Welcome to where the “rubber meets the road”.... the bedside!
I absolutely agree with all the “DO IT!” suggestions already offered. That behavior is good for all of the obvious reasons... and for a less obvious reason. While there is no doubt that your instructor has a huge impact on your clinical experiences.... so do the staff nurses. If the staff nurses like you, and see you as well prepared and eager.... THEY will connect you with opportunities that your instructor may not know about. (Caveat: “DO IT” is within the limits set down by your instructor and the institution. I am advocating courage... not recklessness.)
When I was a student, I found it useful to write out a 3x5 card with the assessments that I needed to do for a specific patient... I could take that to the bedside and use it to keep me from missing things. When doing assessments remember: “If god didn’t put it there... you are responsible for it.” In other words, your assessment is NOT limited to the patient... but includes ALL the equipment attached to the patient too!
Pull back the covers and LOOK. It is very common for nursing students to be uncomfortable pulling back the covers and REALLY looking at the patient. Unfortunately, there are a great number of bad things you will miss if you don’t look there. Remember: “As a nurse, you have the authority and responsibility to look where Momma taught you not to look!” (Of course, you do this in the context of providing privacy and asking the patient for permission.)
Remember that a huge part of a nurse’s job is to prevent, detect, and intervene to prevent REALLY bad outcomes. As you think about your patients, ask yourself...
What are the really bad things that could happen?
What can I do to prevent them?
How would I know if they are happening?
What do I need to do if they happen?
Knowing what your school’s reputation is among the staff can help you understand their response to you. For example, there is a school in my community that has a reputation for most of their students being quite clueless and useless at the bedside. As a result, the strong students from that school have to fight past that reputation with the staff. Knowing that can better prepare you to understand the situation and overcome it.
Put down the clipboard! There is one behavior that often telegraphs a whole set of the wrong messages to the staff...... holding your clipboard to your chest with your arms folded across it. Having a clipboard may be OK.... using it like a shield makes you look scared and useless. Perhaps a story will help put the above in context: My wife was a nurse in an inpatient hemodialysis unit. As you can imagine, it was really busy. As a result, she didn’t have time to mess with unprepared, scared, or useless students who were there for an observation experience. She used to give students about 60 seconds to show “signs of life”.... if the student was engaged and eager, she would bring them into her activities. If the student was unprepared, scared, or disengaged... she would move the student aside and carry on without them. You might wonder: “How can I show “signs of life?” Simple, put down the clipboard, and ask: “How can I help you?”
Understand the value of asking GOOD questions. You can’t know everything. Nobody expects you to. However, we do expect you to TRY to learn. Sometimes we know that things are confusing and if you ask about them... we know that you tried. For example: If you were with my wife in the hemodialysis unit and she said “What do you know about hemodialysis access sites?” If you say “I don’t know”.... that is not a great answer. On the other hand, if you say “I am confused about the difference between an AV fistula and an AV graft.” That is a GREAT answer! How can it be a great answer if you are saying that you don’t understand? The reason is that you obviously TRIED.... or else you could not have asked such a great question! (The AV fistula and AV graft are similar and easily confused by the novice.) In other words, often your questions tell us that you tried or you did not! Another hemodialysis example regarding access: You say: “I have read about assessing the bruit and thrill... but I don’t really understand.” It is VERY likely that at that moment (time permitting) you will be dragged to the bedside and shown what those are! You would be amazed by how much staff are willing to invest in in you..... IF you show interest and are trying to learn. Of course, the best questions go beyond “What” into “Why”..... “If an AV fistula is so desirable, why would a patient have a hemodialysis catheter?” BINGO! That sort of question is GOLD!
Understand the first hour. Many students find that staff can be abrupt and unfriendly during the first hour of the day. Why is that? There can be many reasons but some key reasons are:
Feeling a need to get organized before getting behind with tasks.
Feeling an urgency to see all the patients and determine that they are not trying to die.
Feeling an urgency to check a zillion things in the patients’ rooms. An example is identifying any IV bags that are almost empty.
Acute caffeine insufficiency.
Often staff are more approachable and friendly after they get through those immediate tasks at the start of the shift.
GET A GOOD NIGHT OF SLEEP BEFORE CLINICAL!
EAT A GOOD MEAL BEFORE CLINICAL!
SMILE, BREATHE, RELAX.
