Things You Might Dread about Nursing School Clinicals
You either love nursing school clinicals or you dread them. With a few tips, you can approach your nursing school clinical rotations as awesome learning opportunities that will inspire you and set you up for maximum learning opportunities. We asked a bunch of nurses what they dreaded most about nursing school clinicals, and here’s what we found:
# 1 Care Plans
Far and away, the care plan was THE MOST hated, detested, abhorred, despised and loathed thing about nursing school clinicals. If you don’t yet know what a “care plan” is, no worries! You will soon get the opportunity to wrap your arms around this beast of a project that occurs EVERY SINGLE WEEK that you are in a clinical rotation.
What is a Care Plan?
A care plan is the document you will write before each clinical rotation. It takes you through the process of learning about the patient’s diagnosis, contributing comorbidities, medications, goals and treatments. Each clinical instructor will have varying requirements for how your care plans are completed, but the basic idea is the same.
You’ll go to the hospital the day before your clinical rotation and select the patient(s) to work with the next day. From the chart you’ll obtain all the key information you need, namely:
- History & Physical (just referred to as “H and P”)
- Secondary diagnoses or contributing health problems
- Hospital course (how their treatment has evolved since admission…did they have surgery, were they in ICU, were they on an insulin gtt…basically the KEY things that have happened since they’ve been there)
- Current medications
- Current labs (look back 1-3 days if you can)
- Any diagnostic tests (X-rays, CT scans, MRI, etc…)
- Current orders
Using this information, you’ll write up a care plan in whatever format your instructor requires. DO NOT wait until the last minute to start this project! It can easily take about 6 hours…so plan your day accordingly. I always aimed to get all my data collected at the hospital by 2pm, and my care plans done by 10pm. Totally do-able, but you have to be organized and productive!
What are the components of a care plan?
The requirements differ, but all care plans should include:
- Diagnosis and history of present illness
- Medications and WHY they are taking them
- Nursing diagnoses (more on these, right here!)
- Interventions for each nursing diagnosis and WHY they are needed
- Goals for each intervention
How to enjoy doing care plans!
Ok, maybe “enjoy” is too strong a word. How about, how NOT to dread them! If you have chosen your patients well, then you have selected patients who have whatever illnesses you are currently studying. If you do this, then doing your care plan is essentially STUDYING for your next exam! How cool is that? Plus, it’s really beneficial to see how what you are learning in lecture come to life with a real, live patient. Care plans, when done thoroughly and with the right focus, can become excellent learning opportunities…and not just a giant pain in the neck!
#2 Clinical Pals Who Don’t Help Out
Depending on how your nursing school clinicals are organized throughout the hospital, you may have buddies with you on your floor, or you may be all by your lonesome. Typically, I always had at least one pal with me…and having a pal who would help when I was in a pickle was ALWAYS welcome!
I remember one time I got talked into doing a massive dressing change and wound assessment on a”picker.” A “picker” is a patient who picks at their sores, causing deep unhealing wounds. And yes, these wounds can get infected leading to a hospital stay! Had I been on this project all by myself, I would have NEVER finished on time…the patient had at least ten of these things all over her body. Each had to be photographed, measured and documented…then cleansed and dressed. You should have seen what we did to adhere the dressing to the one smack-dab on top of her head! We were winging it, to say the least! My point is…having clinical pals who gladly came in to help made a long and complex task actually enjoyable.
But, if you get stuck with clinical buddies who you can’t count on to come to your aid, there’s no point in letting it steam your tamales…they will learn soon enough how much of a “team sport” nursing really is!
My best advice for dealing with clinical pals who don’t help is to try to understand their point of view. Most likely, they are struggling just to stay afloat…so how about YOU offer to help them? When they see how amaaaaazing it feels to get a little support, I’ll bet they turn around and show you the same love, too!
#3 Nurses Who Don’t Like Students
I DO NOT UNDERSTAND why any nurse would be rude, unwelcoming or downright mean to a student. Weren’t we all students once who relied on the kindness and wisdom of our more experienced colleagues? But, since the world is full of jerks (and some of them happen to be nurses), it is something that you’ll have to deal with.
