I never had a bad day in clinic.  Clinic was always my favorite, and the place where I shone the most.

I do recall what had to have been a very bad day for my best friend, who was the best student in our class academically speaking.

We were split between units on 2 different floors with 1 instructor.  One day, my friend Kathleen came looking for our instructor, and found me in the hall as I was leaving my patient's room.  She seemed very upset, and asked me where our instructor was.

"In the break room," I replied.  "Whatever is the matter?"

"Oh, I have to find her," Kathleen responded, and she ran into the breakroom.  Seconds later, I saw our instructor burst from the room, her lab coat flapping in the air behind her, Kathleen following behind her like a pale ghost.  I can still see the scene clearly in my mind after 25+ years.

Later, I found out that Kathleen had been instructed to spray Granulex into her patient's besore before she went to physical therapy.  Granulex comes in a spray can (and comes in and out of vouge).  She should have gotten our instructor since it's technically a medication.  However she went to the room, saw several spray cans on the window sill.  She didn't know which one it was, grabbed one and sprayed it on the bedsore.  When the nurse asked her if she'd given the Granulex, Kathleen confessed she handn't known which can to use.

Turns out she used Lysol on the patient's bedsore.

Moral of the story:  1) know your limitations as a student.  2) Know when to ask for help.  3) Know your scope of practice. 4) Remember the 5 Rights.  5) READ the labels!

I am a full time nursing instructor.  Most of the time when my students have trouble it's because they didn't listen to instructions.

Be organized.  Set priorities and be prepared to explain why you choose them. 

Know what's going on with your patient.

Know your drugs.

Practice your skills in lab and at home so you are ready to perform them in clinic.

I used to spend hours and hours in lab, going over skills until I perfected them.  Especially when it came to anything with sterile technique.  It gave me a sense of confidence so when I got the chance to do them in clinic instead of being scare, I was eager.  Too many of my students think they can do skills once in lab and then are ready to do them in the hospital.

I had one student who thought she could check off on Foley catheter insertion in lab after only reading over the skill in her textbook.  She hadn't even opened her cath kit to try it once.  I wouldn't even let her try.

I'm going into my fourth and final year of nursing school, but I have had one or two bad experiences in clinical.

I think the worst was, incidentally, a couple weeks into my first ever clinical placement. It was on a surgical orthopaedics floor, so we saw a lot of elderly people come in after having surgery on their hips or knees or whatever else they had broken after falling. I had one patient who was one of the many elderly patients on the floor, but he was also quite confused. As such, the decision was made to place a vest restraint on him because, although he was non-weight-bearing, he had tried to climb out of bed and walk on his own. His overseeing nurse told me that he needed to sit up in his chair for a while after breakfast, so I did as she asked.

Not long after, though, my patient started to get VERY agitated because he wanted to go back to bed. I explained everything to him, about how important it was that he sit up for just a while longer and offered to take him for a walk in his wheelchair, offered magazines and books to read, turned on the TV, etc.; but, nothing would calm him down. I started to panic a little because I was unsure of what to do and I had never dealt with a confused, agitated patient before. I went to go find the nurse but she was absolutely nowhere to be found (actually, I only ever saw my RN like twice that day - once in the morning and again when I left!). I even got someone at the desk to page her over the intercom, but still nothing! I went to find my instructor, but she was busy with one of my classmates. Meanwhile, I was terrified my patient would hurt himself attempting to get up and into bed. Fortunately, my instructor knew about my situation so as soon as she finished with my classmate, she hurried over to me and helped me out. We made the decision to help him back to bed...the RN, when she FINALLY returned, wasn't very happy with that decision, but the alternative would have been the patient potentially hurting himself (he was really that agitated!)

Anyway, the only tips I can offer you are these:

- Always ask for help if you're unsure. Even if it means waiting a little while and getting something done late, it's better than doing it on time but completely wrong!

- Always double-check, especially when giving meds. It's really easy to get confused or to make mistakes, what with all the different names and numbers going on. Oh yes, and always check that you have the right patient (in other words, check their wristband)! I once heard of a story of a nursing student working on a pediatric floor - the two patients in the one room were playing around and switched beds without telling anyone, so the student gave the wrong kid the wrong medication. It got worked out eventually, but it was a big mess!

- Know your assessments back and front. This is really where it all starts and is very basic; otherwise, how can you know what your patient needs?

