What are clinicals all about????

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What do you do during your clinicals? and do you start clinicals in your first year of nursing school? :confused:

Specializes in ER, Pediatric Transplant, PICU.

Seriously though, I disagree about not being able to say, "I don't know" as a "real" nurse. As long as you follow up with "but I will find out", I don't see why you can't admit you don't know everything. After all, you're not a doctor are you? ;)

My whole point wasn't exactly what you say to the patient - more like, when the doc is asking questions, or radiology calls, or the lab calls, or the like a previous poster say, when the OR calls and wants to make sure it's okay another EKG hasn't been done - its all THOSE things that, as a student, people dont expect you to make a decision in a split second, and you can play the "um, I dont know, let me get their nurse" card.

Of course it's okay to not know everything. But you can't play the "i dont know" card all the time as a nurse, but as a student, you can get away with it a lot more.

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When I was a student, I usually had a chance to:

  • sit down multiple times per clinical day
  • take a coffee break, just because
  • have a leisurely meal or snack
  • use the bathroom when I needed to
  • thoroughly dissect the chart
  • talk to my peers
  • debrief with everyone after each clinical day

As a student, I could easily spend 30 minutes talking to "my" patients and their family members without feeling rushed or slowly backing out of the room. I was an innocent by-stander when tempers flared. I had time to attend nursing and physician rounds. Each clinical "shift" predictably began and ended on time. I never got home late or had to cancel plans at the last minute. I helped with charting, but was not held accountable for my documentation. I saw my friends and family on weekends and on every holiday. Only during my capstone did I work 12-hour shifts, and even then it wasn't a true 12 hours. (FWIW, I completed nursing school in California, the state of golden ratios. I do not live or work in California anymore.)

Now that I'm a nurse, any one or all of these things seem like a luxury. As a D/N rotator, I usually feel more like a human when I work nights, despite the circadian interruption and having many additional job titles (unit clerk, PCT, phlebotomist, transporter, nutrition hostess, pharmacy tech...). Meal time consists of sitting at a wheeled computer and rapidly eating as I complete redundant documentation. I sometimes don't have time to use the bathroom until I'm done with handing off my patients, before sitting down to finish all the charting that patient care prevented me from completing during my shift. First-year has only been on the service for 2 days, patient didn't get a tray, medication is not ready yet, toilet is leaking, rounding sheet columns not fully checked, someone snuck their 5 small children and girlfriend into their room? It's all my responsibility, and I am held accountable for things that, more often than not, are beyond my control. No longer am I the innocent by-stander.

For better or for worse, my co-workers have become my family. Likewise, I often feel like I spend more time with them and my patients' families and friends than my own, as I had to move very far away from everyone I care about to find a decent job. I am constantly exhausted and stressed out about work, even on my off days. I dread my shifts on because I'm often assigned 4-6 stepdown-worthy patients. My unit is hemorrhaging staff, but we're expected to do more with less. I'm barely at the two-year mark and have become a cliché.

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When I was a student, I usually had a chance to:


  • sit down multiple times per clinical day
  • take a coffee break, just because
  • have a leisurely meal or snack
  • use the bathroom when I needed to
  • thoroughly dissect the chart
  • talk to my peers
  • debrief with everyone after each clinical day

WOW- where did you go to school - LOL :D

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My whole point wasn't exactly what you say to the patient - more like, when the doc is asking questions, or radiology calls, or the lab calls, or the like a previous poster say, when the OR calls and wants to make sure it's okay another EKG hasn't been done - its all THOSE things that, as a student, people dont expect you to make a decision in a split second, and you can play the "um, I dont know, let me get their nurse" card.

Of course it's okay to not know everything. But you can't play the "i dont know" card all the time as a nurse, but as a student, you can get away with it a lot more.

I understand what you're saying- but a lot more people (docs, PT/OT/ST, OR transport, RT, etc) are more forgiving than you might think, at least IME. They ALL understand a looney day :D Some will get snippy at times, but it's about what their day has been like, and not generally personal. When they see you honestly doing the best you can to get the info they need, most will back off, and deal with you not having an instant answer- and if nothing else, just say you want to make sure you're giving them the right info on the right patient- that can buy a few minutes :D

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

After nursing school I discovered that there is no time to practice the "art of nursing" which I think is what new grads get so disillusioned about. You barely have time to do the "science of nursing" let alone sitting with patients or doing really thorough patient ed. It's that human connection that gets lost in the chaos of "doing".

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Specializes in ICU, medsurg/tele.

