Nursing School Clinicals

When you think of nursing school clinicals, your mind probably goes straight to working shifts at the hospital, but clinical is actually SO MUCH  more than this. In this post I’ll share with you the wide variety of nursing school clinicals so you can have a clearer idea of what to expect.

Med Surg Clinicals

This is the clinical rotation you think of when you think of nursing school…it’s your main clinical  where you’ll learn the basics of taking care of patients. My  Med/Surg 1 clinical was on a general med/surg unit rather than ortho or oncology, but note that yours could certainly be on a specialty unit. In first semester, your main objectives are to:

• provide SAFE nursing care
• learn how to do a physical assessment
• practice skills like inserting Foley catheters or NG tubes
• give medications
• check blood sugars
• change wound dressings
• mobilize patients
• assist patients with their ADLs (this includes toileting, so get used to it early!)
• get practice with charting, time management and prioritizing

As first-semester students, it is easy to STRESS about every little thing. Really, what your professors are looking for is that you are SAFE, accurate and thorough. Can you give meds following the five (six, seven, eight?) rights? Do you know when to get help? Can you perform a head-to-toe assessment? Do you understand the pathophysiology of your patient’s disease? Have you outlined a plan of care specific for each patient? Are you able to set goals for your patients? Can you manage your time, chart accurately and embrace opportunities to practice your skills? If the answer is YES, then you are doing fine.

In Med/Surg 2, it gets more hands-on and this is where you may get to do rotations in the critical care setting and/or emergency room. I did my critical care rotation in a neuro ICU and it was only one or two days I knew that critical care was where I wanted to be! I helped take care of a patient with a brand new skin graft and we had to do hourly checks to make sure the skin flap was getting blood flow (stressful!). I also got loads of practice doing neuro exams and even got to change out a patient’s tracheostomy inner cannula. I also got to do a day in the ER, which was fantastic, even though the RN I was working with CLEARLY wanted nothing to do with me. I helped her out by placing a Foley catheter (my first ever!) and staying out of her way as much as possible…mostly I observed and soaked it all in. OF course, I helped where I could…taking vitals, emptying urinals and whatnot, but the real excitement was when those critical patients would come rolling in…I ALLLLLMOST got to do chest compressions, but had to get to my post-conference meeting. No worries, I have plenty of opportunities in the ICU these days.

Most of my time in Med/Surg 2 clinicals was spent on a telemetry floor. During this rotation, your professors are looking for you to start getting into the workflow of taking care of multiple patients while practicing those assessment and safe-med-giving skills you rocked in first semester. In Med/Surg 2 we could hang IV piggyback meds (like antibiotics) with supervision, but weren’t allowed to do any IV pushes (this is when you give the medication into the IV via a syringe, typically over 1-2 minutes). I really enjoyed this clinical rotation as I felt much more autonomous than in first semester, but still had great nurses to reach out to for help when I needed it. When I record the podcast version of this blog post, I’ll have to remember to tell you a story about a patient that went south and had to be rushed to ICU…it was my first glimpse of critical care nursing and how a team comes together when patients are in distress. Of all the things you’ll love about your nursing career, I’m going to go out on a limb and say that the teamwork is definitely going to be near the top of the list.

Somewhere in those first two semesters I also got to do a day in the PACU and a day in SURGERY! It was sooooo cool! I got to watch a laparoscopic hernia repair…so a pretty routine procedure, but it was pretty neat-o mosquito and the surgeon was great about explaining everything to me, as were the anesthesiologist and circulating RN.

Mental Health Clinicals

My school had two components to our mental health clinical…an inpatient setting and an outpatient setting. For our inpatient clinicals, we spent time at a psych facility and it really was a very interesting experience and vastly different from inpatient at the hospital (for the most part). The challenge with working with psychiatric disorders in the hospital, is that the patients are also dealing with a physical illness on top of whatever mental illness they have. In the inpatient psych setting, the patients have been medically cleared, so you essentially are able to focus your nursing care on their mental wellbeing, which can be very rewarding and absolutely fascinating.

The psych facility we did our rotations at had three units…a pediatric unit, a general adult unit and the intensive care unit. I’m not going to lie, I cried when I first walked into the psych ICU…they had told us SO MUCH about safety that I was terrified something awful was going to happen. I had visions of a patient throwing me up against the wall or strangling me with their pants…but none of that happened and I actually REALLY enjoyed my time there. Working with patients who are profoundly lost in their delusions of schizophrenia was as fascinating as it was heartbreaking. The general adult unit dealt a lot with patients suffering from depression, suicide attempts, bipolar disorder, eating disorders and various personality disorders. Your psych rotation is where you will learn to do a LOT of therapeutic communication, learn to set boundaries, get comfortable creating behavioral contracts and talking openly about things like suicide, disordered eating, manipulative behavior and a host of other maladaptive behaviors. You will use these skills A LOT in the inpatient setting, I promise! And then there was the pediatric unit. All I have to say about this is it is heart wrenching. Just completely and thoroughly heart shattering. Stay strong, share your concerns, feelings, questions with your clinical professor and try to focus on the good you are trying to do in the world.

