What do you ACTUALLY DO in clinicals?

Al.ginger · Dec 7, 2011

For the first semester clinicals in AD program we did a lot of CNA skills. Also some simple dressing changes, passing meds, tube feedings and one lucky fellow insert straight cath.

MU Nursingstudent · Dec 7, 2011

We started clinicals in our second semester and we do lots and lots. Med.'s, injections, cath's, tube feedings, wound dressing changes, watched hemodialysis and a hepatic stent placement, central line dressing change, enema, assessments, trach. suctioning and care, and many other "CNA" type things as well which although not as exciting I think very important.

ashleyisawesome, BSN, RN · Dec 7, 2011

"Nursing procedures" in the or consist of either writing down everything that's happening and fetching things outside of the sterile field for the surgeon or scrub tech, or handing the surgeon instruments.. We had two days in the or and helped serve as circulators (the ones that write stuff down), and never got to scrub in. -- I say this because of your choice of words, as if you picture nurses slicing people open and manipulating their insides..

You will do a lot of adls, passing meds, dressing changes, foley care etc. You will most likely start out on a med surg floor.

By the end of my first semester I was up to 2 patients at a time and was able to take over full nursing responsibility for both (with instructor present for meds and procedures I was not proficient or confident with).

I'm in entering my 4th semester in jan (out of 5). I just ended my 3rd with mother-baby and my last day I had 3 laboring patients, assisted in one of their births, set the others up with fetal monitoring and took down their history and assessed them periodically, gave some immunizations, did all the newborn care on the baby that was born including bath, immunizations and assist with feeding.

So if by "hardcore" nursing procedures, you mean "stuff that nurses do", then yes, you will do them. Not immediately, but you have to work your way up. You don't learn everything on day one.

MissJulie · Dec 7, 2011

I take my nursing fundamentals final tomorrow (wish me luck) and during our clinicals, we did vital signs, physical assessments, bed baths, clothing and bed linen changes, med passes, catheters, d/c IVs.

Of course, as we progressed through our skills in lab, we added more. I mean, we didn't start with catheters on the first day! We built on, little by little.

I think my favorite day was actually when I had a patient being discharged and d/c the IV and catheter, did some teaching for at home meds, etc. that evening, I felt like a "real nurse"!!! :)

ChristineN, BSN, RN · Dec 7, 2011

You won't learn much about the OR as a student. That is a very specialized area, and not something focused on with NCLEX. If you go into OR you will learn most of the skills you need during your job orientation.

As a nursing student, your first semester is typically CNA type duties. My first semester I did not pass meds, but focused on CNA tasks, bathing, etc as well as focusing on improving physical assessment skills.

After that I had 3 med-surg rotations where I had 1-2 pts. I was passing meds, putting foleys in, charting, central line care, tube feeds, trachs Basically anything the pt needed (with few exceptions) I was allowed to do.

for my Psych rotation we did not pass meds or perform physical assessments. Learned more about therapeutic communication, talking to pts, etc.

OB- did not pass meds, in labor and delivery was only allowed to observe, no hands on care was done by student. In post partum, was allowed to assess mom and baby, assist with care, etc.

ICU--had 1 pt, typically vented. While the RN and/or my instructor was responsible for double checking drips, we could give meds via feeding tube, give feeds, trach care, assist with ADL's, EKG strip interpretation, labs, and more

LeighaChristineSN · Dec 7, 2011

I think how clinicals go depend on your school but, I honestly felt like a glorified CNA the entire time. We did RN tasks but, we also did many aide tasks which I think is how it is in the real world with the exception of in the real world you don't get an instructor breathing down your neck making sure you don't kill anyone. The first two rotations we really concentrated on getting comfortable doing a head to toe. Then we added PO meds and then IV meds. We were always encouraged to see anything we could get in on. There were quite a few shadow days in the cath lab, ICU's, and ED. My favorite was when doctors or nurses pulled you aside to show you something on one of their patients.

What your instructor expects of you differs from instructor to instructor and also depends on your school. I will say however that you shoule know your meds to the best of your abilities and anything that may apply to them ie take b/p before b/p meds or 1 min apical pulse before dig.

Just remember to take advantage of clinicals. Learn as much as you can. Watch as many procedures as you can. Take notes on good nurses and bad nurses and strive to be like the awesome ones. Don't spend to much time being nervous. Get close to your clinical group they are your family and the only other people in the whole world who really inderstands what your going through. Mostly remember to enjoy it because it is over before you know it. Good luck!!!