In nursing school your only focus is on assessing the patient, giving meds, performing interventions and charting. You also have a lot of time to get this done because you have 2 pts. As a nurse you are expected to do all of the above while calling doctors for orders/ waiting around near the phone for them to call back, having to call many different doctors because each of your pts has a different one (on med surg i would be super excited to find out if 2 of my pts had the same MD:) ), giving numerous updates to family and patient, putting orders into the computer, checking orders and scrambling to get a STAT order done that the MD forgot to tell you about ;), solving "domestic disputes" between patients (they dont always get along with their roomates), trying to start an IV on a patient with horrible veins that wont hold still, having a patient crash while you have meds due for your other patients, running around trying to find someone to help you give a boost (in nursing school your classmates were always available), also a lot of things are not done the same way as in school (remember when you were taught the "book" way and the "real" way?), NOT having to construct elaborate care plans for your patient :) (careplans are usually quickly jotted down in whatever free minute you have), running up and down the halls all night for bed alarms, telemetry alarms etc.

oh man i could go on forever. overall real nursing is much different from student nursing but in a good way :)

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Specializes in ICU, medsurg/tele.

oh also having to go off the floor with your patient for a test and having to stay with them the entire time, meanwhile you are thinking of the 1000 things you could be doing on the floor instead of sitting in the MRI control room :) but it is also a nice mandatory break from the chaos of the floor

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Specializes in Medical Surgical Orthopedic.

Like many others have said, the biggest difference is time. As a student, you often get to review your patient's labs, x-rays and history the day before you actually care for the patient. As a nurse on the floor, you're behind before you even get started and have to hit the ground running.

One negative thing I noticed about myself as a new graduate is that I became very task oriented. There was always so much "stuff" to get done that I didn't have much time to think about the big picture. Now, I'm not really worried about giving a Zocor two (or even three) hours late. I focus on what's really important for each patient and get to the other "stuff" when I have time.

I also used to feel stupid when I didn't know something that I thought I should know. I'd even gone so far as to take a med-surg book into the bathroom with me to read about an unfamiliar diagnosis! I didn't want anyone to know that I didn't know. Now, I find myself asking patients about their rare diagnosis or uncommon medication ordered. I also look these things up in front of them. I've never gotten a bad reaction from a co-worker, patient or MD for admitting that I have "no idea". And thank goodness for that, because there are a lot of things that I still don't know.

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like many others have said, the biggest difference is time. as a student, you often get to review your patient's labs, x-rays and history the day before you actually care for the patient. as a nurse on the floor, you're behind before you even get started and have to hit the ground running.

one negative thing i noticed about myself as a new graduate is that i became very task oriented. there was always so much "stuff" to get done that i didn't have much time to think about the big picture. now, i'm not really worried about giving a zocor two (or even three) hours late. i focus on what's really important for each patient and get to the other "stuff" when i have time.

respectfully disagree w/this...if the state or jcaho- or don- finds this, it's a write up

i also used to feel stupid when i didn't know something that i thought i should know. i'd even gone so far as to take a med-surg book into the bathroom with me to read about an unfamiliar diagnosis! i didn't want anyone to know that i didn't know. now, i find myself asking patients about their rare diagnosis or uncommon medication ordered.

excellent idea- those of us with uncommon diagnoses would be thrilled to have someone ask instead of assume it's either some flaky mental condition, or don't care if they understand it or not- essentially not caring if they know how to deal with that disorder

i also look these things up in front of them. i've never gotten a bad reaction from a co-worker, patient or md for admitting that i have "no idea". and thank goodness for that, because there are a lot of things that i still don't know.

:) :) :)

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I love and appreciate all the great advice...It makes a lot of sense. Most people seem to say they love their jobs much more than school...I guess because you finally get to put your own knowledge to use and really get into it...I really can't wait to get going! Thanks again.

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Specializes in Medical Surgical Orthopedic.
:) :) :)

Well then, they're going to have a lot to write up! :D I like to give my meds on time, but it's not always possible with the number of patients I have and those patients' needs. If a patient has a blood pressure of 214/103, they're going to get their hydralazine on time (or early!), but that HS Colace can wait if I have more important things going on.

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Well then, they're going to have a lot to write up! :D I like to give my meds on time, but it's not always possible with the number of patients I have and those patients' needs. If a patient has a blood pressure of 214/103, they're going to get their hydralazine on time (or early!), but that HS Colace can wait if I have more important things going on.

I hear ya ! :) When I had 14 acute neuro patients on 11-7 (first hospital job- at 7 months out of school) it was a sprint to get the midnight meds done (and vs) ...and God forbid anybody wanted anything ! I prayed for the comatose patients who couldn't use the call light- but wished I had more time with the walkie talkies.... :)

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