For our outpatient component, we went to a group home that serves as a transition for people leaving the inpatient facility but who aren’t quite ready to be on their own. We more or less just hung out with the residents, went for a walk BY A SHOOTING RANGE (not even kidding) and gave a presentation on some kind of self-care topic and got the residents involved in some kind of hands-on project (I think our self-care topic was managing stress and we all made those squeezy stress balls together…I may still have mine somewhere!).

Pediatric Clinicals

Our pediatric clinical had an inpatient component as well as a portion that was done at a school with the school nurse. For inpatient, I spent most of my time on a pediatric oncology unit which wasn’t nearly as depressing as you would think. Kids are amazing, and, in many ways, a lot easier to deal with than adults. You’ll get really good at weight-based calculations in your peds clinical and get very familiar with all of Erickson’s and Freud’s work. Plus, there’s a playroom. You’ll love it.

For the school nurse component, we worked one-on-one with a troubled child in the school setting. I had to go to the school once a week and spend a whole hour just interacting with and talking with this student who was apparently pretty troubled, but I honestly couldn’t tell you what the issue was…I don’t remember much about that experience except that I was BORED out of my mind and then had to go home and write up something called a “process recording” where I had to recount everything she said and everything I said as well as what I felt and was thinking at the time. It was an excellent exercise in developing great recall of conversations, but OMG was it dull. Each week I tried to come up with things we could do together…tutoring, playing games, anything that would build rapport and get her to open up to me. It was probably one of my least-favorite things, but only because I found it so dull to spend an hour one-on-one. I have NO IDEA if other schools do this, but this was my experience. Glad it’s over!

Oh, I almost forgot, we also had to do a community-based pediatric clinical. Mine was at some county agency where parents who are trying to get their kids back go for counseling and follow-up. My classmate and I did these super long presentations on things like childhood illness, parenting styles, child development and whatnot. It was grueling because we had to engage these people for a 2 or 3 hour period and had very little guidance. Anyway, we got through it and hopefully the things we taught them helped.

Mom/Baby Clinicals

Our OB class encompassed several mom/baby experiences.

• Labor and Delivery: I got to see one vaginal birth and one cesarean. It was pretty cool, but OB was definitely not my  jam.
• Postpartum: This was actually much more enjoyable. The moms were so appreciative and no one was sick. It was kind of awesome…a positive environment (which doesn’t happen often in health care).
• Newborn nursery: This was really fun! I’m not into babies, but newborns just kind of lie there all bundled up. We gave them their baths, took measurements, put the babies under the bili lights if they needed it. It was fun!
• Outpatient prenatal monitoring clinic: B-O-R-I-N-G. Hours and hours of not doing anything but observing. Not my fave.

Community Health Clinicals

For community health I worked with a county agency that provides funding for people who need in-home assistance. Essentially, if the person qualifies, they can get the support services and the county pays the person providing the services. Part of that involved doing home visits, determining what people needed, ordering medical equipment and supplies, helping patients navigate their medical care, verifying their prescriptions (you have HOW many expired bottles of furosemide??) and various things related to in-home health care support. I had two clients that I followed for a 6 week period or so. I’d set up appointments to go to their home, do a needs assessment and then go back to the county office to make follow up phone calls and whatnot. It was actually really interesting and THE best part was that it gave us LOADS of free time. We essentially met at the office at 8 or 9am, then did all the things for our clients we needed to do and would meet back at the office around 3pm for post-conference. We had HOURS of free time, so my friend and I always went out to a nice long lunch at this amazing Thai food place, and my other friend would go visit her grandma. And yes, I did awesome things for my clients…I helped someone get a proper-fitting prosthetic leg, so I feel pretty guiltless about all that awesome Thai food I had 🙂

Home Health Clinical

I can’t remember how much time we spent doing home health clinical hours…it wasn’t much. Maybe two days at the most. It was….interesting….to put it nicely. From my home health rotation, I learned a few ‘pearls of wisdom’ from my preceptor:

• never use the restroom in a patient’s home; apparently cleanliness is often not a priority and her tales of bathroom grime scarred me for life
• never take your shoes off, even if the patient/family ask you to (see above)
• never let yourself get backed into a corner or up against a wall; make sure there is always a clear line to an exit so you can leave in a hurry if needed
• never enter a dwelling if you do not feel safe
• do your charting from a coffee shop and enjoy a cuppa joe while you work!

Is that it?

There may be other little things that I forgot. I remember going to an assisted living facility to teach the residents about flu prevention, attending an AA meeting to learn about addiction and recovery, going to a support group for caregivers of Alzheimer’s patients…the list goes on and on. When I look back on all this, I think, “No wonder I was busy!.” It exhausts me to even think about it now, but hopefully it gets you pumped for nursing school and all the experiences and challenges you’re about to face. You got this!

Get this on audio in episode 54 on the Straight A Nursing podcast.

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