Clinical
EXPECT TO DO STUPID THINGS
I managed to miss my first OB patient's birth. I went to do my my half-hourly check and she was sitting there with a baby in her arms. I thought, "Oh crap, I am in a whole mess of trouble." Sure enough I hear my clinical instructor from down the hall saying, "Where's Janice, I'm going to kill her."
In OB I forgot the thermometer was attached to the wall with a really springy cord. I let it go and it pinged my patient in the face. Later she declined to have me put in a Foley for some reason.
I wondered why the patient on the gurney with the sheet over his head did not want to see where he was going.
I forgot to bring the GPS when we had to go to Arlington High School to do service learning hours. It didn't help that we stopped in Lakeland and asked someone at a gas station where Arlington High School was and he replied, "In Arlington, I would think."
I didn't know The Med puts its toilets in a closet and was standing there with a container with 500mL of urine in my hand while my clinical instructor told me twice to empty it in the toilet. Man, was he having fun.
I swear they sit around and tell 'stupid student stories' at faculty meetings or keep journals with entries that start, "Dear Diary, you'll never guess what my clinical student did today..."
There is, however, a difference between stupid and dangerous. If you don't know how to do something, don't fake it- ask for help.
SOMETIMES IT GETS GROSS
I had an instructor make me empty a rectal tube bag into the toilet right after we got back from lunch. It went something like this: squeeze, GAG, squeeze GAG, until she took pity on me and dumped the whole thing in a biohazard bag.
ORGANIZATION IS KEY
Before:
- Make sure your printer has ink
- Iron your uniform the night before
- Have a clinical 'checklist' posted with all the stuff you need
- Have a bag designated for clinical that does not leave your car
- Have each other's phone numbers and the instructor's if she allows it
- Set Alarms. I had all three of my phone alarms on, my regular bedroom alarm clock and a clock I purloined from my daughter that was in the shape of a castle, with big pointy turrets. I actually slept with that alarm in bed. I lived in fear that one week I'd have to call in and say, "I can't come to clinical because I impaled myself on an alarm clock."
During:
- Carry a notebook
- Have sixteen black pens available
- Know what you need to be doing at each moment
- When a computer becomes available, grab it and chart
- Make you own checklists. I made these and used them throughout clinicals:
KNOW YOUR STUFF
The phrase, "I don't know" uttered from you lips during clinical is like the kiss of death. Anticipate questions that might come up. Make connections to what your learned in class. Know your meds. Every instructor I had at SW was very patient in helping me learn procedures, they were less patient if I didn't know what I was talking about.
Bring resources and divide between you who brings what. Maybe the text, certainly a drug guide, a lab book guide, a procedures book.
Remember the hospital computer has resources as well. You can look things up there. I spent time studying on the computers when things were slow and provided no one needed them.
Resources that help you know your stuff before clinical:
BE ASSERTIVE BUT RESPECTFUL
If you need help-ask for it. Instructors are more than willing to help you, but remember they have seven students to tend to and your concern may not be a priority (there's a lovely NCLEX word).
Ask questions. I'd rather ask a million stupid questions than harm a patient.
If you feel like certain situations are beyond your control, speak up. One week I had an RN precepting me who did not want me to chart and my instructor asking me when I was planning on getting my charting done. When I finally spoke up, they came to a compromise and I stopped tearing my hair out.
I had an instructor who was obviously upset with me, but I did not have the presence of mind to calmly say, "OK, let's go talk about what I did, so I can fix it."
I did tell and instructor that I really wanted to do the blood draw before we left. He let me.
BE PROFESSIONAL
Never say in front of a client "This is my first time EVER putting in an IV, I'm so excited." Think before you speak. Sometimes we forget the patient is even in the room while trying to talk to a clinical instructor.
Yes, sometimes you want to-don't. go in the bathroom for five minutes. You can go home and do what I did-dramatically throw yourself on the bed and say, "I am NEVER going back." Talk to your friend afterward, but stay professional.
When you are presenting your patient in post-conference and your classmate makes a joke and you want to die laughing, just carry on as if he hadn't spoken.
MAKE OPPORTUNITIES
Some clinicals are slower than others, but there is still a chance to learn:
- Attend more than one C-section
- Go to the morgue
- Run a therapy group in MMHI
- Help another student
- Attend medical tests
- Watch procedures like bronchoscopy and thoracentesis
- Talk to the doctors
- Listen in when the doctors are teaching the interns
- Interact with the family
- Learn about a new culture
- Attend classes the hospital gives for patients
- Transport a patient
- Talk to the CNAs
- Watch post-mortem care on a dead baby, even if it is emotionally wrenching
- Watch how your nurse calls and interacts with physicians
- Talk to the patients beyond getting their history
MISCELLANEOUS TIPS
- 6:30 really means 6:30. Some instructors consider 6:31 late. Believe me.
- Mr. S has a way of sneaking up behind you when you are in the middle of a procedure.
- Ms. F is very laid-back and easy to work with.
- Mr. K is extremely good at teaching assessment skills. Seriously great Foundations instructor.
- Ms. L is scary, but you will learn an incredible amount from her.
- "Park on the roof" means the first space where you can see the sky
- Eating in the hospital cafeteria every week gets VERY expensive, but it's really hard to pack a lunch at 4:30 am, it's a trade-off
- Scan your 'clinical passport' documents into your computer.
- Turn your phone off.
- Nobody looks at that clinical skills check-list thing after AH1, but know where it is until then
- Clinical paperwork takes a really, really long time
- Do not do those things that they put in the rules. You KNOW if they are in there, SOMEBODY did it at one time. Somebody was stupid.
- If you pick the clinical that is the day before the test day, don't despair. Think of clinical as a study opportunity It was easier to answer test questions on halo traction when I had just had a patient in halo traction.
- Do not try to do anything that requires thinking after clinical do yourself a favor and go to sleep.
- You get to evaluate your instructor in SET on PAWS. Then you can say things like, "Some of us learn better when we are taught with kindness and patience."
HITTING THE CLINICAL JACKPOT
AKA things that make you want to do a little happy dance:
- getting an open computer.
- Getting an 'S' instead of an 'S minus' (or, god forbid, a 'U')
- Your patient does not need accuchecks.
- Your clinical instructor does not notice for 12 weeks straight that you glued you SW logo badge on your sleeve and the superglue kind of gooped out all over the sleeve.
- You do not get blood, urine or food on your white pants.
- You hate vomit and manage to go two years without a patient throwing up.
- You hear the words, "We'll leave a little early today."
- You get to go to the restroom twice.
GET THIS BOOK:
It's great--
Remember that clinical is a taste of nursing. When you get out you will be a 'nurslet' as Dr. M likes to call us. Mr. K told me it takes a good six months to a year to feel fully competent This is where you are figuring out what you want to be when you grow up.
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