Tell me about your clinicals...

I posted earlier but I don't think anyone knew I was asking for input because I ran on and on and on and on LOL!

Sorry!

Just wondering if others would share their typical clinical experience? I'm in the 2nd semester, and we are not yet giving meds. We do maternal assessments, baby assessments, post partem care, vitals, etc.

It's been wild...for the details see my earlier post but in the meantime, just wondering if you could share your experiences like what the routine is. For example our routine today was:

prior to 0730 - get to school and change in to scrubs provided by school.

0730 - meet instructors on 2nd floor to get report

0740 - find primary nurse and get report

get morning assessment - 12 point maternal assessment on mother

get breakfast tray to mom at 8am but before 830.

get fresh ice/water, etc.

go to nursery and do newborn focused assessment

change baby diaper and bedding if needed

sponge bath for baby

take baby to mom for feeding

chart on mom and baby

change mom's bed

teach mom all discharge teaching (we have to do this all the time, everyday, and keep repeating the stuff)

1130 - do noon assessment on mom to include vitals, fundus and lochia

get anything else she or baby may need.

assist with other things as needed

report out to primary

lunch at 1200 - 1230

report back to primary

finish charting (focus notes have to be approved by instructor first)

have instructor check off on all charting (flow sheet and focus notes)

1330 - back to classroom for post conference

During this time the baby I was caring for had a circ so that includes circ checks q15 mins for 1 hour.

[purplekath]

I'm in Australia so it may be different - we get allocated shifts in various places, and work the same shifts as an RN...so 8.5 hours morning or evening usually. Although I'm told that next year we will be getting 12 hour nights as well. Yikes!

I've been on a hospital surgical ward for the last few weeks. We work under an RN. The RN usually gives me 1-4 patients to do everything for, depending on their level of need.

A rundown of the last shift I did:

Listened to taped handovers for all patients on the ward, and got allocated 4 patients to care for.

My 4 patients were 2 aneurysm repairs, 1 MVA and one acute renal failure.

For all 4 patients I took 4 hourly obs, O2 sats, DVA assessments and IVT checks. Once in the shift I did waterlow scores for all of them. About 3 times in the shift I did meds for all, including injections. Kept FBC's for 3 of them, catheter care for 2 of them, NGT care for one of them, bowel chart for one of them. Did pressure injury assessments for all and PI dressing for one. Mobilised them all within their ability - passive ROM, rolling, walking, sitting etc.

Throughout the shift it was about managing incidental things. One of my patients had recurrent anxiety attacks which took regular help and care through each one. Another was experiencing numbness down one flank from his epidural in situ - so I monitored that situation hourly and notified his doctor. Another got severe oedema in the legs about 1/2 way through my shift, so I repositioned him, propped his legs and gave massage which helped, and by the end of the shift it had resolved. Another lady (not the renal failure pt) was outputting low urine, so I spent a bit of time encouraging her to drink more, after checking her for fluid retention and checking her tests on the computer, checking the catheter insertion etc. Sat with her and explained the importance of good hydration, made her several icy drinks to tempt her and gave her a couple of cups of tea which she was DESPERATE for. By the end of the shift she was outputting normally.

It was an evening shift, so no major bed changing or bathing, but I did peri-care, face washes and oral care throughout for comfort. Changed a set of sheets after a spill, changed gowns and pillowcases etc before everyone was ready for sleep. Before everyone bunked down for the night I did obs (so I didn't disturb them later), last heparin injections, back care and decrinkling of undersheets to reduce the risk of PI. Also gave my guy with anxiety attacks a bit long back, shoulder, hand and foot massage before bed. While doing that we watched a quiz show on TV, laughed and joked and talked. Then made sure he had a spare incontinence pad by his bed "just in case", a full jug of water, his book, his buzzer and a million other things. My rationale was that spending 30 mins with him at bedtime might save the night staff hours of anxiety-attack management through the night!

During visiting hours they all had visitors, so I tried to keep out of their rooms and just answered phones, directed visitors, put flowers in vases, helped other nurses with their obs etc.

After everyone was asleep, I ran around and made sure they had their trays, supplies, water, buzzers etc nearby. At this stage it's soooooooooo satisfying to see them all snoozing comfortably.....almost felt like kissing their precious little foreheads, but resisted the urge! lol

Then wrote up all their progress notes, taped a handover for the next shift and went home!

I LOVE NURSING!! Can't wait to hear about everyone else's shifts....every shift is so different and nurses can make such a difference :-)

[Indy, LPN, LVN]

I've been clinical-free through the summer; summer was taken up by core courses. But your courses/clinicals sound like the arrangements are a LOT different from ours. We had four 12-hour days in OB and that was all. Well, that was all the hours in the hospital. I think the homework took me about 20 hours a week. Our time was spent, two days on postpartum, one day in labor/delivery, and one day in the nursery.

For postpartum, we did not do assessments by ourselves, but the instructor was with us. So we weren't gonna forget a body part. And we weren't gonna palpate a uterus more than was absolutely necessary, etc. We did have to show competence and learn to take vitals on a newborn, and IF there was a birth while we were in the nursery, we would watch the newborn exam and fill out our own sample one alongside the nurse, and compare results.

I'm a lot more comfortable in med-surg, and this quarter is cardiology, renal, immune and male reproductive. Oh yes, and we start IV therapy this quarter in clinicals as well. It's gonna be fun. :-)

[mavnurse]

This is my first semester and my clinicals are in oncology.

7:30 - report to floor, take vitals

7:45 - start getting 9:00 meds ready (I can't give them until my instructor comes to my room, but I have to have them ready asap)

8:30 - go back to room after breakfast has arrived and help pt with eating if they need it, if not, I go find something else to do

9:30 - bath and change bed, anything else pt needs - this is when I do my big assessment, and the pt interview if they can communicate well enough

10:15 - in the nurse's station doing paperwork

11:15 - take vitals again, go back to conference room

Next week I can start giving injections.:uhoh21:

[Nursingangel]

I am doing my mental health rotain this week and I pretty much go in and get all the pt vitals, they are amblotory so they come to me. Then chart them all and go to group thearpies to observe. We have to try and incaurge pt that don't want to proticipate in groups to get out and active. Then we read the charts will not in groups. We also take the patents upstairs to eat. That is about it for the next copple of weeks.:uhoh21:

[landonsles]

I amin my first semester and I feel like I am ill equipped at clinicals. Sure I know how to make beds and give baths (I have two kids, so this is a piece of cake) and I can do vitals. But the clinical instructor has not told us/gone over the assessment I keep seeing posted in here. Is the assessment the head to toe variety--and if so, how do you do half the stuff without the equipment needed? Any input will be greatly appreciated.

[mavnurse]

^^^Our assessment is head to toe and the only equipment we need is our stethoscope. It's probably not any major in-depth thing, but we look at cap refill, skin, hair, nails, listen to breath sounds, heart, check for edema, etc.

[landonsles]

Our head to toes are soooo indepth. For instance on eyes--we have to check vision (Snellen chart), inspect the outer eye, do accomodation tests, and look at the internal structure with an ophthalmascope. And so on and so on. Each system has this incredibly long protocol to follow. If I were to do a head to toe on a pt, I would need so many extra instruments.

Did you learn the complete head to toe??