Everything You Need to Know about Nursing Clinicals

To prepare for your clinical day:

The only thing I need to say is that if you clinical instructor gives you a patient the day before~~research this patient. Look up his diagnosis and become familiar with specific interventions for this patient. (I am sure by now, you have a Care Plan Textbook. This is what you bought it for. Look up the patient's diagnosis. When you do so there will be a list of numerous interventions. Be prepared to do the main interventions as it pertians to your patient. This is what your instructor is looking for. Your ability to care for your patient. Don't worry, your instuctor will help you. However, I am positive he/she will ask you what you are preparing to do for your patient. You will know the answer to this question because you looked in your careplan textbook.) Look up your patients history and physical. You can't care for your patient if you don't know his/her past history. This becomes expecially important in not only the care of the patient, but for teaching the patient about their health as well. The better you know their past, the more prepared you can be to teach your patient behavior modification with regards to their health.

Look up your patient's medications. Know both the Generic Name and the Trademark Name of the medication. Know the action, normal dose, main side effects of the medications. These would be the ones highlighted in bold black letters in your Nurses Drug Guide. In this way, if your patient complains of ie. palpitations and you tell your clinical instructor, the first thing he/she will want to know, if it was not a preexisting condition, is what medications your patient is on. If you have done your research you would know whether or not these palpitations are due to the medications or not. And if you are able to tell your instructor this, believe me, they will be pleased.

Look up any procedures you patient is scheduled for. Become familiar with the procedure. Try to understand why the patient needs this procedure.

Look up lab values. Especially, the abnormal ones. Understand what type of negative effect abnormal lab values can have on your patient. For this too will have to be a part of your nursing intervention.

When you have done these things before clinical 1)Familiarized yourself with patient diagnosis, 2) Looked up medications, 3) Looked up any procedures the client is scheduled for and 4) Familiarized yourself with lab values. Then, you can draw some type of conclusion as to what interventions you will be doing for your patient. This is what you will be doing in clinical: Caring for the patient. This is what your instructor is there for.

May I also suggest that you carry with you a small tablet. On this tablet write anything you think you may need to know to care for your patient. For example, if he is getting an injection as part of his medication, write in your tablet the five sites he can have an IM and how to do so. If he is on antibiotic therapy, write in your tablet the correct way to hang an IV. If he is having a sterile dressing change, write in your tablet sterile procedure. Whatever you come across that is new to you, write it in your tablet. This way you will know for next time and you will be prepared for your instructor. I did this in clinical. I still carried around my tablet from school for a few months after starting my first job. Please do this for yourself. You will be pleased you did and so will your instructor.

The key here is not so much knowing what to do. Remember you are a student. Expect to make mistakes. The key to being a good student is to come to clinical prepared to carry out your mission as a student. Always be prepared by doing the research the night before. If your clinical instructor gives you the information the day before, prepare on spending a good 2-4 hours in preparation. I use to hate when I did all this preparation for my patient and I came to clinical the next day only to find out my patient had been discharged! This may happen too and if it does, your instructor will take this into consideration I am sure.

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And now, please take a few moments to read what an actual clinical instructor has to say about your time in clinical:

Expectations In Clinical Setting

Good mooning class,
I'll be your instructor today.

You're about to embark an important part of your student experience...that of clinicals. You have studied and probably participated in labs. now it's time to turn you loose on a patient population. Take a deep breath...it's not that bad and it is crucial to your development as a nurse.

I'm your instructor today, so let me clue you in what I am looking for.

I AM NOT looking for the perfect student. they always make me a little nervous. I am going to probably shock you with some realities on life on the floor...guess what. It's not like the textbooks. No where is. I don't expect that of you.

Primarily I'm looking at your use of the nursing process. You are a beginner. I expect you to make mistakes. You can learn from them. What we're doing right now is applying some of that book learning into the practical world.

Nursing process is an important part of that, esp. here. Lets look at it:

ADPIE Remember that.

I'm looking at your assessment skills. You need to learn to use your eyes, ears, touch and smell to become proficient at this art. Some nurses never do. You begin your assessment hopefully the day before the actual hands on with an assessment/assignment session. Look at the H&P. [history and physical] See what your patient is about. Look at labs. Look at X-rays. Stories to be told there. It's all part of the assessment process, but don't stop there. Assessment begins the second you take on that patient and doesn't end even at discharge. Labs change daily and the patient can too. LOOK AT THE PATIENT!!!

NANDA format probably. I'm looking at your ability to assess the patient and formulate a nursing diagnosis. What does your assessment tell you? Where are we going?

OK,,,what do we do next? We need a plan! I'm ABSOLUTELY not interested in you copying word for word from a book. I know those books by heart and you can't fool me. I'm looking a WHAT you want to do with that patient, what the assessment has told you needs to be done.

Who's going to do what when? Specify...you are the patient advocate and need to ensure he receives proper care. "The primary nurse will ensure the patient is turned and repositioned for comfort q 2 hours." Scientific reasoning? Decubitus ulcers start within two hours of impaired circulation.

Did your plan work? Simple as that. Document that it works. Re-evaluate and reassess if the plan did not work. in real nursing this happens all the time. I may let your make a little mistake to prove that to you as long as it doesn"t not harm the patient.

Your care plans will come back with red marks all over them. Learn from it. I DO NOT keep track of your mistakes, but rather how you learn from them.

I'm looking at your med administration very very carefully. Expect me to "pop quiz' on what that med you're about to put in that patient's mouth. You need to know classification, action, side effects. You also need to teach the patient those things. Make a mistake? Yes, that's serious. very. you are the p[patient advocate and it's your job to CHECK CHECK CHECK. Ask me. Check the order, [physician's order] not just the MAR. [medical assessment record] Assess for therapeutic effect and side effects. Communicate. ASK ME questions if there is ANY doubt.

Careful here I'm picky. Is the bed made? Is the care done? Is the patient comfortable and does he need anything?? I will ask them. Yes behind your back. You will hear about it and redo it if I'm not happy and the patient is not happy. Yes, I'm watching you. all the time. I do have eyes in the back of my head. And this is more stressful on me than you.

Am I out to flunk you? I'm not. I have failed exactly two students in my career. One lied to me about taking vitals. Another one did not have the temperament to be a nurse and blew up at a patient. You are STUDENT NURSES AND THIS IS A LEARNING EXPERIENCE. You need nurturing and care and gentleness and kindness as I lead you down this dark path we walk.

And never forget...in your worst moments, when you doubt that you will ever be a nurse and do what I do, YES YOU WILL. I promise you.....don't doubt that.

YOU will be like me one day!

After all, I was once like you.

Someone led me too, many years ago. I still remember her name. It was Maggie.

Well, I hope this was a help to you. How was your first day in clinical? Please try not to worry. Although this is easier said then done. I use to throw up in the morning the day of my clinicals. To this day, I don't think my instuctor knew this. I would always joke in clinicals. She had no idea how scared I was. But I calmed down as time went on and by the time graduation came, I missed my clinical days!!!!!!!!!

Good luck my friend. Please do email back after you take care of your first patient!
Anneliese Garrison, RN