Typical Clinical Day

[vintagemother, BSN, CNA, LVN, RN]

I was just reading the thread about the nursing student feeling like she's in a den of wolves. As an LVN student, I'm no longer enthusiastic about clinicals.

My school structures clinicals accordingly:

Each student has a check list of tasks that the teacher must observe, ranging from assisting with elimination to changing an occupied bed to applying heat and cool compresses.

We aren't assigned patients or a staff person to work with.

I think some students just walk into a patients room and start caring for him and then let the CNA know, "I'm going to do x,y,z for this person".

> Am I mistaken in this belief?

After the morning care and breakfast is over, as students, we wander the halls looking for something to do. I answer call lights, assist patients with elimination, spend time with residents who desire companionship, research medications and medical diagnosis for the resident I cared for in the morning. I let the CNAs know I am available if they need me for anything and keep my eyes open for opportunities to help.

BUT..........

There is nothing else for me to do besides hope a call light comes on or research charts for 4-5 hours. I, and most of the students, spend hours trying to stay out of the way of the staff.

When we students huddle together, we appear lazy. When we stand near the nurses station, we are complained about because we take up too much space. So most students stick together in a large utility room with charts spread out so that they look busy.

When I compare this to CNA clinicals, we were assigned a CNA and shadowed her/him all day. I loved the opportunity to do all of the CNAs "grunt" work and enjoyed the fast pace. The CNAs quickly learned to utilize some of us students to help get their work done faster.

In my LVN school, we are only allowed to do CNA tasks, but we are told to think about it from a nursing perspective. We also aren't given a days worth of CNA tasks to do.

Oh and I know, from watching my fellow students getting tattled on, to never speak to the nurses. We aren't allowed to ask questions or ask to observe anything they do.

Rather than complain about this, I'd like to ask other nurses and student nurses what their clinical days are like so I can get some insight into how to make my days more educational and enjoyable.

[Compassion_x]

Usually the CNAs know that nursing students are there, and know generally what they will be doing. And honestly, as a CNA myself, they usually don't mind if you're going to be taking care of their patient for the day. So don't worry about it being rude.

In my clinicals, we are assigned a patient, and have to do two sets of vitals before leaving (one by 8, one by 1130). On one day we are assigned to do a head to toe assessment, the other we pass their meds. We also have sheets that we fill out with information from the patients charts, and we write down all their meds and med information, and have to write a pathophys paper on their chief complaint (if it's a disease, the instructor will assign us one if our patient doesn't have a disease). We also have to write nursing diagnoses, interventions and the whole ADPIE thing for our patient. We spend the last hour doing this, from 1130 to 1230. We also do charting in the hospitals online charting system. When we are bored we help out our classmates, and we also usually have time for a short breakfast break in the cafeteria.

[pixiestudent2]

Well in my fundamentals class we were in a hospital. we were assigned 1 patient and we were to do all care and tolieting. We started by getting report with our RN, then we were responsible for a safety assessment, physical assessment and vitals. We also did medications and any task learned in skills lab.

And charting of course!

[CardiacKittyRN]

In my fundamentals semester we were at our clinical site from 6:45am-3:30pm. At the beginning of the semester, we were assigned one patient, but the last two weeks we got 2... we were told pt name/room number & the nurse and CNA responsible for that patient. It was up to us to go up to the nurse/CNA and let them know what we were allowed to do (assessment/vitals/linen change/ AM care/ PO, IM, subQ meds). My day would go pretty much like this... do AM care/vitals/blood sugar checks (if needed) and help my pt. set up there breakfast if they needed help, look over the chart/look up any meds I didn't know, AM assessment then AM med pass with the nurse, noon vitals/blood sugars... After lunch it would usually get slow. I'd help with afternoon meds or go assess random pt's for practice (asking 1st of course)..

Where is your clinical instructor during the day? Ours would come get us and show us stuff if someone had a cool patient or if a specialist was on the floor doing something (one day we got to see a wound care nurse do dressing changes..) She would also let us go along with our patient if they went for X-ray or MRI. I would ask your clinical instructor what she wants you to do in your downtime. Are you allowed to follow the nurse?Usually nurse wouldn't mind letting me help if I just asked and showed that I wanted to learn. Sorry to hear to hear your experience hasn't started out so great, but I hope it gets better!

[Skips, MSN, RN]

That's really odd that you're not allowed to observe or talk to the nurses. You're there to learn how to be a nurse, not a CNA.

We are not given a list of tasks to complete during clinical. We're given a patient that we are to care for during the next two days, unless they get discharged. We have a primary nurse we communicate with. We pass meds, do assessments, take vitals, do any tasks that might need done (taking Foley out, putting one in, etc.) with our nurse or the instructor there. We can ambulate our patients, give them a bath/shower, toilet them, etc. without an instructor there. We also look through their chart and fill out our clinical paperwork. We do that when we pre-lab, too, but we compare meds and labs to previous days while we're there. We can also assist/observe other nurses on the unit doing tasks. Some of them are very receptive to this.