- Make sure you communicate really well with your overseeing RN - tell him/her how long you'll be around for, what you can do, what you cannot do, any skills you want to learn, etc. Report regularly to the RN throughout the day, as well, especially if there are any changes with your patient(s). Also know which RN will be taking over for your RN when s/he's on break (it's frustrating searching for your RN, only to find out they've been on break the whole time, lol).

- Also, bonus points if you can manage to talk with the other members of the team (e.g. MDs).

Here's a few tips you masy consider.

• Don't tick your clinical instructor off


• Be early - real early


• Be prepared


• If you do not truly know something do not pretend that you do - bluffing is quickly exposed


• Find out first thing where the Policy and Procedure manuals are and use them BEFORE you attempt to do something the first time


• Ask intelligent questions of the staff


• DO NOT look at patient charts for anybody unless you are assigned to that patient


• Do not give any medicine you have not read about thoroughly even if it is a routine med


• Be willing to do anything required no matter how disgusting


• Do not complain - about anybody or anything


• Do not discuss politics of any kind

Good luck.

Haha, I still AM terrified whenever I'm faced with a doctor! I think it's just performance anxiety - I know they will expect details and updates, but I'm afraid of screwing something up or not knowing something. Still, I've had some pretty good MDs who were very encouraging. One time, I was doing some charting on one of my patients and the MD came over and asked to look at it for a minute. I obliged and the doctor looked at me and said, "Are you this patient's nurse?" to which my reply was, "Well, I'm the nursing student..." The doctor then looked at me pointedly and said, "So, then, your his nurse!" Before that, I had never really thought of it like that, but it really was very encouraging in a different kind of way.

So, I guess to the OP again, another piece of advice as you head into your first clinicals: you are not "just a student"! Sure, you're learning and you aren't licensed (yet), but your patients are yours and you are responsible for their care within your scope of practice. Moreover, the nurses are there to help and guide you, but some (not all!) may try to look down on you as "just a student" - don't let that happen! Stand up for yourself if you need to, stand up for your patient, and know that you have every right to be there and to learn as much as you can.

theala says ...

I enjoy getting my students to talk to MDs on the phone to call report or ask for orders.  I listen in on the conversation, and rehearse it before we call.  They are always scared, but much more confident after they've done it once :)

I've been an RN for 19 years, but a couple of clinical experiences still stick with me. One on a ob/gyn rotation in which the instructor took me to a patient's bedside, whipped her covers down and said, "That is engorged breasts". I was mortified for that young woman. Then the instructor had me feel of the breast to see what engorgement feels like. The patient had her face turned away, and never said anything, but I was never so embarrassed in my life. No considerationseemed to be given the patient's feelings about a male student doing what the instructor said.

The second was well after having passed NCLEX and having worked on a floor. I transferred to the ICU where I had the another "worst" clinical experience. There didn't seem to be any plan of training for me. I didn't know what I was supposed to learn, and the nurse I was assigned to, seemed to be more interested in showing how good a critical care nurse he was, than teaching me. I was then given to another nurse for training who brow beat me moment by moment because I didn't know this or that, or something else. I was an anxious wreck. Obviously I failed in that endeavor, and returned to the floor from which I had come. The head nurse admitted that they didn't really have any plan for training new nurses.

What's to be learned from this? Always tell the patient what you will be doing and answer questions before doing it. Second, if you feel "at sea" about a course of training, sit with an authority and ask just what it is you are supposed to learn in the situation, then make sure your instructors follow through on what you are supposed to learn. Trust your instincts. They tell you what you are seeing that you cannot yet articulate.

Ed Kitchin RN, BPS

dwright says ...

I am entering my first year and clinicals start six weeks after the quarter starts and was curious as to what were some of your worst clinical experiences and any advice to avoid common mistakes?  Thanks all!!!  Dan

ALLWAYS.. listen to instructions, get to know the regular staff on the floor, always remember YOUR A STUDENT know that compared to other licensed nurses and aides who work there...YOU KNOW NOTHING.. utilize them as your safety net, resource people, and most of all, though they may seemed bothered by you, THEY WILL HELP YOU..never ASSUME ANYTHING  and beware the M.D.s who presume that 1. your stupid and will try to make you even stupider, and 2. it can get ruff on the floors, but they got thru it and you will too!!  and ..THOUGH ITS A HEALING ART AND SCIENCE, YOU'LL NEVER FAIL TO BE AMAZED HOW NURSES CAN WALK INTO A ROOM AND DO WONDERFUL THINGS FOR PERFECT STRANGERS AS LONG AS THEY ARE "PATIENTS' BUT WILL WALK BACK INTO THE HALL AND HUMILIATE A FELLOW NURSE!!. I have been nursing 40years in Sept, and still to this day never will understand why nurses are cruel to nurses...ever!! Rely heavily on your confidence in yourself,always rely on your gut instinct, and watch those that have been doing it for awhile..find your allies, know your foes and keep your mind open and your mouth shut.....learn, study and it will soak in..good luck..john

I remember the ABSOLUTE WORST clinical of my entire nursing career of thirty two years. It is horribly funny now when I think about it.