I remember a charge nurse who was SO MEAN to all of us students…we dreaded going to her floor to get our patient assignments the day before clinical. So, how did we deal with it? We came up with a plan where just ONE student would approach her to ask for a list of suitable patients. This task would fall to whoever got there first, and then that list was shared with the others. This way, we weren’t all drifting in over the course of the day constantly interrupting her.
But what if you get assigned a nurse who doesn’t want to deal with you, teach or supervise your tasks? In that case…you do what you can unsupervised, and call your clinical instructor for things that require supervision. Show that you can be helpful in some way, even if it’s just ADLs and taking everyone’s vitals and blood sugars. Share your assessment findings with your nurse and move on. With any luck, s/he will see that you CAN be a valuable member of the team, and try to be more inclusive.
And what if you’ve got a straight-up bully for an RN? This post can help with that. And, also…here’s a hug.
#4 When Your Patient Gets Discharged
Sometimes you’ll show up for your clinical day only to find that your patient has been discharged, moved to another unit, or transferred to ICU. When that happens, you basically have to start over with new patients. While this can be supremely frustrating, just know that being flexible is one of the key characteristics of successful nurses and enjoyable nursing school clinicals.
Your clinical instructor will have varying requirements for this, but for a blanket rule of thumb is that you will NOT want to start any patient care until you have done the following:
- Read the H&P of your new patients
- Written out their list off meds
- Devised a basic plan for their care that day…two or three nursing diagnoses and interventions.
Basically, you need to be able to show your clinical professor that you know SOMETHING about the patients you are helping to care for before you blunder in there and start trying to mobilize a patient fresh from back surgery. Make sense?
#5 Nursing School Clinicals Post-Conference
Though I loved post-conference, I learned quickly that not everyone else did! For starters, it’s always at the end of your clinical day, so really…all you want to do is go home and put your feet up! Plus, if you’ve got clinical instructors like I did, they will really drill down into the details of your patients, which can feel a little like sitting in the hot seat.
However, if you always look at post-conference as yet ANOTHER way to study, then you will see how immensely valuable it is. This is an awesome time to get clarification from your clinical instructor about concepts you are having trouble with, using your actual patients as examples. Any time you can learn a topic from various angles and through multiple modalities, you solidify and strengthen your knowledge base. Post conference is, essentially, a small-group study session with your instructor as the tutor. Now THAT’s an awesome way to spend an afternoon!
#6 Feeling Like You Don’t Know What You Are Doing
This could easily have been in the number one spot as it is one of the most often heard complaints about nursing school clinicals…especially first semester. If you’ve never stepped foot in a patient’s room before (or even been a patient), it can be Mega Intimidating. Here’s a few tips to alleviate some of this anxiety:
- If nothing else, you can help with ADLs. Introduce yourself to the techs or CNAs and let them know you’d love to learn how to do ADLs by helping them. Not only will you learn from the experts, you will gain a friend for life!
- Take some time to explore the unit and get to know where things are. When someone asks for an item…you can volunteer to go grab it with confidence (and not come back 20 minutes later empty-handed!)
- Focus on what you CAN do…vital signs, refill water pitchers, feed patients, take blood sugars, help patients to the bathroom, empty urinals, tidy up rooms, hold a leg while dressings are changed….whatever you CAN do, do it! As you gain more skills in Skills Lab, you’ll be able to take on more tasks. Trust me, it gets better!
- Observe and learn. If you hear of a procedure being done, get permission to observe. If a patient is having trouble, find an out-of-the-way spot to watch the nurse perform his or her assessment and intervene as needed. Later, you can ask the nurse to walk you through their decision-making process as a way to gain valuable clinical judgment skills.
I remember my one clinical day in the ED, watching as a very sick patient came through the door. Everyone in the team sprang into action…each person taking on a task. They didn’t have to talk to each other about what to do…they just KNEW. Later, after the dust had settled, I asked one of the 4th semester students who was precepting there how on earth they all knew what to do. He said, “You get to where you know what needs to be done…you just look around, see what hasn’t been done yet and do it.” I thought he was either psychic or super super smart….but you know what? It does become second nature…you’ll get there, I promise!
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What things do you dread about nursing school clinicals? How have you overcome them? Let us know in the comments below!
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