You've made it! You passed all of your prerequisite courses, started nursing school, and you're about to begin your very first clinical rotation. What should you bring? What should you do? What if it seems like you're doing nothing? This guide will help you answer those questions, as well as help you to get all you can out of your clinical rotations to give patients and their families the very best care possible when you enter practice and continue learning as a new graduate.
In nursing school, you will participate in a number of clinical courses that have a lecture component as as well as a clinical rotation where you apply what you learn in lecture. Typically, this will include fundamentals, medical-surgical nursing I and II, psychiatric-mental health, maternity/OB, pediatrics, community health, and a preceptorship capstone. Each clinical has peculiarities specific to that area, however these steps will help you in any of them!
STEP 1: Research the Clinical Area!
This is something I always did in nursing school. Once I knew the specific unit that the clinical would take place on, I did some background reading on the patient population, types of diseases/disorders seen, interventions done, etc. That way, when I walked onto the unit, I had at least some idea about what I would encounter. You may not know this until after your first day, but that still gives you the opportunity to do a quick review of areas relevant to the clinical area you're in. You'll look like a rockstar if you know a little about the patient population, and that can only help when you participate in patient education.
STEP 2: Come Prepared!
Always come to clinical with everything you need. Generally, you should bring:
Pocket Drug Guide
Lunch and/or a snack
Depending on the rotation, you may bring other things, or not bring certain things from that list (you don't really need your stethoscope for psych clinical). I also have a small clipboard that has clinical information on the outside and that can keep all of my papers together in one place. Another item I liked to bring was a small clinical pocket guide relevant to the clinical area. Often, nursing textbooks have a companion pocket guide, and there are also the "Notes" brand of pocket guides. So, if I was on OB/maternity, I'd bring the OB/Maternity Notes pocket guide. That way, I could look up diseases/disorders my assigned patient had, look up how to do certain procedures and skills, etc.
Remember, if you're not prepared, you won't do well.
STEP 3: Focus on the Basics!
As a nursing student, you don't know everything. As a new graduate RN, I still don't know everything. Seasoned nurses still don't know everything. Nursing school provides the foundation for you to continue learning and experiencing for the rest of your career. Therefore, now is the time to get comfortable with the basics. Chances are you won't be able to do certain interventions. In my first clinical rotation (fundamentals), we weren't allowed to administer medications. So what can you do when you have restrictions? Focus on the basics! To me, this is focused on two areas: patient safety and patient assessment.
One of your main goals as a nurse will be to ensure that the patient is safe while under your care. As a student, you can participate in this endeavor. Learn to ambulate patients with IVs, foleys, wound vacuums, etc (as long as they have orders to be out of bed of course!). Learn how to use the bed and chair alarms. Learn when restraints are allowed to be used. You may not be able to administer IV medications, but learn with your nurse how to check to ensure the correct medication is running at the correct rate.
I'll never forget one of my professors emphasizing that assessment is probably the most important skill a nurse can learn, and that assessment can save your behind (and the behind of the patient). When in clinical, if you can't do anything else, practice your head to toe physical assessment skills. Practice getting a history from the patient. If your patient has certain devices, look at them, consider how they affect anatomy and physiology, and integrate that into your clinical picture of the patient. You're told your patient has a systolic murmur or a mechanical valve, so listen to their heart. Listen to lungs for crackles and other adventitious sounds. I was always told that you may not know what you're hearing or observing, but the most important thing to learn at the beginning is when something isn't normal. Perform a head to toe assessment on all of your patients, and always take a full set of vital signs (and while we're at it, practice taking a manual BP! Often if the BP is really low or high, you'll be asked to anyway in practice, so now is the time to ensure you know how to do it!).
STEP 4: Make Connections!
Think about it. You want to work in a hospital (or a clinic, or in home care, or some other clinical area). You're doing your clinical rotation in a place you think you want to work in. What should you do? Make connections! Talk with the nurses on the unit, and find out what they think about working there. Ask about the experience requirements needed. Bring your resume towards the end and leave it with the nurse manager. Many students receive job offers through the connections they made during clinical. Remember, this will only work if you follow my other tips:
TIP: Come prepared. Know what you're doing. Don't stand around doing nothing. Be engaged.
Believe me, the nurses and others on the unit will notice. Even if you don't get an offer, the nurses that notice how engaged you are will often bring you in to see one of their patients that has something interesting going on, and this only enhances your education.
STEP 5: Don't Stand Around!
