Clinical

You Mean I Actually Have to See Patients?

Okay, let's be honest. As a first semester nursing student starting off in clinical for the first time there is a mix of emotions. You're so excited to put on your new scrubs, wear your stethoscope around your neck, and spew out all of the new information you learned last night from chapter 37 of your Med Surge text book. 

But, you're also super nervous - you've never dealt with patients before! How can someone expect you to walk into a stranger's room while their ill and ask them questions like: "Do you drink alcohol in excess? When was your last bowel movement? What is your home life like?" You're nervous, shy, and uncomfortable asking personal questions as part of your assessment. I mean, why can't you just keep taking blood pressures on your manual cuff like you mastered last semester in Health Assessment!?!

We have all been there as first semester clinical nursing students. We have all wanted to avoid awkward conversation with people who might judge us for being students. However, have no fear because this post aims to calm your nerves for all those nervous about actually being a nursing student in the hospital. 

 

The Nerves 

I will be completely honest and be the first one to say: I WAS VERY NERVOUS FOR CLINICAL. In certain ways, I still get anxious over clinical, specifically  my first day on a completely new unit where I don't exactly know what to expect. 

As annoying as it may be to hear, and as difficult as it may seem to do, the only way to get rid of your nerves is to just jump in! The best clinical experiences with patients I have had throughout my experiences have been times where I just knocked on the door and left all insecurities in the hallway as I walked in. I introduced myself, had my printed report sheet out to ask all of the questions I needed for my Care Plan, and tried to assist the nurses as best I could. 

The nerves will fade away with the more experience you have. Just trust the journey and grow into your roll as a student nurse to the best of your abilities, and at an appropriate pace for what your instructors expect of you.

 

Being Shy

As stated previously, I can be very shy. Having a raspy voice doesn't necessarily help either because now I'm in a situation where I don't want to talk, have to talk, and have to force myself to talk even louder than desired in order to be heard. I'm sure it's safe to say that majority of you don't have the same problem unless your fighting a cold, in which case you're even more miserable because we all would rather be in bed while sick instead of at clinical. However, with shyness, I take the same approach as my nerves. Sometimes, you have no clue what to say to a patient. Sometimes you don't even know what to say to your nurse! That's all okay, as long as progression in improvement is made. 

My large suggestion for overcoming clinical struggles is to make your own personal goal list. Each week, after your clinical shift write down areas that you noticed or were told needs improvement. Then write down tactics that can be implemented to change those things. Make it a mission to work towards those items the next day you're at the hospital and I promise you there will be improvement. There's no way there can't be improvement if you're really working at it. 

 

Lean on Your Friends

 It is very easy to get attached to your clinical group members while on the floor. Having a conversation about the cool thing you just did or discussing how you're all dreading the exam in three days - it's easy to bond over the experiences you all share. Utilize those relationships. There have been many moments during clinical where one of my group members have given me a compliment on something I was freaked out about, or gave me helpful study tips I used on exams. Nursing is material that is best learned in groups, in my opinion, and the easiest way to form one is through your assigned clinical group! My very best friend from the nursing program came from my clinical group my first semester of clinicals.

 

Skills 

Probably the most important tip I have for doing your nursing skills in the clinical setting is: always ask for help when needed. A lot of preceptors will help you with your skills - especially starting off. But, as you gain more experience and work your way up with your classes, you gain a little more independence. This means trying to insert that IV all by yourself [IV exposure can be far and few between depending on the unit your on. I've done 4 independently as a student so far]. 

Your mannequins in your skills lab is not comparable to the person laying in the bed in front of you, so if you need to go over steps with your clinical instructor or nurse preceptor beforehand - go right ahead. If you need guidance with placement of a catheter, ask. Even if it's something as simple as helping someone up to the bathroom and you don't think you can support them alone - there are plenty of people on the floor to help you. The one great thing about the nursing profession is the support you get from everyone around you with patient care. 

During my first round of Clinical Role Transition last semester [I will have another one next semester since I am retaking], one of the most valued compliments I received was how I do not hesitate to ask for help when I feel it is needed. Yes, it can feel somewhat embarrassing or like you're a pest sometimes - but I feel as though it is always worth it. I would rather ask for help than make a mistake on something that could impact someone's life forever. In my opinion, if someone gets annoyed with you for trying to practice safely by making sure you're doing things correct, they're not truly practicing safely themselves. 

As for actually performing your skills, practice makes perfect. Obviously, there are a certain number of nursing students in each clinical group, and only a certain number of preceptors and patients willing to have a student. This can mean you might have boring days on the unit, while other days are full of exciting things. One of my professors once said "The skills will come to you", and I truly believe that. It takes time, but you will get it, and you should not get totally frustrated just because you haven't been able to practice something yet on an actual patient.

On the other side of the coin, I do not think a student should get cocky with their skills. I would say it is safe to assume that giving SubQ injections is probably the most common skill a nursing student will accomplish. Yes, it's not very difficult to perform, but caution should still be practiced [God forbid a needle stick might occur]. Take your time, be in the moment, and do not become a nurse who just goes through the motions. Those three motto's will serve you well the rest of your career.  

 

 

Debriefing and Report 

You finally made it! The day is done, your feet are killing you, you can finally rush home to stuff your face and take a nap before you spend the rest of your night studying. But wait - there's more. [There's always more with nursing school...]

Even though they have been on the unit all day and have had in-depth conversations with you about your patient, and you've secretly been sharing stories with your clinical group members during down time at the nurses station - debriefing still needs to happen. When you first start off in clinical your nursing instructor will coax you through what they want from your report. They'll ask you questions and you'll sit there for five minutes each question trying to come up with some answer about congestive heart failure when you've only learned about diabetes and hand-washing techniques so far.

In my experience on how to get yourself out from under the interrogation light from your nursing instructor is to remain organized during your shift and utilize your downtime. Rewrite your garbled notes that you took in the morning during shift report [You know, those ten minutes when you awkwardly stood behind your nurse listening to facts about the patient you're about to take care of, scribbling barely legible words and abbreviations]. Keeping your report sheet organized will help you tell the story better, and help you create a concept map in your mind about what happened. Instead of gossiping to your friends all the way at the end of the unit where no one can find you, sit at a computer and search through nursing journals on the diagnosis your patient has that you've never heard of before.

As time goes on it certainly becomes easier, and with certain instructors they might be more lenient on you as you progress through the program. Listen to your group members respectfully and relish the sigh of relief you'll have once you get to stop talking about your day in front of everyone. 

It's a piece of cake. 

 

Tips from Lessons I Have Learned 

1. Always utilize your downtime
2. Always bring back old class information to create a big picture, even when it's not required of you. This will make sure the information is really in your brain and will help you become a better nurse in the long run. 
3. Work past your insecurities or limitations. We all have them, it's what we do to overcome them that creates a great nurse. 
4. Stay organized. That will always be beneficial.
5. Buy good shoes and coffee on the way. 
6. Always ask for help when needed
7. Take your time with skills and medication administrations. Safe is better than sorry. 
8. Always say yes to new opportunities - even if you're scared. You'll feel more accomplished afterwards.
9. You will find your own groove eventually, try out new tactics to reporting to find your personal style
10. Try your best and be genuine. Your patients will be appreciative and understanding that you are learning. 



Thank you so much for reading!! I hope this helps!!

- Michelle

#BSNbabe