Priorities in clinicals

kellyo, LPN · Mar 31, 2005

Anyone going to reply???

Hello all. I'm a 2nd semester ADN student. I was wondering what advice/teaching/guidance you give your students about setting priorites in their clinical day. We don't get our pt information the evening before clinicals. We get report, get a quick look at the MAR, pt chart, and then do our physical assessment. Where's the first place you recommend looking in the chart? The H&P?, labs?, physician's orders? Do you recommend setting up a timeline for medications and proceedures? Any advice will be greatly appreciated!

VickyRN, MSN, DNP, RN · Mar 31, 2005

Hello all. I'm a 2nd semester ADN student. I was wondering what advice/teaching/guidance you give your students about setting priorites in their clinical day. We don't get our pt information the evening before clinicals. We get report, get a quick look at the MAR, pt chart, and then do our physical assessment. Where's the first place you recommend looking in the chart? The H&P?, labs?, physician's orders? Do you recommend setting up a timeline for medications and proceedures? Any advice will be greatly appreciated!

I'm so sorry, Kelly, for not responding sooner. Organization is one of the most critical skills you must master in nursing school, and later on the floor!

Since medications are top priority (with the very disturbing numbers of serious medication errors taking place annually), I would recommend checking the MAR against the primary care provider's orders FIRST. Since you are crunched for time, you should only need to go back over the most recent 24 hours' worth of orders, as most institutions have 24-hour chart checks in place. Next, take a quick peek at the patient history and physical and last progress note entry. Then, quickly scan the most recent labs, being on the outlook for any critical lab values.

And yes, I definitely recommend setting up a "cheat sheet" for medications and procedures. Most every nurse I know does (including myself!). A very appropriate saying - "A short pencil is better than a long memory." Try to prioritize your tasks at hand. You want to be on time for meds, as this is a top priority. Try to check your chart throughout your shift (especially right before time to give meds) to make sure there are no new orders or updated lab values.

Don't forget when you are in the patient's room (during your first assessment), to double check your IV pumps and any drips for correct calculations, and make sure your tubing and bags are in date. Make sure the patient's oxygen (if applicable) is at the ordered level. If it's not, don't adjust it yourself, just find out why... If your patient is on telemetry, make sure the leads are in the right place, and that the alarms are turned on. And, of course, double check that your patient is safe, call bell within easy reach, required number of SR's up (usually only two), and the bed is in the low position with the wheels securely locked.

Hope this helps :)

kellyo, LPN · Mar 31, 2005

Thanks, Vicky! I knew I could count on you! I've seen your supportive posts to others. You've given me a map to visualize and plan my day!

Kelly

I'm so sorry, Kelly, for not responding sooner. Organization is one of the most critical skills you must master in nursing school, and later on the floor!
Since medications are top priority (with the very disturbing numbers of serious medication errors taking place annually), I would recommend checking the MAR against the primary care provider's orders FIRST. Since you are crunched for time, you should only need to go back over the most recent 24 hours' worth of orders, as most institutions have 24-hour chart checks in place. Next, take a quick peek at the patient history and physical and last progress note entry. Then, quickly scan the most recent labs, being on the outlook for any critical lab values.
And yes, I definitely recommend setting up a "cheat sheet" for medications and procedures. Most every nurse I know does (including myself!). A very appropriate saying - "A short pencil is better than a long memory." Try to prioritize your tasks at hand. You want to be on time for meds, as this is a top priority. Try to check your chart throughout your shift (especially right before time to give meds) to make sure there are no new orders or updated lab values.
Don't forget when you are in the patient's room (during your first assessment), to double check your IV pumps and any drips for correct calculations, and make sure your tubing and bags are in date. Make sure the patient's oxygen (if applicable) is at the ordered level. If it's not, don't adjust it yourself, just find out why... If your patient is on telemetry, make sure the leads are in the right place, and that the alarms are turned on. And, of course, double check that your patient is safe, call bell within easy reach, required number of SR's up (usually only two), and the bed is in the low position with the wheels securely locked.
Hope this helps :)