Tips for first clinical?

Forever Sunshine, ASN, RN · Oct 10, 2011

I recently had a student following me around. Its hard having 25 residents and a nursing student. I tried my best to do things the nursing school way so she could learn. But it did slow me down.

When I have nursing students I like to throw them in there. Get an apical pulse, b/p, etc. Things I know they are allowed to do.. they will be doing if it arises. Make them interact with the patient and realize that the patients don't bite.(Ok most of the patients don't bite lol. But I wouldn't let a student get a blood pressure on a patient who would harm him/her. The instructor and my supervisor wouldn't be too happy with me lol). I think thats a big fear with nursing students. Some are afraid of the patients and lean too much on the nurse.

Nothing against the student. I want her to learn things the right way. I taught her a couple things she didn't know before. So I am happy about that.

Students ...don't take offense when the nurse runs away from you. We sometimes need to put ourselves into auto pilot to get our jobs done.

Laurenslovely · Oct 10, 2011

From working in the past at a teaching hospital, I can tell you that nurses sometimes get burnt out on having students ALL the time. Sometimes you want to NOT have to teach, to be able to just take care of your patients.
Also, I tended to spend more time with and enjoy students who were prepared. If I sensed or saw that the student was clueless, I wasnt going to put my time into him/ her. And yes, your instructor can build bridges or burn bridges for you. There was a particular instructor from a particular school that we all loved. And her students were ALWAYS prepared. There was another school where it was the opposite.....instuctor never around and students seldom prepared.
best of luck

I agree... I think our instructor burned some bridges for us. She's very blunt and forceful so I think some nurses go the other way when they see her. And yes, NYU is a teaching hospital so that may apply in my senario also.

Thanks! :) Lauren

Laurenslovely · Oct 10, 2011

You know I never thought about it. The city that our college is in has a state prison and we don't have the option of having students there. I hadn't thought about it before but now you have me interested.

The sane way you don't have nursing students in the nursing homes/rehab facilities! Thats the dum&@$t idea I've heard!

sunnyskies9 · Oct 10, 2011

yeah some nurses are just jerks. I had a few clinicals that were that way. but I'm a new grad, and I try to help the students in any way possible. just stick with it!

deann52 · Oct 10, 2011

I have nursing student in L&D and I will give tips :) I know you are in another unit but the tips are easily transferable.

Know your patient when you come in, know their disease, the solids status, their meds, our teacher made us come in an hour before shift or the day before to know our patients.

I will not let you touch my patient if I feel you don't know what your doing.

Learn the basics somewhere outside a specialty unit, like taking vitals, spiking a bag, drawing up a medication, emptying a foley, etc and then DO them! If you have a patient that needs a foley emptied just do it! Mark the amount as exact as you can, the color, and time. Then let the nurse know. Note: The only exception is if they have a urometer, ask at the beginning of your shift if it is ok to do so throughout the day.

Take initiative! Don't always ask, "what is that?" Find out!!

Care that you are there. My biggest pet peeve in L&D in students that don't want to be there. I had one student ask me a question, I handed him the book. He said, it's too early, I haven't actually started yet. I never took time with him again.

I know what you are supposed to know throughout your coursework in L&D. I DON'T expect you to know how to read a fetal strip (or even know what one is!) in the beginning and I always teach my students the first day the barest basics. But I DO expect you to know the basics and be able to read a basic NST by Finals!

Do the grunt work, always ask for something to do even if they give attitude. Eventually they will notice that you are on top of things, busy and a hard worker. I won't spend my time on anyone less! :)

This may be harsh but it is truthful. I LOVE teaching. But students have to prove they are worth the time to the nurses.

AndiSN · Oct 10, 2011

The sane way you don't have nursing students in the nursing homes/rehab facilities! Thats the dum&@$t idea I've heard!

Wow, I certainly don't think it's the dumbest idea I have ever heard at all. Also, nursing homes/rehab facilities are excellent places for first semester students to start. While I did not spend my first semester in a nursing home, some of our other clinical groups did. A skilled nursing facility is an excellent place to get your basics down. The people in our class who went to those learned a lot. The nursing staff was happy to have extra hands for baths, turning patients, ambulating patients, feeding patients, all that patient contact that helps people new to the profession of nursing more comfortable in patient contact.

Now I don't really know what all is involved in nursing at a prison but I can imagine that the nurses there have a great deal that they could teach. We have spent time in nursing homes, public schools, community environments, clinics, and mental health facilities that some people may say wouldn't be a good learning experience but nursing is a lot more than just "hospital nursing". I have spent a good deal of time in the hospital as well but I feel that I have learned so much from all of my experiences.

