?

2. communicate your learning level and abilities to the primary nurse (who you call a preceptor... the staff nurse who is legally responsible for the patient but who is letting you help to learn.) (BTW "preceptor" is indeed the correct word to use in some settings, such as a Designated Education Unit, which not all hospitals use). "I'm Matt, I'm in my first semester. This is my first day in acute care. I am allowed to give meds to one patient and I would like all the practice with sterile procedure that I can get today" or something of the sort. Also: "I want to be as much a help as I can" goes a long way.

3. Do not talk or ask questions when the primary nurse is preparing meds, on the phone with a doctor or lab, or engaged in a task that requires a lot of attention. DO ASK questions when you are not 100% sure how to do something.

4. You can learn a lot from the nursing assistants, physical therapists, transporters, etc so keep your eyes and ears open. Ultimately though, you are there to learn to be a nurse so working with the nurse should be your priority.

5. you are not there as free labor, but it doesn't hurt to "earn" your place on the unit (answer call lights that aren't "yours", make beds, be a valuable part of the nursing team. ) The hospital and hospital staff does not get paid to have you there. Make it worth their while.

6. "Educator" is a role that all nurses take as part of their professional duties. This means educating patients, each other, and yes...students. Teaching students is part of their job, but some forget this. You make get paired with a nurse who is unwelcoming or rude to students. This is not okay but don't take it personally. Do talk about it with your clinical instructor, who should take the issue to the nurse or the nurse manager.

Good luck! I'm glad you are being proactive in making your clinical experience a success!