I'm not in an LPN program, though, so it's probably different for us. I'm in a BSN program.

[CT Pixie, BSN, RN]

Odd way to have clinicals.

during my LPN schooling we were assigned a patient to care for, both the nurse and the CNA were aware of what we would be/would not be doing with the patient.

Instead of waiting for call lights to ring and/or hiding out in the room with the charts to appear busy, why not interact with the residents/patients on that unit? You can learn a lot from them. While you are interacting with them you can do a look/see type assessment of them without even touching them (great way to hone your head to to assessment skills). Look at their skin, look for any edema, look at their eyes, do they appear to have dry mucous membranes (watch their mouth as they speak, does it appear very dry on their tongue), walk with them and you can assess their gait, you can assess their respirations..are they audibly wheezing, just general chit chat can give you a glimpse to their mental status and orientation (do they appear confused, are they answering questions appropratly etc). You can do a very good assessment without ever really laying hands on the person nor using any quipment.

I work LTC and love my geri patients. Even if you just sat and chatted with them for a while, you'd make their day. They get company and conversation and you get to learn how to interact with patients.

You can do 'CNA' tasks and still think about it from a nursing perspective. As I said, do a look/see at the person. Do you notice edema in the lower extremities? Yes...ok, as a nurse what could you do in an attempt to lesson that edema...check and make sure the socks or stockings aren't too tight, get them to put their legs up...are their legs dangling and not touching the floor in the wheelchair..you could get foot rests for them. While doing AM care and washing them up...look at it from the nursing perspective. Do you notice any reddened areas? What causes that, what can be done to stop it, as you brush their teeth/or put in their dentures take a look in their mouth and look for any open areas, check the mucous membranes etc...

[vintagemother, BSN, CNA, LVN, RN]

We have asked our instructor what to do during down time and she told us to look on charts and do assessments and chat with residents.

I can spend over an hour just chatting with residents as well as can spend several hours buried in a chart taking notes, learning meds or studying lab values.

I do not mind doing "CNA" tasks or doing basic caregiving. I do mind having lots and lots of down time.

I've been working in a different area where there is a greater need for caregiving and I am able to stay pretty busy there because the residents need a lot of hands on care and the staff utilizes us.

I've had the opportunity to go to different clinicals with different teachers and it was set up very differently. I just wondered I'd there was a more ideal set up or something different I can do.

Thanks for the replies!

[ixchel]

Wow! I'm so sorry your experience is so limited. Last semester we focused a lot on the basic skills that the CNAs would do. This semester we will be focusing more on focused health assessments and the more medical side of things. We've been passing meds since day one and we'll be doing IVs this semester. We get to ask the nurses, doctors, PAs, NPs and basically anyone in existence questions. We're encouraged to use others as resources as they are the best resources we have. The more we know, the better we'll be. I believe the more you are encouraged to learn and grow and do, the more confident you will be when you don't have an instructor as a safety net. Honestly, I think it might be a good idea to question these limitations you have been given, and be prepared to explain why you think things need to change. If you have the ability, and if things don't change, consider a different program. I know you want to get out and be licensed ASAP, but if you aren't getting what you need to be a good nurse, then this program is hurting you-- not helping.

[Jill2Shay]

My clinicals start in 2 weeks, but that's how they say it will go. We pick a patient, gather all their info, write a detailed care plan (this takes about 6-8 hours) and then for the day we're there (0530-1430) we care for that person. Assessments, vitals, toileting, oral care, dressing, bathing, etc. If there's nothing to be done for that patient we're to assist the staff in anyway we can. If an opportunity arises to observe something relatively uncommon, like a complete bed bath, our instructor will call some of us in there to watch and/or help.

If I felt unwelcome in my clinical site I would bring it to the attention of my instructor. I would be pretty livid.

[SunshineDaisy, ASN, RN]

Wow! I'm sorry you don't get more experience. We start out in 1st semester in week 4 in LTC, the sub acute care doing CNA type stuff and shots. In 2nd semester we are in med surge and do more. IV's, foleys, NG tubes, trach suction, tube feedings, sterile dressing changes, wound care. Our instructor or a nurse has to be present. We also have a skills checklist we date and initial and the instructor initials. In 3rd its the same except it's peds and OB. We learn all the OB stuff and do whatever the nurses let us. 4th semester we have critical care and then preceptorship. They let us do everything in critical care and our instructor isn't there as much. She floats around and gets our info and then we rarely see her till the end of the day. She says by 4th semester we are nurses and she will treat us as such. She won't hold our hands like the do in the other semesters. We are on our own with our nurse and act accordingly. it's a great experience actually.