Forever Sunshine, ASN, RN · Oct 10, 2011

The sane way you don't have nursing students in the nursing homes/rehab facilities! Thats the dum&@$t idea I've heard!

Are you saying that nursing students in nursing homes/rehab facilities is the dumbest idea you ever heard?

VickyRN, MSN, DNP, RN · Oct 10, 2011

Sometimes nurses are just too busy to mentor students - it's very busy and rough out there in the trenches, and only getting worse.

Some of the suggestions on the thread so far are excellent. Take initiative and thoroughly research your patient, his/her meds, the pathophysiology of the illness, and high-priority nursing interventions that would be warranted for the patient's condition.

If your nurse is too busy, then look elsewhere for learning opportunities. Interview the patient(s) - oftentimes, no one understands or knows the disease process and the experience of the illness better than the patient. Some patients love to relate their illness, treatments, and are excellent teachers. Once on the Rehab Unit, we had a patient who had a stroke which left her nearly paralyzed on one side of her body. The patient was a nurse and invited students (one at a time) into her room to do a head-to-toe assessment on her. She guided the students through the assessment process and also gave them valuable pointers on how to do a neuro assessment - all from a first person perspective. What a marvelous learning opportunity as this patient was on the unit for three weeks and LOVED to have students visit her!

Another possibility - follow the physicians, nurse practitioners, and residents as they do their rounds. You can learn so much as they share their knowledge.

Best wishes to you :)

pockunit, ADN, RN · Oct 10, 2011

You know I never thought about it. The city that our college is in has a state prison and we don't have the option of having students there. I hadn't thought about it before but now you have me interested.

We'll be doing observations at the county jail, but no pt care. I think it's a liability issue, probably. Also, they just may not have the staff to deal with all those extra bodies. Even though the CI is supposed to be in charge of the students, they just can't be in 4, 5, 9, whatever places at once.

I think it would be invaluable experience, though.

Mrs. SnowStormRN, RN · Oct 10, 2011

Wow, I certainly don't think it's the dumbest idea I have ever heard at all. Also, nursing homes/rehab facilities are excellent places for first semester students to start. While I did not spend my first semester in a nursing home, some of our other clinical groups did. A skilled nursing facility is an excellent place to get your basics down. The people in our class who went to those learned a lot. The nursing staff was happy to have extra hands for baths, turning patients, ambulating patients, feeding patients, all that patient contact that helps people new to the profession of nursing more comfortable in patient contact.
Now I don't really know what all is involved in nursing at a prison but I can imagine that the nurses there have a great deal that they could teach. We have spent time in nursing homes, public schools, community environments, clinics, and mental health facilities that some people may say wouldn't be a good learning experience but nursing is a lot more than just "hospital nursing". I have spent a good deal of time in the hospital as well but I feel that I have learned so much from all of my experiences.

I was one of those students whose first clinical experience was in a nursing home, AND my patient was due for her catheter change. LOL! First day in clinicals and I already had a skill signed off. Nursing home clinicals should be first, I agree. Even though the nurse has more patients, it is more "routine" in nursing homes, which is beneficial to new students. It also is an enviroment that is "less" threatening, ICU and even MedSurg would be terrifying to a new student. PLUS the residents love the attention!!! The students learn how to interact with a patient, and this should be done with a more stable patient. Hospital patients are very sick and can sometimes be cautious when it comes to new students (IMO). I noticed when doing hospital clinicals the patients felt safer when they found that the students were "SENIOR NURSING STUDENTS." Take the advice given here, it's pretty awesome.

Ruby Vee, BSN · Oct 10, 2011

i just started clinicals at a neurological unit in a high ranking hospital in nyc. i am so happy and i want to absorb every bit of information i can!!! but i notice the nurses are wayyyy too busy to be bothered with us and the new grads are too overwhelmed and give us attitude. the staff who have been there longer are nice. anyway, my clinical group and i feel as if we are invading their territory when all i want to do is learn. did these nurses forget they were once nursing students (not so long ago)?!?
can someone give me tips to learn the most i can? i feel like the patients are nicer and want to educate us about their diseases more than nurses do and we practically chase down the nurses to ask questions about something we saw. my clinical instructor is a whole other story-- she is off the wall.
thank you!!
lauren )

one tip is to start out with a different attitude. if you go into clinical with the attitude that nurses don't like students, you're going to find lots of nurses who don't like students. even if they do like students. self-fulfilling prophecy and all that.

