I am in my second semester of nursing school and I am seriously thinking about throwing in the towel.
This semester our instructors expect us to be able to handle two patients, doing total care. I still have only had one patient at a time so far, and I am bewildered with that just one. By the time we finish meeting with our instructor and getting report, I have 30 min to get in my assessment, do vitals, do ADLs, and then document everything. I am feeling like I can barely handle one patient, let alone two.
I keep telling myself I will get better with experience, and I keep reminding myself why I wanted to become a nurse in the first place, but I still find myself so stressed before, during, and after clinicals that I can't eat or sleep. It's starting to really impact my studying as well.
I would really appreciate any advice on anything (time management, prep sheets, how to assess quickly, how to document, seriously I mean anything).
We are doing clinicals on a surgical floor, and we do focused assessments. We have to document a full assessment, but we don't do a formal and complex assessment. In general, I ask my patients their name, where they are, and what date it is (then I can chart that they are A&O x 3, and I've satisfied the neuro assessment). I may check the pupils, but if they are oriented, and aren't complaining of anything neuro-related, I generally skip that. Next, I listen to breath sounds in the front and back. After I've done this, I move on to heart sounds. I assess heart sounds, rate, rhythm, and apical pulse. Next, I move to the abdomen, I do a general survey of the abdomen simply by looking at it. I note if it appears distended, normal, etc. Next, I listen for bowel sounds, and note them. Finally, I palpate the abdomen for pain (unless my patient has had an abdominal surgery). I then move on to the lower extremities. I check pulses in the feet, capillary refill in the toe nail, and assess the warmth of the skin. Next, I assess the capillary refill of the fingernails, the quality of the radial pulses, and the warmth of the skin in the upper extremities. I then ask the patient if they are having pain, when their last bowel movement was, whether they are having problems urinating, and when the last time the urinated was, and I take vitals if it is time for vitals to be taken. If the patient has a catheter, I don't ask any questions about urination. Instead, I assess the catheter site to make sure it doesn't look infected, and I check to see how much urine is in the collection bag. If the patient has any drains (like JPs, hemovacs, or chest tubes) I assess the insertion site, and the amount, color, and characteristics of the drainage. If the patient has an NG, I do the same. If I haven't seen the patient ambulate yet, I have them squeeze my hands and push against my hands with their feet. I use this information to chart about their musculoskeletal system. If I've seen the patient ambulate, or helped them ambulate, prior to my assessment, I use this information to chart about the musculoskeletal system. By doing the assessment this way, I get all my information without wasting 45 minutes doing a complete head to toe.
NCRNMDM, ASN, RN
465 Posts
We are doing clinicals on a surgical floor, and we do focused assessments. We have to document a full assessment, but we don't do a formal and complex assessment. In general, I ask my patients their name, where they are, and what date it is (then I can chart that they are A&O x 3, and I've satisfied the neuro assessment). I may check the pupils, but if they are oriented, and aren't complaining of anything neuro-related, I generally skip that. Next, I listen to breath sounds in the front and back. After I've done this, I move on to heart sounds. I assess heart sounds, rate, rhythm, and apical pulse. Next, I move to the abdomen, I do a general survey of the abdomen simply by looking at it. I note if it appears distended, normal, etc. Next, I listen for bowel sounds, and note them. Finally, I palpate the abdomen for pain (unless my patient has had an abdominal surgery). I then move on to the lower extremities. I check pulses in the feet, capillary refill in the toe nail, and assess the warmth of the skin. Next, I assess the capillary refill of the fingernails, the quality of the radial pulses, and the warmth of the skin in the upper extremities. I then ask the patient if they are having pain, when their last bowel movement was, whether they are having problems urinating, and when the last time the urinated was, and I take vitals if it is time for vitals to be taken. If the patient has a catheter, I don't ask any questions about urination. Instead, I assess the catheter site to make sure it doesn't look infected, and I check to see how much urine is in the collection bag. If the patient has any drains (like JPs, hemovacs, or chest tubes) I assess the insertion site, and the amount, color, and characteristics of the drainage. If the patient has an NG, I do the same. If I haven't seen the patient ambulate yet, I have them squeeze my hands and push against my hands with their feet. I use this information to chart about their musculoskeletal system. If I've seen the patient ambulate, or helped them ambulate, prior to my assessment, I use this information to chart about the musculoskeletal system. By doing the assessment this way, I get all my information without wasting 45 minutes doing a complete head to toe.