Sunday, March 6, 2011

Estelle’s Guide to Nursing School: Part 6 - Surviving Clinicals Your Fundamental Semester.

Hello, my loves. My name is Estelle and I write over at the little blog *Word Lust*. Over the past few months, I have been writing a series of articles so creatively named *Estelle’s Guide to Nursing School* [click for parts 1-6] The purpose of these articles is to give you some no-BS advice about surviving nursing school and possibly even having a bit of fun along the way…while at the same time providing you with a few laughs in order to keep your sanity while nursing school tries its damnedest to make you a mental patient. So sit back, relax, and enjoy. ;-)

I am not going to lie. Clinical can be scary, especially if you are like me and had NO hospital experience what so ever when you entered your program. Some of my classmates had a slightly easier time adjusting to it than I did because they were nursing assistance or patient care technicians before they got into nursing school. With me, no such luck. I was an English tutor.

Clinicals during your fundamentals semester are designed to get you comfortable dealing with patients [or clients…however your programs refers to the people who you will be taking care of]. The focus is on physical assessment, assistance with ADLs [activities of daily living], and communication. Basically, can you take a pulse, give a bath, and ask someone when the last time they had a bowel movement was without blushing yourself to death?

But no matter. Even if you have never taken care of another human being in your life, your program will likely understand that. This is why you must log so many hours in the practice lab or perform so many mock physical assessments before you ever lay eyes on a real live patient.

Generally, your first semester you will be taking on the role of nursing assistants. You will be recording vital signs [blood pressure, pulse, respirations per minutes, pain rating, etc], performing very basic physical assessments [checking skin condition, peripheral circulation, heart and lung sounds, etc], and assisting the patient with anything they need [bathing, eating, walking, linen changes]. You will probably also administer medication under the watchful eye of your professor. Depending on the skills taught your first semester, you might even have the opportunity to perform a few skills you have learned in the practice lab (wound/ostomy care, dressing changes, Foley catheter insertion, etc).

Here of some of the things I learned my first semester in nursing school:
1. Take advantage of preclinicals. Meet your patient and their family if you can. Explain who you are and what you will be doing the next day [or whenever your actual clinical day is]. Look around the room. What do you see? Does your patient have any IV fluids running? What about a bedside commode? Also, remember to check the doctors’ orders while you are gathering information. Does your patient have any scheduled activities? Physical therapy, occupational therapy? Do they on bed rest or up ad lib? These are all things you should be looking to find out so you can keep the surprises to a minimum the next day.

2. Ask your professor what is expected of you. I know this sounds simple but clinical instructors know that you are going to be anxious about dealing with real, live patients for the first time so talk to them about it. More than likely they will do their best to alleviate your fears [unless you have a sadist for an instructor…then you are completely fucked....Haha. Just kidding....kind of].

3. Get some sleep the night before. I know this is difficult because, generally, you will be up for quite a while stressing over careplans and medication cards to do any actual sleeping. But at least try.

4. Have your clinical bag packed and your scrubs laid out the night before. I know this sounds like common sense but you would be surprised how many people don’t do it. The morning of your first clinical day, you will probably be fumbling around or in a daze. That is just one less thing to worry about.

5. Coffee. Change of shift at most hospitals or nursing homes is at 7am. So expect your report time to be 0630. If you are like me, you are probably going to get there around 0545…which means you leave the house at 0515…which means your alarm is set for 0400 or earlier. Trust me, you will learn to love coffee or you will be a zombie.

6. Fake it til ya make it. Walk in your patient’s room like you have done it a million and a half times. The less anxious you appear, the more confidence you inspire in the person you will be taking care of.

7. Remember, this is not the patient’s first rodeo. More than likely, they have been in the hospital before and this is not their first day on this visit. They have had nurses take their vital signs and NAs help them bath or walk to the bathroom. More than likely, you are more embarrassed about it than they are.

8. Take advantage of any opportunity you are presented with to perform a skill. Chances are, you learned, not just how to do a physical assessment but also have to put in a Foley catheter and NG tube, and how to give an injection. The nurses on your unit will know that students are there and will often inform your instructor if anything like this comes up. Jump at the chance. Your professor will be right there with you the whole time and who knows when you will get another chance.