NCRNMDM, ASN, RN · Dec 7, 2011

We are on a post-surgical floor that also accepts ICU step down and medical overflow. We are first semester students, but we do everything. We insert IVs, foleys, NG tubes, etc, we hang IV meds, give IM and SC injections, give PO meds, and administer tube feedings and medications via NG tube. We empty hemovacs, JPs, chest tubes, NGs, foleys, and wound-vac drains. We discontinue IVs, foleys, NGs, etc. We do head to toe assessments, take vitals, and record everything we've done in the computerized medical record. We assist with bathing and ADLs (if needed, or if the CNA is too busy) and we record these in the computer as well. We monitor I&O, record this information, and report low or high values. We monitor lab results (such as electrolytes, CBC, WBC count, H&H, INR, etc) and report abnormally low and high values with our interpretation of the possible cause. We do dressing changes on surgical sites, chest tubes, etc. We can perform bladder irrigation, although no one has done this yet. We give enemas and rectal meds, and ensure that the enema is effective. We do pain assessments, wound assessments, etc and document these in the computer. We call the MD to ask for extra orders, to have orders changed, or to alert him/her to a change in patient condition. We travel with our patient to all diagnostic tests as both a learning experience, and an opportunity to monitor them while they are off the unit. If our patient is transferred to ICU, we go with the ICU nurses and help them move the patient to their bed, hook them to the cardiac monitor, obtain vital signs, and begin IV infusions, etc. Pretty much the only thing we don't do is set up PCA pumps. Once they are set up, we can make changes to the rate, but we can't perform the initial set-up. Other than that, we do everything.

Clovery · Dec 7, 2011

My first semester we mostly just did vitals and assisted with ADLs (like bathing, going to the bathroom, etc). Halfway through we were cleared to pass oral medications and do caths & wound dressing. We didn't have a lot of opportunity for that.

My second semester was peds & OB and we did a lot more - post partum and newborn assessments, catheters, oral and injectable meds, nebulizer treatments, NG tube feedings. We all had at least one opportunity to observe a lady partsl and cesarean delivery. Aside from the RN skills, we also did all the vitals, changed diapers, fetched supplies, made beds, generally helped out as needed.

The next two semesters we are in med/surg and I expect to be busy!

NurseNotRatched, ADN, BSN, CNA · Dec 7, 2011

nolander said:
So I was wondering what actually happens, and what instructors actually task you to do during clinicals? Are you just helping patients with daily living activities as if you were a cna or are you actually doing more hardcore nursing procedures? For example, will the bulk of my clinical time be spent helping someone to the bathroom, or will I be in the or learning or nursing procedures or what?

Just to chime in on what most everyone else has said, yeah, in the first semester you'll mainly do cna type stuff and probably pass po meds. You'll start off with one patient.

I am finishing up my 2nd to last semester (thank you god!) and this semester my group has been on a telemetry unit. A typical clinical day for me: arrive by 0630, meet in conference room and get patient assignments (we have 3 patients at this point), find nurses/cnas and introduce myself if I haven't worked w/ them yet, get report, prioritize, start assessments & give 0730am meds at the same time if applicable, chart assessments, am meds to clients, clinical paperwork during down time, perform allowed procedures if applicable or help or find "something cool" to watch or do (IV starts, dsg changes, NG tube, watch adenosine being pushed, etc.), check bp and pulse on pt's getting beta blockers, etc (again, we were on telemetry), make sure diabetics have ordered lunch and cnas have obtained accuchecks, give insulin, give afternoon meds, report off to nurse, eat lunch, give 1400 meds, catch up on documentation/paperwork during unit's quiet hours from 1400-1600, give any other meds at correct scheduled time, ask nurse if there's anything else that you can help with before reporting off, leave floor at 1700 and meet back in conference room, post conference, leave by 1900. We can push anything except cardiac meds and narcotics w/ instructor present, hang bags, give insulin, give ims, insert and d/c foleys, get stool samples, straight caths, change dsg (except for central lines), give discharge teaching, help w/ admissions, etc. Also, we can't hang blood products or tpn (too expensive).

So yes, we do "real" nursing stuff but also help the cnas when things are caught up. In the beginning, before we had 3 patients, we would follow the one patient we had. I had one patient that had a bilateral atk amputation i got to watch in the or (surgeon said it was ok). Another time i got to go to physical therapy with my patient who had just had a total knee replacement the day before.

FreshLittleStudent · Dec 8, 2011

I just got done with my first semester of clinicals. We were in a nursing home and for a majority of our day, we spent doing what would be the CNA's job. I helped move patients, clean them, and sometimes even digitally removed stool. We fed the patients and since we were not on a strict time clock (it WAS our first clinical) we were able to make sure that our wonderful elderly actually finished their food.

Since our teacher had been a charge nurse at the facility we were at, we were able to have a bit more a free hand than a normal 1st semester group normally would. We each took turns following the wound care specialist, doing blood sugars and vitals for the hall nurses, and general treatments like Foley flushes. A few of us even prepared a couple residents who passed to be moved to the funeral home. Since we had not had Med/surg I or drug apps, we were not able to actually pass meds to anyone.

It was still a wonderful experience where we were able to bond with a main single patient. We also know what a CNAs job consists of, the type of time constraints they work under, and how they should do several of their jobs. That can only help us after we graduate and become a supervisor of the CNAs below us. It gives us respect to what they do rather than take it for granted.

I will still miss my patient. I did cry when I left her and the hilarious lady I usually also fed during meal times.

turnforthenurse, MSN, NP · Dec 12, 2011

Depends on your rotation. In the beginning you will be focusing more on "CNA-type" duties in addition to other basic nursing skills like dressing changes, injections and medication administration. As you progress you will learn more skills. Psych was the only rotation where we really didn't do anything except for concentrate on therapeutic communication with our patients. This seems to be the norm in many nursing programs.

What do you ACTUALLY DO in clinicals?

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