Back in my day we had "rubber" behinds to practice giving injections in. I had my landmarks perfectly in my mind . The night before clinicals and giving that "first injection" I dreamed of that rubber behind in my face all night. The next day when it was time for the injection of PenG, I rolled my patient over and to my horror her glutes were nothing but hard knots from so many injections. There in midstream I had to change injection sites!!!!! Of course I had to do a vastus lateralis approach. There I was, my instructor literally "breathing the hot breath of scrunity" down the back of my neck, poised to give this injection. The minute I stuck the needle in (after marking off my landmarks) the patient said 'Ouch". I was NOT prepared for this reponse from my patient as the 'Rubber behind" never responded to my repeated pricks!!!!!!  What did I do? I pulled the needle out without giving the medicine!! Boy my instructor was MAD!!!!! This served as a horrible end to my first clinical!!!! Whenever I had injections to do after that I would literally bribe my classmates to go and do them. My second year of school my instructor came to me and said she realized she had never checked me off on giving injections. I told her surely she had made a mistake!!!!! She was quite sure she had not and going deathly pale and breaking a sweat, she finally asked me what was wrong. I fessed up and told her about my first year experience!!! Well, she fixed that for me as I ended up going around with the medicine nurse(we had those back then) and giving 56 injections in 4 hours to patients on the floor(big hospital). I was no longer afraid to give injections after that.

Point, it is okay to be afraid the first time you do something and if you are speak to your instructor about it. They are there to encourage and help . Point number two : Rubber butts do not talk!!!!!

dwright says ...

Wow - yeah, half seems like commone sense (read labels), but I guess in that situation, she was being logically in here mind or too scared to ask for advice.

I really appreciate you sharing the story and advice, it means a lot!!  I will definitely take what you have wrote and remember to utilize throughout school!!! 

Thanks again!!  Really appreciate it.

Dan

I am surprised that the instructor didn't fail her. I get nervous doing clinicals, but I do read, I might shake a little performing watched skill performances, but if I am not being graded are underpressure by the instructor, I am ok,

by the way Dan, and Theala  great advice

Good luck!  Everyone has given you great advice.  However, remember Murphy's Law:  If it doesn't happen to you as a student, trust me, it will happen when your out into reality.  But, just go with flow and learn from it, then you can sit back and do blogs, right?? lol

One way to keep the nurses from "treating you like crap" is to remember that they are busy, some have their own stuff going on that you might not know about (not making excuses, but just reality), some have so many students (and preceptees) that they just get "burned out" on them, and some, honestly are afraid that they are being scrutinized.  I am a full time nursing instructor, and this is the advice I give my students:

Learn the names of the nurses and techs you are working with (and call them by name) go talk to them, let them know what you are doing, and for how long and make sure you report off at the end of your clinical day.

Never stand around, and don't sit in "their" space.  There is always something to do, so always be doing something, even if you are simply rounding on other patients, stocking, checking for water refills, changing needle boxes, etc.  Don't go to gather info from the chart during the busiest times of the day.  Offer to be available during their breaks (if they get them).  Ask who you should contact if there is a problem.  In other words, don't go on break at the same time the nurse or tech does.  Ask them when a good time would be.  Also, don't go on break until your patients are taken care of, especially at meal time.

Be very careful when reporting vital signs, blood sugars, etc, that you have the correct patient and data.  Be meticulous in what you chart and make sure it is accurate.  Report changes in your patient's status immediately.  And critique (in post conference, with your instructor and peers) but try not to criticise.  Although you may be working with a "slacker nurse", you also may not have the big picture.  Until you have walked in those nursing shoes, you really can't judge, but like I said, you can critique. 

Tell the nurse how much you appreciate his or her time.  Don't ask questions that you can find the answers to yourself.  Be as prepared as possible, but if you don't know something, say "i don't know, but I can find out".  Keep a smile on your face, don't complain, and again, say thank you. Attitude is a huge piece of a good clinical experience.   My students who follow my advice have excellent experiences, even with the nurses who "don't like students".   This advice is probably good for new grads too.  Hope this helps!