nurses do remember what it was like to be students -- at least i do, and i've been a nurse for over three decades. but we are busy -- sometimes we're too busy to be bothered by students asking questions. i know that sounds harsh -- and it probably is harsh -- but the reality is that when your patient is bleeding so many liters per hour and your transfusing so many units per minute, the patient comes first and a nursing student is awfully far down my personal list of priorities.

i like students -- most students. in order to be one of those students that nurses enjoy working with and like to teach, here are a few tips:

don't turn down opportunities the nurse offers you because "i've done that already" or "i don't need to do that." if you do that more than once, nurses aren't going to bother seeking you out if there's something to see or a skill to be practiced.
be visible. if there's something good going on, i don't want to have to hunt you down.
don't be a hog: don't hog the limited chairs in the nurses' station or the break room, don't take over the charts or the computers. don't cluster in the door of the medroom so that we can't get past you. and don't partake of the nurse's potluck until everyone has eaten, if then. unless, of course, you've been invited to participate and have brought a dish to share. (i'll never forget the time our patients ordered a chinese feast for us to thank us for caring for one particularly difficult patient who was on our unit for a year. before any of the nurses even knew the food had been delivered, a group of students descended upon it like hungry locusts and demolished not only the presentation, but a good portion of the food. by the time some of the nurses were able to get to lunch, there was nothing left.)
do your homework. if you're caring for a hemotology patient for the first time and had the opportunity to go through her chart the day before (which seems to be the norm in my area), look up her meds, disease process, etc. i'm happy to show you how to do mouth care, let you practice blood draws or ng tubes or whatever . . . but i really don't have the time to explain the entire disease process to you. study enough so that when the nurse tells you "we give them this med because of that," you'll have some idea how that fits into the total picture. if you've already studied -- and it shows by the questions you ask -- i'm a lot more inclined to spend some of my precious time answering your questions (even over lunch) than i am if it looks as if you haven't googled the basics.
be friendly to the nursing staff -- and polite and respectful. few of us are going to extend ourselves for someone who is unpleasant to us. (and in case you're wondering, the attitude that "nurses don't like us" or "nurses are mean to us" shows. and it makes us less likely to like you.)
understand that your presence doubles, triples or quadruples my work load. something that might take me two minutes to do may take nearly an hour to teach you -- especially if you're not willing to look up the procedure and try to gather the supplies on your own. i'm happy to talk you through foley insertion, but please be prepared.
i've often read on allnurses.com that nurses should appreciate having students around because "we do their jobs for free." understand that nothing could be farther from the truth. the patient is our responsibility and we have to ensure that the patient care you give is correct and up to our standards. if it isn't, we have to fix it. it takes twice as long to fix something than it would have to do it right in the first place, and if fixing it involves soothing ruffled feathers, it may take ten times as long.
be grateful for the opportunities you're given and for any teaching you receive. be really grateful. express your gratitude often and show it. bring bagels or brownies or cookies on your last day of clinicals. or better, on your first day so that the nurses will see you all as a great bunch from the start. take the time to write a thank you note to the nurse who let you watch something interesting, practice your skills or helped you understand blood gases. send it to her and a copy to her manager. on the other hand, if you don't have such a great experience understand that it isn't meant to be mean to you or dismiss you -- sometimes things just get out of hand.
take responsibility for your own education. i shouldn't have to find you things to do. come prepared with a list of objectives. it's much easier for me to help you learn if you can tell me at the start of the shift: "i've never hung blood before, so i'd like to be involved in that. we're concentrating on mouth care and peri care this week, but i see your patient is having an echo and i'd really like to watch if that's ok."
i have never worked with a student who didn't teach me something i didn't already know or help me to see something in a different light. from the former sound technician who taught me how to care for cables and cords to the sister of a special needs brother who taught me about caring for an adult patient with the intellectual capacity of an eight year old to the lpn to rn student who worked in labor and delivery and saved me from freaking out when my hematology patient with a platelet count of 13 suddenly started giving birth to the brazilian student who gave me insight into her culture to the filipino student who showed me how to make my dressings a thing of beauty, i've learned something from everyone. i'll learn something from you, too.

Ginger's Mom, MSN, RN · Oct 11, 2011

I have to ask the question, where is your nursing instructor. It is their job to find nurses who are student friendly ..... and you should be going to nursing instructor with questions not the nurse.