This is the bane of existence of every clinical instructor. They hate to see students braced against the wall, chatting about the exam they have coming up, doing nothing. Yes, you'll probably have downtime on the unit. No, this isn't the time to just stand and do nothing. If you brought pocket guides, this is the time to review pathophysiology and nursing care related to what you're seeing. This is the time to go into the patient's chart and review their history and any notes written. This is the time you could ask other nurses if they need help with anything. Who knows, maybe they'll invite you to watch something interesting! This is also the time you could help the techs/nursing assistants. If they need help to change a patient, help out! If you're allowed to do finger sticks, volunteer to do the finger sticks if you aren't doing anything else. Answer call lights. Believe me, as a student there is plenty you can be doing to maximize the limited time you have when you think there's "nothing to do".
STEP 6: Medication Administration!
Ah, medication administration. This is probably something we all look forward to. Most schools have some sort of limitation on what students can do in the medication administration process, often related to hospital policies as well. For my school, we were not allowed to give IV push medications. Always remember to follow the rules with medication administration. The last thing you want to happen is you giving an IV push medication to a patient, something bad happening, and you weren't supposed to, but did because the nurse said, "just pull the curtain, I'm here, lets do it" (believe me, it happens). Always remember and follow the Rights of Medication Administration. And never blindly give medications. As a nurse, you will be a licensed health care professional that has a body of knowledge that impacts patient outcomes. You never give a medication without understanding its indication, side effects, monitoring parameters, etc. Remember to look up any relevant laboratory studies or vital signs prior to giving the medication. Even if the BP was checked 30 minutes ago, I was always encouraged to check my own BP right before administering a cardiac medication, just in case. Remember, patient safety!
STEP 7: Keep a Journal!
I wasn't always good with this, but I know many that enjoyed keeping a journal of their clinical experiences. I used to work with a nurse that kept a journal as an RN, and would write down interesting experiences she had. I think journaling is a good idea, as you're able to write down what you saw for the day, and reflect on what you learned from those patient experiences. Journaling can help you organize your thoughts and grow as a practitioner.
STEP 8: Critical Thinking is Key!
This is one of my favorite things about nursing. As we know, nurses are not robots who blindly follow orders. We go through our education to learn how to assess a patient, determine problems and potential problems, make a plan of care, implement it, then evaluate the response of the patient to that plan. Wait a minute, that sounds like the Nursing Process! The nursing process is foundational to critical thinking. In your clinical rotations, read the patient's chart. Read the history and physical. Read the nursing and progress notes. Look at the lab values. Look at the radiology reports. Think about the head to toe assessment you did. Think about the medications you administered. By doing this, you see how the patient's disease relates to how they present, as well as how it relates to the problems you identify, as well as the medications prescribed. You will begin to anticipate potential problems, and ultimately learn how to advocate for patient needs.
STEP 9: Care Plans are Annoying, but Helpful-Here's Why!
This is related to critical thinking. We all dreaded doing care plans in nursing school. They were long, we had to use the nursing diagnosis book, and just weren't that fun. But looking back, I see how useful they are for nursing students and beginning practitioners. The care plan is how you implement your critical thinking skills and ensure that all of your patient's needs are being addressed. The care plan is the nursing process in action. So, while you may not like doing care plans, think about how much you learn about how to plan care for a patient, anticipate their needs, and how their clinical presentation affects the care you give as a nurse.
STEP 10: The Preceptorship-It All Comes Together!
Many schools will have a preceptorship capstone clinical in the final semester. This is where you are assigned 1 to 1 with a nurse and follow their work schedule for a set number of hours. This was hands down my favorite clinical rotation. I was assigned to a cardiac telemetry unit at a cardiac specialty hospital. I came in at 6:45am, listened to the morning huddle, got report with my nurse, and participated in everything that she did, until 12 hours later we gave report to the night nurse. The preceptorship is where everything comes together. Take advantage of this experience if you have it. You're now able to see what it's like to be a nurse for entire shifts instead of the limited time you had in other clinical rotations (often only 6-8 hours at a time). You are 1 to 1, so you see everything: the charting (I didn't realize how much was involved in charting a shift assessment until my preceptorship!), calling providers, preparing patients for surgery, receiving patients from procedures, admissions, discharges, etc. Now is your time to really be involved and learn as much as you can in this final experience. This is absolutely not the time to stand around doing nothing. Now is also your final time to make a really good impression and maybe even get a job offer at the end!
I hope this guide helps you! Clinical rotations are where you see what you've been reading about in your textbooks and learning in lecture. You perform the skills and interventions you practiced in the lab on real patients. You see and participate in what it's like to be nurse in the clinical area you're assigned to, and this is not an experience to throw away. Make the most of this experience, and you will always take away something that impacts your clinical practice as a new graduate, whether or not you're in an area you have no interest in.