Need help with clinicals!! (getting organized)

[lab211]

Just finished a few days of clinicals with major organizational problems.

This is how our morning starts;

0645: we get our patient assignment(1 patient)

0645 till 0815: we are to have gotten report, read the patient's chart (admission history, past history,medications ordered and the rationale,lab and other diagnositic work),Check medication administration record for schedule of meds, pull the standard of care for the medical diagnosis and any labs, chest x-ray,etc., report to patient's nurse what your standard of care is for the day, do a complete head to toe assessment on the patient

Including vitals, and familiarize yourself with each medication-the 6 medication rights. How does a student with limited clinical hands on do all this half way efficiently? To make matters worse our school has had major issues with getting their students clinical time(would you believe, I went through Peds,OB,Psych without any hand-ons bedside care....for the most part I was assigned to do computer simulations?? This is ridiculous.

More than a few of us I believe have been mis-led by mis-led faculty advisors.

It would be especially helpful to hear from someone who has been through the same situation and had turned it around.

[Mirasol]

Sorry I have never heard of not having live patients during each rotation. But i can say it is hard for everyone to organize at first. I am a brand new nurse and I struggle with it. The good news is you do get better and when you are a new RN you go thru some type of orientation helping you organize. Also I believe working the night shift at first is a great idea. It is much less hectic, few doc's, few new orders, few visitors and those that can-- sleep. Anyway, sorry i couldn't relate to your exact circumstance, good luck!!

[Daytonite, BSN, RN]

Organizing and prioritizing is something that will take most a long time to master. As I was reading your post I was thinking that even I, an experienced nurse of 30+ years, might not be able to accomplish everything you have to do in an hour and a half. One thing I do have is experience to build on, however. That, unfortunately, is something that just comes with time which you can't hurry along.

There are certain things you have to do when you hit the floor. Report is one of them. A thorough perusal of your patient's chart is something you just have to put off until later. You can scan a chart quickly, it only takes a matter of a few minutes, to look at the most current doctor's orders that have been written on the doctor's order sheet and get a quick look at lab or x-ray results. The same goes for the med sheet. All you need to look at is the patient's allergies and the names of the meds being given and the times, particularly the ones you'll be responsible for giving. Those are the very first ones I'd focus on looking up if you don't know what they already are. But just get the very basics on them (what the drug is being given for and the normal dose). You can go back later to get more in depth information on them. The same goes for the Kardex. Give it a brief reading, but the information that is most important for you is what you will need to be doing with the patient during your time with them. You need to know what meds, IVs and treatments have to be given as well as any tests that have to be done. Basically, these are doctor's orders that need to be carried out.

After that 10 or 15 minutes you need to be down at your patient's bedside greeting them, introducing yourself and asking how their night went. Your eyes should already be sweeping the environment picking up assessment clues. Tell them you are going to be their nurse for the morning/day. "Can I see your ____ ?" and get right to the physical assessment. Then pull out your stethoscope and listen to the lungs and heart. If you're also doing vital signs, get them now as well. Be pleasant, but assertive about this. You'll have the very basics of a your assessment done in minutes. If the patient is eating breakfast, they can return to it and you can go back to the nurses station to really take a good look at the chart now. If you are also required to assist the patient with morning bath and ADLs that can be done a little later and you can do a great deal more of your detailed assessment at that time.

As for standard of care for the day, I assume you mean what the normal nursing care would need to be. That comes with time and experience. I can't imagine lugging a nursing textbook into clinicals with me to look that information up. If the facility uses clinical pathways of care it would be helpful to find out where those are kept on each unit and pull one after report--but that would be IF the facility used them. Not all facilities use that type of care plan. But, basically, your hands on time with the patient should be to hone in on getting their ADLs for the day done (making sure they are getting their meals, assisting with feeding if you have to, attending to their bath, dressing [not so much an issue in the acute hospitals], toileting, and that some kind of physical activity is being done [this may come from doctor's orders]). As an RN in the hospital environment you also need to be on top of tests, medications and treatments that have to be carried out as well. In the places where I worked and had to do the patient's physical care (we had no nursing assistants), most of us RNs hunkered down to get all the basic nursing care needs out of the way and completed ASAP to free us up for all the other major stuff we had to attend to. Keep in mind that the patient's have one agenda on their mind, getting their immediate needs met, and we have another, getting orders carried out.

I am listing the links to the report sheet I used at my job to take down information during report and throughout my shift. It can be modified to be used for one patient if you know how to work with Word and Table formatting. Or, I will be happy to customize a sheet for you if you PM me and tell me how to change it for you. I also have a student clinical worksheet that I had been working up for the allnurses students as well. It has a place to write down a patient's medications and medication times as well as a Review of Systems and space to write down physical assessment findings. Use these if they will help you organize.

Report Sheet.doc

Student Clinical Report Sheet.doc

I must tell you, however, that as a new nurse, I struggled with organizing. I think many do. And, I was a bookkeeper before I went into nursing, so you know I like everything to be in it's proper place! I started developing my own report sheets many years ago for that very reason. Just about every place I worked I found something to incorporate into my personal organization. I hear the frustration in your post. I can only tell you that it takes time and patience to develop these skills. I learned a great deal about giving hands on care from the LPNs I worked with (we had no nursing assistants at that time) and from the nursing assistants in the nursing home where I did work as a nursing assistant during my last year of nursing school. Organizing your work day will be a "work in progress" for you as it has been for me and most of us. There were many times when I would lie in bed thinking of how I could be making better use of my time at work. That is the difference between being the chief bottle washer and the head cook.

Hope this helps you out. Please feel free to ask more if this doesn't suit your situation. I was a clinical nurse on med/surg units for a long time for a good part of my career. Organizing and prioritizing daily tasks was something I got very good at and found it was a major hurdle for the new grads I precepted to tackle as well.

[Sarah LnDHopes]

Daytonite, Thank you for that Student Clinical Sheet! I won't start clinicals until Fall, but I am definitely saving that, and hopefully it will help :)

[Daytonite, BSN, RN]

sarah0119. . .That copy of the Student Clinical Sheet has a few typos in it. I just downloaded and attached a corrected copy. Use this one instead. If anyone has any other ideas as to what can improve or expand this sheet (it will probably take it to a second page that could be printed on the back of one sheet of paper) please let me know and I will amend it and it make it available to everyone.

Student Clinical Report Sheet.doc

[S.T.A.C.E.Y, LPN]

Have you considered asking your clinical instructor if you can do your patient selection the day before. Then you have all night to do your research and show up prepared. Thats how we did it, until our fourth year, when we were given a little more of a real-world type experience where we would just show up and be assigned.

Express your concerns to the clinical instructor, and ask if your group can try it out for one week.