9. If it looks wrong, chances are it is. It is scary to think about but the unexpected can happen while you are in the hospital. If you suspect something is not right with your patient [they seem listless or agitated, they are having trouble breathing, there is any change in their vital signs or any abnormality in their physical assessment that the nurse didn’t mention to you upon report], inform your instructor and/or your primary nurse immediately.

10. Most importantly, don’t do anything without checking with the instructor first! Never give a medication [even if the primary nurse tells you to], alter IV flow rates, screw with the oxygen settings on the wall…basically anything…without clearing it with the instructor first. Yes. It seems like a pain in the ass [especially when the ordered medication the nurse is asking you to give is normal eye drops] but the instructor is responsible for everything you do while on the unit. God forbid, something goes wrong. They are only trying to protect their job…and their nursing license.

The whole purpose of hospital/nursing home clinical is to give you some real life experience taking take of real patients. Relax. You won’t kill anyone.

Take care, darlings. And happy learning. :-)


  1. Very nice post! I hope to use the advice the more chances I get during clinicals.

  2. heck YES girl, great post. i am an instructor and would love to have you for a student. i wanted to give you some applause after reading some of these...#2, #6, #8, #10. keep it up! :)

  3. this is a great article and I pretty much I agree with every single advice it gives. i'm a first semester student and it so happens that we had the opportunity to do tb testing on many of the residents one day during our clinicals. i had never done it in my life but it was a great experience, and i didn't kill anyone. and i also agree about the part of getting all your stuff ready the night before your clinical day. i didn't do this and i forgot my watch, and clinical paperwork. i was so unprepared my first day, but i survived and learned to never do that again, cause really, who's alert at 0400 to remember anything?

  4. Great read... I start nursing school very soon. Eeek!

  5. In my experience as a nursing student, most instructors during clinicals are sadists -- instead of a learning environment they expect you to be as good as the hospital nurses. It becomes a toxic experience. You're intimidated and belittled, often in front of the patients and their family. And the writtten assignment after each clinical day ("care plan") is a monster that takes hours to write to even begin to meet the expectations of these hormonally imbalanced bitchs. Lord help me get through this with some self esteem and sanity left when I finish.

    1. Perhaps nursing isn't for you...

    2. I went back to school for nursing at age 50 after holding a 4 year degree in another field and working in that field for 20 years. It wasn't any easier for me. I think your post is GREAT, and let me tell anyone who is struggling - HANG IN THERE. Someone had told me about their experience with a HORRIBLE clinicals instructor at my school. OF COURSE she was my instructor for my first quarter clinicals. Since I was the oldest, she put me through SHEER HELL. I SURVIVED. I am now licensed 4 years, and let me tell you, when a resident tells me now "You're the kindest nurse I've ever known" or "You're my FAVORITE!" all that pain just MELTS AWAY. IT WILL BE WORTH IT, I PROMISE YOU. HANG IN THERE - YOU GOT THIS!

    3. I am sorry you had a bad experience with your clinical instructors but you can't really blame all clinical instructors. I have some of the most amazing clinical instructors. They're patient, they walk you through it. If yours are belittling you in front of patients and their family you may want to report that to the DON of your nursing program as that is very unprofessional. As far as the paperwork you seem to not like, it's very realistic as to when you get out into the real world and work as a nurse. Of course today almost everything is on a computer but that doesn't make it less time consuming. If you hate paperwork just wait until you have a patient/resident fall or elope.

  6. This made me feel a little better about starting my clinicals at the nursing home where I used to work as a CNA. Nursing homes usually always put more on people than they can bear, so I am basically having a major nervous breakdown at the thought of going back there. I would have felt sooooooo much better if we had been allowed to do our clinicals at the hospital. Anonymous, I always refer to the head nurses at that nursing home as the bitches because they act like bitches.

  7. Urge incontinence is the involuntary loss of urine associated with an abrupt and strong desire to void (urgency). Urge incontinence is usually, but not always, associated with the urodynamic findings of involuntary detrusor contractions referred to as detrusor overactivity. Although involuntary detrusor contractions can be associated with neurologic disorders, they can also occur in individuals who appear to be neurologically normal. When there is no associated neurologic disorder, the urodynamic finding is termed unstable bladder (detrusor instability). When a neurologic deficit exists, the involuntary detrusor contraction is called detrusor hyperreflexia.


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